Swallow Studies: What to Expect - Madison County Health Care System

When eating or drinking becomes difficult, knowing what is happening can help determine what comes next.

Swallowing is something most of us rarely think about, until it becomes difficult.

Maybe you have started coughing when you drink. Food feels like it gets stuck. Meals take longer than they used to. Or perhaps you have noticed these changes in someone you care about.

At Madison County Health Care System, our Speech Therapy team provides swallow evaluations, including Flexible Endoscopic Evaluation of Swallowing (FEES), to help evaluate how safely and effectively a person is swallowing. A swallow study can give your healthcare team a closer look at what happens when you eat and drink and help guide recommendations based on your individual needs.

All swallow studies at MCHCS require a referral from a healthcare provider. If you are concerned about your swallowing or the swallowing of someone you care for, talk with your healthcare provider about whether an evaluation may be appropriate.

Do You Need a Swallow Study?

Most people have experienced that cough when their drink goes “down the wrong pipe” or might have trouble swallowing something occasionally. But when swallowing difficulties happen regularly, they are worth discussing with your healthcare provider.

Signs of a possible swallowing problem may include:

Coughing during or shortly after eating or drinking
Frequently clearing your throat during or after meals
A wet or gurgly-sounding voice after eating or drinking
Feeling like food or liquid is stuck in your throat
Needing more time or effort to chew and swallow
Difficulty swallowing pills
Food remaining in your mouth after swallowing
Shortness of breath or difficulty breathing after meals
Avoiding certain foods because they are difficult to swallow
Unexplained changes in eating, drinking or weight

Sometimes a family member or caregiver notices these changes first.

Swallowing problems, also called dysphagia, can occur for many reasons. They may be associated with conditions such as stroke, traumatic brain injury, Parkinson’s disease and other neurological disorders, head or neck conditions, certain cancers, injuries or other medical changes.

If something about eating or drinking has changed, don’t feel like you need to determine the cause yourself.

Start the conversation with your healthcare provider.

What Is a FEES Swallow Study?

FEES stands for Flexible Endoscopic Evaluation of Swallowing. During a FEES evaluation, a trained speech-language pathologist uses a very small, flexible scope with a camera to look at the structures in your throat while you eat and drink. The scope is gently passed through the nose and positioned so your speech-language pathologist can see your throat and airway on a monitor. You will then be given small amounts of food and liquid so your swallowing can be evaluated in real time.

A FEES study can help your care team evaluate things such as:

How well you manage food, liquids and saliva
Whether food or liquid enters or approaches the airway
Whether material remains in the throat after swallowing
How effectively you clear food or liquid
Whether swallowing changes as you become tired during a meal
Whether certain positions, techniques or strategies make swallowing easier or safer
Which food or liquid consistencies may be most appropriate for you

Because FEES uses a small camera rather than X-ray imaging, there is no radiation exposure during the evaluation.

Why Would My Healthcare Provider Recommend a Swallow Study?

A swallow study may be recommended when your provider or speech-language pathologist needs more information about how your swallowing is working. It can help answer questions that cannot always be answered simply by watching someone eat or drink.

Your healthcare provider may consider a referral if you are experiencing ongoing swallowing concerns or if swallowing has changed following an illness, injury, surgery or medical diagnosis. The information gathered during the evaluation can help your healthcare team determine what (if anything) should change and whether additional treatment or evaluation is needed.

How Do I Get a Swallow Study?

Swallow studies at Madison County Health Care System require a referral from a healthcare provider.

If you are experiencing swallowing difficulties:

Tell your healthcare provider what you have noticed.
Be specific. Let them know if you cough when drinking, food feels stuck, meals are taking longer or something else has changed.
Ask whether a swallowing evaluation may be appropriate.
Your provider can review your symptoms and medical history and determine the appropriate next step.
If a swallow study is recommended, your provider can send a referral to MCHCS.
Our team will work with you to arrange your evaluation and provide any instructions you need before your appointment.

You do not need to know whether FEES is the correct test before talking with your provider. Your healthcare team can help determine the type of evaluation that is appropriate for your concerns.

Already Referred or Scheduled?

The instructions you receive from our Speech Therapy team are specific to you and your health history. Always follow those instructions rather than general directions you may find online.

Before your appointment, let our team know if:

You have questions about eating or drinking before your evaluation.
You have questions about taking your usual medications.
You have significant nasal obstruction or have recently had nasal surgery or an injury involving your nose.
You have frequent or severe nosebleeds.
You have a bleeding disorder or take medications that affect bleeding.
You become ill before your appointment.
You have any concerns about being able to participate in the evaluation.

It is always better to ask than to guess. Our team wants you to understand what to expect and feel comfortable asking questions before your swallow study.

FAQs About Swallow Studies

Many people don’t know what a swallowing problem looks like, or when a change is worth mentioning to their healthcare provider. These common questions can help you recognize possible swallowing concerns and better understand how a swallow study may help.

