Patient guide · Dysphagia workup
FEES — flexible endoscopic evaluation of swallowing, direct visualisation of laryngopharynx during swallowing.
FEES is a nasal endoscopy that directly visualises the laryngopharynx during swallowing. Complements videofluoroscopy (VFSS) for dysphagia workup — no radiation, portable, and provides detailed anatomical detail of the airway and swallow.
Why patients choose us
- 01
The right hands
We route you to a speech-and-language therapist or ENT surgeon who performs FEES routinely — the person scanning you interprets what they see.
- 02
Often answers same-day
The airway view and swallow trials are discussed at the couch, with a written report and rehab plan to follow.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
The six things to know about FEES.
A quick orientation before the detail — what FEES is, who does it, and where it sits in the dysphagia workup.
- 01
Definition
A nasal endoscopic view of swallowing — the laryngopharynx watched directly as you eat and drink.
- 02
Performed by SLT or ENT
A speech-and-language therapist or ENT surgeon trained in nasendoscopy.
- 03
No radiation
FEES uses a flexible scope and a fibre-optic camera — no X-rays, no contrast dye.
- 04
Portable
Can be done at the bedside — useful in stroke units, ITU, care homes and outpatient rooms.
- 05
Complements VFSS
Videofluoroscopy (VFSS) shows the timing; FEES shows the anatomy and secretions.
- 06
Secretions and aspiration
Grades pooling of secretions and detects silent aspiration that a bedside test would miss.
Indicative pricing
What a private FEES costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
An outpatient FEES in our network: £350–£550, with findings often the same day.
| Study type | Indicative range | Typical duration | Report turnaround |
|---|---|---|---|
| Outpatient FEES (SLT-led) | £350–£550 | 30 min | Same-day |
| FEES with ENT surgeon | £450–£750 | 30 min | Same-day |
| FEES + videofluoroscopy (VFSS) package | £700–£1,100 | 60 min | Same-week |
| Bedside FEES (inpatient / care home) | £500–£900 | 45 min | Same-day |
| Full dysphagia MDT work-up (FEES + ENT + SLT) | £900–£1,500 | Half-day | Same-week |
| Urgent same-week FEES | £500–£900 | 45 min | Same-week |
Prices vary by clinic, whether an ENT surgeon is involved, and whether a same-visit videofluoroscopy is included. We come back with a firm quote within one working day.
The problem
A FEES is only as good as who performs and reports it.
A bedside swallow assessment misses silent aspiration by definition. FEES sees it — but only if it is done, and interpreted, by a clinician with a routine FEES caseload.
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Coughing on food or fluid?
We arrange a FEES with a clinician who can grade the swallow and set diet advice.
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Post-stroke or post-radiotherapy?
We fold the FEES into a proper dysphagia plan — SLT, dietetics and ENT if needed.
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Recurrent chest infections?
We look for silent aspiration and route findings to the dysphagia MDT.
Preparation and steps
From referral to rehab plan — what happens, in order.
One clinician from first message to report — often within days.
Phase 1 · Before your FEES
Referral and preparation
Phase 2 · On the day
~30 minutes at the clinic
Phase 3 · After
Report and rehab plan
- 01
Before
Referral
Referral from a speech-and-language therapist, ENT surgeon or neurologist — self-referral is possible in some clinics.
- 02
Before
Topical lidocaine to the nose
A small dose of topical anaesthetic to the more patent nostril — the scope is thin, and numbing keeps it comfortable.
- 03
On the day
Flexible endoscope via the nose
The scope passes gently along the floor of the nose to a point above the larynx — you sit upright, breathing normally.
- 04
On the day
Trials of coloured food and fluid
You are offered small tastes of coloured water, purée and solids — the clinician watches each swallow in real time.
- 05
On the day
Aspiration and residue graded
Penetration, aspiration and post-swallow residue are graded on validated scales (PAS, YPRSRS).
- 06
On the day
Post-swallow strategies tested
Chin-tuck, effortful swallow, texture change and posture manoeuvres are trialled on the spot to see what makes the swallow safer.
