{"id":1189,"date":"2026-09-21T16:32:48","date_gmt":"2026-09-21T13:32:48","guid":{"rendered":"https:\/\/www.profdrelifaksoy.com\/en\/?p=1189"},"modified":"2026-09-21T16:32:48","modified_gmt":"2026-09-21T13:32:48","slug":"what-is-the-difference-between-fees-and-videofluoroscopy-and-which-one-is-preferred","status":"publish","type":"post","link":"https:\/\/www.profdrelifaksoy.com\/en\/what-is-the-difference-between-fees-and-videofluoroscopy-and-which-one-is-preferred\/","title":{"rendered":"What Is the Difference Between FEES and Videofluoroscopy, and Which One Is Preferred?"},"content":{"rendered":"

If you cough while eating, feel that liquids are going down the wrong way, experience recurrent lung infections, or have a sensation of something getting stuck in the throat, it is important to understand not only whether swallowing is \u201cdifficult,\u201d but also at which stage and why it becomes difficult. The difference between FEES and videofluoroscopy<\/strong> lies in the fact that they answer this question using two different but often complementary methods. The correct test is selected according to the cause of the swallowing disorder, the patient\u2019s general condition, and the clinical question being investigated.<\/p>\n

What is the difference between FEES and videofluoroscopy?<\/h2>\n

FEES, which stands for Fiberoptic Endoscopic Evaluation of Swallowing, involves evaluating the pharynx and larynx by advancing a thin and flexible endoscope through the nose<\/a>. While the patient swallows foods of different consistencies and amounts, food residue, saliva accumulation, vocal cord movement, and the approach of food toward the airway are directly observed.<\/p>\n

A videofluoroscopic swallowing study<\/a>, on the other hand, is commonly known as a \u201cbarium swallow study.\u201d The patient is recorded under X-ray imaging while consuming foods or liquids of different consistencies containing barium. This method demonstrates the timing and coordination of swallowing movements from the oral cavity through the pharynx and upper esophagus.<\/p>\n

The basic distinction is this: FEES shows the pharyngeal and laryngeal structures directly, in color and in detail, whereas videofluoroscopy evaluates the flow of swallowing, the progression of the bolus, and certain structural-functional relationships using X-ray imaging. It would not be correct to say that one is absolutely superior to the other. Each test answers a different question.<\/p>\n

What information does FEES provide?<\/h2>\n

During FEES, the endoscope is advanced through the nose and the pharyngeal region is evaluated before, between, and after swallows. The procedure can generally be performed in an examination setting. It does not involve radiation; therefore, the ability to repeat it according to clinical need is an important advantage.<\/p>\n

This examination is particularly valuable for evaluating saliva that accumulates in the throat or above the vocal cords. It allows detailed observation of whether food residue remains at the base of the tongue, along the pharyngeal walls, or around the vocal cords after swallowing. It provides important information about the ability to protect the airway in vocal cord paralysis, reduced laryngeal sensation, swallowing problems after head and neck surgery, and neurological diseases.<\/p>\n

During FEES, a brief loss of visualization known as \u201cwhite-out\u201d occurs because the pharynx closes momentarily during swallowing. For this reason, the exact millisecond at which food enters the airway may not always be directly observed. However, findings before and after the swallow can strongly indicate the risk of aspiration, meaning food entering the respiratory tract.<\/p>\n

When may FEES be more appropriate?<\/h3>\n

FEES may be a practical option when transferring the patient to the radiology unit is difficult, or when intensive care or bedside evaluation is required. It is also useful in patients whose swallowing performance changes during the day, who fatigue quickly, or in whom the effects of different feeding strategies need to be observed immediately.<\/p>\n

For example, FEES can directly assess whether compensatory strategies such as tucking the chin, turning the head in a particular direction, or swallowing twice reduce residue. Seeing the food in its natural color may also make the examination easier to understand for some patients.<\/p>\n

What information does videofluoroscopy provide?<\/h2>\n

During videofluoroscopy, the patient is given liquids, purees, soft solids, or solid consistencies mixed with barium as needed. Imaging may extend from the oral preparation phase of swallowing through the pharynx and upper esophagus. This makes it possible to dynamically examine movements such as the tongue pushing food backward, the timing of the swallowing reflex, elevation of the larynx, and opening of the upper esophageal sphincter.<\/p>\n