1. Why do I cough when I eat or drink?
Coughing while eating or drinking can happen when food or liquid irritates or enters the airway instead of moving smoothly toward the stomach. An occasional cough doesn’t necessarily mean you have a swallowing disorder, but frequent coughing during or shortly after meals can be a sign of difficulty swallowing. If this happens regularly, especially with certain foods or drinks, tell your healthcare provider what you’ve noticed.

2. Why do I cough when I drink water?
Thin liquids such as water move quickly through the mouth and throat. If swallowing isn’t well coordinated, you may cough during or after drinking. Repeatedly coughing on water or other liquids is worth discussing with your healthcare provider, particularly if it is a new change or happens frequently. Coughing during or immediately after drinking is one of the signs associated with swallowing difficulty.

3. Why does food feel like it gets stuck in my throat when I swallow?
Feeling like food is sticking in your throat or chest can be a symptom of dysphagia, or difficulty swallowing. Swallowing problems can occur in the mouth or throat, but they can also involve the esophagus (the tube that carries food to the stomach). Tell your healthcare provider where the food feels stuck, what types of foods cause the problem and how often it happens. Those details can help determine what type of evaluation may be appropriate.

4. Why is it hard to swallow pills?
Difficulty swallowing pills can happen for several reasons. Some people have trouble with the size or texture of a medication, while others may have an underlying swallowing problem. If pills regularly feel stuck, cause coughing or choking, or have become harder to swallow than they used to be, talk with your healthcare provider, especially if you’ve also noticed difficulty with food or liquids.

5. What are the signs of a swallowing problem?
Swallowing problems don’t always look the same. Possible signs can include:

Coughing during or after eating or drinking
Frequently clearing your throat during or after meals
A wet or gurgly-sounding voice after eating or drinking
Feeling like food is stuck in your throat or chest
Needing extra time or effort to chew or swallow
Food remaining in your mouth after swallowing
Difficulty swallowing pills
Trouble breathing after meals
Unexplained weight loss
Avoiding foods or drinks that have become difficult to swallow

These symptoms do not automatically mean you have a swallowing disorder, but ongoing or worsening changes are worth discussing with your healthcare provider.

6. Can I have a swallowing problem without coughing or choking?
Yes. Not every swallowing problem causes an obvious cough or choking episode. Some people can have dysphagia without noticeable symptoms. Food or liquid may also enter the airway without triggering a cough response, which is sometimes called silent aspiration. This is one reason your healthcare team may recommend additional testing when there are swallowing concerns or certain medical risk factors.

1. What causes difficulty swallowing?
Difficulty swallowing (also called dysphagia) can have many causes. Swallowing depends on the coordinated movement of muscles and nerves throughout the mouth, throat and esophagus. Difficulty can develop when those muscles or nerves aren’t working as expected or when something physically interferes with the movement of food or liquid. Swallowing problems may occur with conditions such as stroke, Parkinson’s disease, other neurological disorders, brain injury, head or neck conditions, cancer treatment and other medical conditions. You don’t need to determine the cause yourself. If your swallowing has changed, start by telling your healthcare provider.

2. Is difficulty swallowing serious?
Sometimes swallowing difficulty is temporary or occurs only occasionally. However, frequent or worsening trouble swallowing should be evaluated by a healthcare professional. Depending on the cause and severity, dysphagia can make it difficult to get enough food or fluids and may contribute to dehydration, weight loss, choking or food and liquid entering the airway. If swallowing has become noticeably more difficult, don’t simply work around the problem, talk with your healthcare provider.

3. What is dysphagia?
Dysphagia is the medical term for difficulty swallowing. It can involve problems moving food, liquids, medication or saliva through the mouth and throat or through the esophagus toward the stomach. Dysphagia can affect people for many different reasons and may range from mild difficulty with certain foods to more significant swallowing problems.

4. What is aspiration?
Aspiration happens when food, liquid, saliva or other material enters the airway instead of moving toward the stomach. Aspiration can sometimes cause coughing or choking, but it does not always produce obvious symptoms. Swallowing difficulties that allow food or liquid to enter the lungs can also increase the risk of respiratory complications such as aspiration pneumonia. A swallow study can help your healthcare team evaluate whether food or liquid is entering or approaching the airway.

5. How do I know if food or liquid is going into my lungs?
You can’t always tell based on symptoms alone. Some people cough or choke when material enters the airway, while others may have little or no obvious reaction. An instrumental swallowing evaluation can give clinicians information that cannot always be determined simply by watching someone eat or drink. If you have concerns about your swallowing, talk with your healthcare provider about whether further evaluation may be appropriate.

6. Are swallowing problems a normal part of aging?
Older adults are at greater risk of developing swallowing difficulties, but persistent trouble swallowing should not simply be assumed to be a normal part of getting older. Aging is a risk factor for dysphagia, along with certain neurological conditions, cancer treatment and other health factors. If you or someone you care for has developed repeated coughing during meals, food sticking, difficulty swallowing medications or other changes, mention them to a healthcare provider.

