FEES vs. Modified Barium Swallow: What’s the Difference and Do You Need Both?
- Athanasia Anna Svenning Daley
- 3 days ago
- 4 min read
Many people hear they need a swallow study but don’t fully understand what that means. Two common swallowing tests are the Modified Barium Swallow Study (MBSS) and FEES, which stands for Flexible Endoscopic Evaluation of Swallowing. Both tests assess swallowing safety, but they work very differently and serve different purposes. Knowing the difference between FEES and MBSS can help patients, caregivers, and providers make informed decisions about diagnosis and treatment.
What Is a Modified Barium Swallow Study?
A modified barium swallow study takes place in a radiology suite. During this test, a patient swallows food and liquids mixed with barium, a contrast material that shows up clearly on x-rays. The radiologist and speech-language pathologist watch how the barium moves from the mouth through the throat and into the esophagus.
This swallowing evaluation for aspiration provides a detailed view of the anatomy and physiology of the swallowing process. It helps identify problems like aspiration (food or liquid entering the airway), delayed swallowing reflex, or structural abnormalities.
Key features of the Modified Barium Swallow Study:
Uses x-ray imaging to see swallowing in real time
Shows movement of food and liquid through the mouth, throat, and esophagus
Helps detect aspiration during swallowing
Typically requires travel to a radiology center or hospital
Because it uses radiation, the MBSS is usually a brief test and performed under controlled conditions.
What Is FEES (Flexible Endoscopic Evaluation of Swallowing)?
FEES is a swallowing test that uses a small, flexible camera passed through the nose to look directly at the throat during swallowing. This flexible endoscopic evaluation of swallowing allows clinicians to see the throat’s structures, secretions, residue, vocal cord movement, and airway protection in real time.
Unlike the modified barium swallow study, FEES does not use x-rays or radiation. It can be performed at the bedside, in clinics, or even as a FEES swallowing test at home for patients who have difficulty traveling.
Key features of FEES:
Uses a flexible camera inserted through the nose
Provides a direct view of the throat and vocal cords
Shows secretions, residue, and airway protection during swallowing
Can be done in various settings, including in-home FEES evaluation
No radiation exposure
FEES is especially useful for patients who are medically complex or have limited mobility. It allows repeated assessments without radiation risk and can be performed quickly.
Main Differences Between FEES and Modified Barium Swallow
Understanding the difference between FEES and MBSS helps clarify which test might be best for a given situation.
Modified Barium Swallow Study (MBSS) | FEES (Flexible Endoscopic Evaluation of Swallowing) | |
Where the test is done | Hospital or outpatient radiology department | Clinic, bedside, or in the patient's home |
How the test works | X-ray imaging while swallowing food and liquid mixed with barium | Small, flexible camera passed through the nose to view the throat |
Radiation exposure | Yes | No |
Food & liquid used | Barium-coated liquids and foods | The patient's own foods, liquids, and medications |
Key benefits | Provides a full moving image of bolus flow and timing across swallow phases | Can be performed in a natural eating environment with real foods and repeated swallows without radiation exposure |
When Might You Need Both Tests?
Sometimes, a swallowing evaluation for aspiration requires both FEES and a modified barium swallow study. Each test provides unique information that complements the other.
For example:
MBSS can show how food moves through the entire swallowing pathway, including the esophagus.
FEES can reveal secretions and vocal cord function that MBSS cannot.
If initial testing is inconclusive, combining both tests can improve diagnosis.
Patients with complex swallowing problems may benefit from both to guide treatment.
Your healthcare provider will decide which test or combination fits your specific needs.
Why FEES Is Often Ideal for Medically Complex or Mobility-Limited Adults
Many adults with swallowing difficulties face challenges traveling to radiology centers for a MBSS. FEES would be optimal for these patients because it can be performed at the bedside or even at home. This mobile swallow study option reduces stress and risk for patients who are frail or have limited mobility.
Additionally, FEES does not expose patients to radiation, making it safer for repeated evaluations. It also allows clinicians to observe airway protection and vocal cord movement in real time, which is critical for preventing complications like aspiration pneumonia.
How to Decide Which Swallow Study Do I Need?
If you or a loved one has been told to get a swallow study, it’s natural to wonder, which swallow study do I need? Here are some tips:
Ask your healthcare provider about the goals of the evaluation.
If you need a detailed view of swallowing mechanics and esophageal function, an MBSS might be best.
If you have mobility issues or need repeated assessments, ask about a FEES swallowing evaluation.
Consider availability: oftentimes, patients have to wait weeks after scheduling their MBSS.
Discuss any concerns about radiation exposure with your provider.
Understanding the difference between FEES and modified barium swallow study helps you feel confident in your care plan.
Swallowing problems can lead to serious complications if not diagnosed correctly. Knowing the difference between FEES and MBSS, and when each test is appropriate, supports better outcomes.
If you are interested in learning more about swallowing testing, contact us at Nexa Speech Concierge today!
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