- 07
After
Written report and rehab plan
A written report with IDDSI-graded diet advice and a rehabilitation plan is sent to you and your referrer.
Typical end-to-end: 3–7 days. Urgent cases: same day.
What it shows
When a FEES is the right test.
FEES answers a specific question — what is the airway doing during a swallow, and can it be made safer. These are the findings we look for most.
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Pooling of secretions
Saliva collecting in the pyriform sinuses or vallecula — a marker of impaired clearance.
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Delayed swallow trigger
A late pharyngeal response — food enters the airway before the swallow protects it.
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Silent aspiration
Material entering the airway without cough — the finding a bedside assessment cannot see.
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Post-swallow residue
Food left in the vallecula or pyriform sinuses after a swallow — a risk for later aspiration.
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Reduced laryngeal closure
Incomplete closure of the true vocal cords or arytenoids during the swallow.
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Vocal cord palsy
One or both cords not moving — an important cause of aspiration and voice change.
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Zenker’s diverticulum overspill
Retained material in a pharyngeal pouch spilling into the airway between swallows.
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Red flag: aspiration with recurrent chest infections — dysphagia MDT referral
Aspiration plus recurrent lower-respiratory infections is a dysphagia MDT referral, not a wait-and-see.
Next steps
What happens after your FEES.
FEES is the beginning of a plan — these are the pathways it typically opens.
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Compensatory swallowing strategies
Chin-tuck, effortful swallow, head turn and supraglottic swallow — trialled during FEES and taught before you leave.
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Diet texture modification (IDDSI)
IDDSI-graded diet and fluid recommendations — from Level 0 thin fluids to Level 7 regular, matched to what your airway tolerates.
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Speech and language therapy
Structured rehabilitation of the pharyngeal swallow — strength, coordination and sensory retraining.
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Videofluoroscopy for detailed timing
VFSS complements FEES with a real-time X-ray view — better for timing, transit and upper-oesophageal sphincter opening.
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ENT evaluation of vocal cord function
Formal laryngeal assessment when cord movement or a mass is in question.
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Neurology referral
For stroke, Parkinson’s, motor neurone disease and other central causes of dysphagia.
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PEG-feeding discussion
If the swallow is unsafe at all textures, a candid conversation about gastrostomy feeding — timing, benefits and limits.
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Structured MDT follow-up
Coordinated review with SLT, ENT, dietetics and the referring team — one plan, one point of contact.
Our vetted London network
A small panel of clinics, we picked them.
Partners across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinic in our network.
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Speech-and-language therapists or ENT surgeons with a defined FEES caseload
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Validated grading scales used (Penetration-Aspiration Scale, Yale Residue)
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Same-day written report with IDDSI diet and fluid recommendations
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Onward dysphagia MDT pathway when aspiration or an unsafe swallow is found
Red flags
When a FEES is not a wait-and-see.
FEES itself is very safe. The important safety points are the clinical patterns that mean the swallow needs assessing now, and cannot be watched from afar.
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Silent aspiration
Material entering the airway without a cough — the very finding FEES is designed to detect.
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Recurrent chest infections
Repeated lower-respiratory infections in the context of dysphagia — an aspiration work-up is overdue.
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Vocal cord palsy (occult malignancy)
A palsied cord may be the first sign of a mediastinal or skull-base lesion — cross-sectional imaging follows.
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Post-stroke dysphagia
Persistent swallow difficulty after stroke — FEES quantifies it and guides rehab and diet.
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Progressive dysphagia
A swallow that is getting worse over weeks or months — always warrants specialist assessment.
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Head-and-neck cancer
Baseline and surveillance FEES during and after treatment — the swallow changes at every stage.
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Post-radiotherapy dysphagia
Late radiation effects on the pharynx — stiffness, reduced sensation, aspiration risk.
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Neurodegenerative disease
Parkinson’s, motor neurone disease, multiple sclerosis — FEES informs when texture change or PEG feeding is due.
