FEES vs MBSS: Which should I choose?

I love managing dysphagia. And I LOVE instrumental studies and diagnostics. It's been my clinical focus since I started my career in speech pathology and I haven't looked back. I started my training in instrumental studies with MBSS, which was the default at the time (the acute care hospital I worked for did not have access to FEES). I remember the big debate between MBSS vs FEES was just starting to build (and still rages today). But I didn't care. I was fascinated with MBSS. A moving x-ray?! I didn't even know x-rays COULD move. Videofluoroscopy was my rabbit hole into a world of anatomy and physiology that I could only understand on a surface, theoretical level from my textbooks before. 

After years of studying the MBSS and learning every facet of anatomy and physiology and its clinical implications for the patient, I came across the opportunity to undergo FEES training. It was right when I started to work for the critical illness recovery hospital I still work for today. Most of our patients have trachs and vents and transferring them back and forth from the hospital was uncomfortable, expensive, and tricky from a medical perspective since they were so compromised. FEES seemed like a way to solve all of these issues in one sweep. But I knew nothing about it. And I loved and trusted MBSS for my clinical decision-making. Losing it and switching to something else felt like giving up an arm. 

Luckily I had the opportunity to do my FEES training with Dr. Langmore. Yes, THE Dr. Susan Langmore who invented FEES. I was awe-struck. Training with such an SLP giant would be like flying with the Wright brothers. And the experience matched my excitement. I learned all of the amazing advantages of doing FEES: It's safe. It’s radiation-free. You don't need a radiology team to set up and use expensive equipment. There isn’t a time limit. The portability allows the exam to be done in essentially any clinical setting. It can be done in the comfort of the patient's own bed with loved ones by their side. And it's effective. Some say more effective than the MBSS, particularly in identifying penetration/aspiration and residue (among the most important information derived from an instrumental study). 

I'll have to admit I was skeptical in the beginning. How could this little scope be as effective, if not more so than a team of people using a massive piece of expensive technology? But the more research I read and read, I began to see that FEES was at least as effective and clearly more practical for my patients. And the kicker- it can be done ANYWHERE. This little scope and laptop can literally fit in a briefcase. I was hooked. Still am. 

This is not at all to say that FEES is better than MBSS. I just find FEES to be more practical and for many reasons, better for most of the patients I see. And at the end of the day, isn't that what really matters? Today, FEES is my first choice, but I remain very active in videofluoroscopy. They are both gold standards, reliable, and have their own strengths and weaknesses. Together, they’d be the dream team, but we are a long way away from universal access to the “platinum standard” (both FEES and MBSS conducted simultaneously). Until then, simply getting patient access to one of these studies is the priority. Whichever gives the patient (whoever and wherever they are) easier access, is #1 in my book. 

Liked it? Why not share it?

Comment below. I feed on feedback.