This test is particularly strong in evaluating problems related to the timing of swallowing. It can more clearly show when food approaches or enters the airway while passing through the pharynx and whether aspiration occurs before, during, or after swallowing. Problems involving the oral phase and certain abnormalities in upper esophageal passage can also be included in the evaluation.<\/p>\n

However, videofluoroscopy uses radiation. Although exposure is generally low-dose and brief, the necessity of the examination should be assessed individually for each patient. In addition, the test is performed in an environment equipped with radiological imaging, and the barium-containing foods used may provide an experience that differs from the patient\u2019s usual diet.<\/p>\n

When may videofluoroscopy be more appropriate?<\/h3>\n

Videofluoroscopy may be preferred when the oral chewing and transport phase needs to be examined in detail, when delayed initiation of the swallowing reflex is suspected, or when additional information about upper esophageal passage is required. In swallowing disorders caused by stroke, traumatic brain injury, Parkinson\u2019s disease, or other neurological conditions, it may be used to determine the mechanism of the problem.<\/p>\n

A sensation of something getting stuck in the throat does not always indicate a problem originating only from the pharynx. Depending on the nature of the complaint, different examinations of the esophagus may also be required. Therefore, interpreting the result of a single test independently of the patient\u2019s history and ENT examination would not be appropriate.<\/p>\n

What determines which test is selected?<\/h2>\n

Test selection should be based less on the question \u201cwhich one is more advanced?\u201d and more on \u201cwhich clinical question are we trying to answer?\u201d Does the patient begin coughing before swallowing? Are liquids or solids more problematic? Is there a voice change, weight loss, history of pneumonia, or a neurological disease? Is there a condition that could make passage of an endoscope through the nose difficult? All of these details affect the decision-making process.<\/p>\n

FEES provides detailed information about secretion management, laryngeal sensation, vocal cord movement, and residue after swallowing. Videofluoroscopy, on the other hand, provides a broader view of the sequence and speed of movements through the oral cavity, pharynx, and upper esophagus. While one method may be sufficient in some patients, the two evaluations may complement one another in complex cases or when findings are conflicting.<\/p>\n

In children, the choice of method is also individualized according to age, cooperation, feeding method, and the suspected problem. The aim is not to burden the child with unnecessary procedures, but to obtain sufficient information for safe feeding using the most appropriate method.<\/p>\n

What should the patient expect before and during the examination?<\/h2>\n

Most patients do not require special preparation before FEES. Passing the endoscope through the nose may cause a brief sensation of pressure or discomfort; however, communication with the patient continues throughout the procedure. The evaluation is performed with different consistencies as long as it is safe, and the patient\u2019s natural swallowing behavior is observed.<\/p>\n

Before videofluoroscopy, the material to be used and the consistencies to be swallowed are explained. The patient is imaged in a seated position; different head and neck positions may be tried when necessary. In both examinations, the primary goal is not to challenge the patient, but to analyze swallowing safely and create a plan that reduces the risk of aspiration.<\/p>\n

According to the results, modification of food consistency, swallowing therapy<\/a>, positioning recommendations, reflux treatment, approaches for vocal cord movement disorders, or advanced interventions when necessary may be planned. The value of the test lies not only in the image itself, but in transforming that image into a treatment strategy appropriate for the patient\u2019s daily life.<\/p>\n

Swallowing difficulty should not be normalized over time. Especially if there is meal-related coughing, a choking sensation, unexplained weight loss, frequent lung infections, or voice changes, evaluation by an experienced ENT and swallowing team is the most appropriate step toward safe eating.<\/p>\n","protected":false},"excerpt":{"rendered":"

If you cough while eating, feel that liquids are going down the wrong way, experience recurrent lung infections, or have a sensation of something getting stuck in the throat, it is important to understand not only whether swallowing is \u201cdifficult,\u201d but also at which stage and why it becomes difficult. The difference between FEES and […]<\/p>\n","protected":false},"author":1,"featured_media":1190,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-1189","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"_links":{"self":[{"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/posts\/1189","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/comments?post=1189"}],"version-history":[{"count":2,"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/posts\/1189\/revisions"}],"predecessor-version":[{"id":1192,"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/posts\/1189\/revisions\/1192"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/media\/1190"}],"wp:attachment":[{"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/media?parent=1189"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/categories?post=1189"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.profdrelifaksoy.com\/en\/wp-json\/wp\/v2\/tags?post=1189"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}