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Unsafe swallow at high volumes
A swallow that copes with sips but fails at cup-fuls — a specific finding that changes daily advice.
Reading your report
A FEES report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication and swallow history
Your details, the reason for the FEES, and the history of dysphagia, weight loss and chest infections that frame interpretation.
- 02 Technique
Scope, anaesthetic and consistencies trialled
Which nostril, what topical anaesthetic, and the textures and volumes offered during the study.
- 03 Findings
Secretions, penetration, aspiration, residue
Anatomy, secretion grade, PAS score per texture, residue location and severity, and manoeuvres that helped.
- 04 Impression
Diet plan and next step: read this first
IDDSI diet and fluid grade, rehab plan, and the concrete next step — read this first.
Sources
Guidance this page draws on.
- Royal College of Speech and Language Therapists. FEES position paper and competency framework.
- ENT UK. Guidance on flexible nasendoscopy and dysphagia assessment.
- European Society for Swallowing Disorders. Position statements on FEES and VFSS.
- Dysphagia Research Society. Educational resources on instrumental swallow assessment.
Last reviewed 2026-07-30 · Next review 2027-07-30 · 6-minute read
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about FEES.
Quick answers on the test, how it compares with videofluoroscopy, who performs it, and what silent aspiration means.
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What is FEES?
FEES stands for flexible endoscopic evaluation of swallowing. A thin flexible endoscope is passed through the nose to a point above the voice box, and you are offered small tastes of coloured food and fluid so the clinician can watch the swallow in real time. It is the direct anatomical view of the laryngopharynx during swallowing.
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Does FEES hurt?
No. Topical lidocaine is used in the nose, the scope is very thin, and most people describe the sensation as strange rather than painful. You can talk and breathe normally throughout, and eat and drink straight afterwards.
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How is FEES different from a videofluoroscopy (VFSS)?
They are complementary. VFSS uses a fluoroscopic X-ray and shows the timing of the swallow, upper-oesophageal sphincter opening and transit. FEES uses a fibre-optic scope, uses no radiation, and shows the anatomy, secretions, cord movement and post-swallow residue directly. Many complex cases are worked up with both.
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Who performs FEES?
A speech-and-language therapist or ENT surgeon trained in nasendoscopy. In the UK, SLT-led FEES is well established and follows the RCSLT competency framework.
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What is silent aspiration and why does it matter?
Silent aspiration is material entering the airway without provoking a cough. Bedside swallow assessments miss it by definition — FEES is one of the few tests that reliably picks it up, and it materially changes diet and rehab advice.
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Do I need to fast before FEES?
No. FEES is designed to be done during a normal swallow — you eat and drink coloured samples during the test. Take medications as normal, and bring any texture-modified diet you use at home so it can be trialled directly.
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In practice, in London
Why private flexible endoscopic evaluation of swallowing fees moves differently in London
With flexible endoscopic evaluation of swallowing fees, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. On the NHS, flexible endoscopic evaluation of swallowing fees typically sits behind a triage step and a wait that can stretch from a few weeks into months. In London’s private sector, the same appointment often lands within days. That speed matters when symptoms are disrupting work, sleep, or a plan you’d already committed to — and it’s the single most common reason people call us in the first place.
A typical private booking for flexible endoscopic evaluation of swallowing fees in London starts with a consultant conversation — sometimes in person on Harley Street or Marylebone, sometimes on video if that suits better. Any imaging or diagnostics happen at a nearby CQC-registered facility, and reports usually land within 24 to 72 hours. The whole loop, from first call to written report, is often done inside a fortnight. For flexible endoscopic evaluation of swallowing fees specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
We’re careful about what a private pathway for flexible endoscopic evaluation of swallowing fees can and can’t promise. It can compress a wait, put you in front of a subspecialist quickly, and get a proper report in your hands within a week. It can’t rewrite what the imaging or the bloods say. Setting that expectation up front tends to make the whole experience less stressful.