1. What is a swallow study?
A swallow study is a type of evaluation that gives your healthcare team a closer look at how swallowing is working. There are different types of instrumental swallowing evaluations. These tests can provide information about how food and liquid move through the swallowing process and whether additional strategies, treatment or medical evaluation may be helpful. Your healthcare provider and speech-language pathologist can determine which type of swallow evaluation is most appropriate for you.

2. What does a swallow study show?
A swallow study can help clinicians better understand how safely and effectively you are swallowing. Depending on the type of study, your healthcare team may be able to evaluate how food and liquid move through your throat, whether material enters or approaches the airway, whether food or liquid remains in the throat after swallowing and whether certain strategies or food and liquid consistencies improve swallowing. The information can then be used to make recommendations specific to your swallowing needs.

3. What is a FEES swallow study?
FEES stands for Flexible Endoscopic Evaluation of Swallowing. During FEES, a thin, flexible scope with a small camera is gently passed through the nose. A trained clinician can then view structures in the throat while you swallow different foods and liquids. FEES can provide detailed information about swallowing function and airway protection without the use of X-rays or radiation.

4. What happens during a FEES swallow study?
During a FEES evaluation, you remain awake and seated. A thin, flexible scope is gently passed through your nose so your clinician can view your throat on a monitor. You will then be asked to eat or drink small amounts of selected foods and liquids. Your clinician may also have you try different positions or swallowing strategies to see whether they make swallowing easier or safer.

5. Does a FEES swallow study hurt?
Most people can expect some pressure or temporary discomfort as the flexible scope is passed through the nose. Some people may also notice a gagging sensation. Your therapist will explain the procedure and monitor how you are doing throughout the evaluation.

6. How long does a FEES swallow study take?
The exact length of your appointment can vary depending on what needs to be evaluated. The procedure itself commonly takes about 20 minutes, although each person’s experience and overall appointment time may differ. Our speech-language pathologist will provide specific information about what to expect for your appointment at MCHCS.

7. Is a FEES swallow study safe?
FEES is commonly used to evaluate swallowing and does not involve radiation. Like any medical procedure, it can have risks or temporary side effects, including nasal discomfort, nosebleed, gagging or other uncommon complications. Your healthcare team will consider your individual health history and discuss the evaluation with you.

8. What is the difference between FEES and a modified barium swallow study?
Both tests provide valuable information about swallowing, but they evaluate it differently.

FEES uses a thin, flexible camera passed through the nose to directly view structures in the throat before and after swallowing. It does not use radiation.
A modified barium swallow study, sometimes called an MBS or videofluoroscopic swallow study, uses X-ray imaging while a person swallows food and liquids containing barium.

You don’t need to decide which test you need. Your healthcare provider and speech-language pathologist can help determine which evaluation is most appropriate for your symptoms.

1. When should I see a doctor for trouble swallowing?
Talk with your healthcare provider if you frequently have trouble swallowing or notice an ongoing change in how you eat, drink or take medications. You should also seek medical care if swallowing difficulty occurs with unexplained weight loss, repeated vomiting or regurgitation. If food becomes completely stuck and you cannot swallow, or a blockage is making it difficult to breathe, seek emergency medical care immediately.

2. How do I know if I need a swallow study?
You don’t need to know before talking with your healthcare provider. If you’ve noticed frequent coughing when eating or drinking, food getting stuck, difficulty swallowing pills, longer or more difficult meals, or another change in your swallowing, tell your provider what is happening. Your healthcare provider can review your symptoms and medical history and determine whether a swallow evaluation, instrumental swallow study or another type of medical evaluation is the best next step.

3. Who treats swallowing problems?
Our speech-language pathologist, Maddie Heimbaugh, MA, CCC-SLP, is trained to evaluate and treat many types of swallowing disorders. Depending on what is causing the difficulty, your care may also involve your primary care provider or specialists in areas such as neurology, gastroenterology or ear, nose and throat care.

4. Do I need a referral for a swallow study?
Yes. All swallow studies at Madison County Health Care System require a referral from a healthcare provider. If you’re concerned about your swallowing, start by talking with your primary care provider or another provider involved in your care. Describe what you’ve noticed and ask: “Do you think my swallowing should be evaluated?” If your provider determines that a swallow study is appropriate, they can send a referral to MCHCS.

5. Where can I get a swallow study near Winterset, Iowa?
Madison County Health Care System offers swallow studies, including Flexible Endoscopic Evaluation of Swallowing (FEES), through Speech Therapy at Madison County Health & Rehab Services in Winterset. A healthcare provider referral is required.

Madison County Health & Rehab Services
Phone: (515) 462-5206

If you’re experiencing swallowing difficulties and have not yet been referred, start by talking with your healthcare provider.

For Family Members and Caregivers

Sometimes the person experiencing a swallowing problem does not recognize that something has changed.

Family members and caregivers may be the first to notice:

Repeated coughing during meals
Frequent throat clearing
A wet or gurgly voice after eating or drinking
Avoiding certain foods
Meals taking significantly longer
Difficulty swallowing medications
Changes in how much someone eats or drinks

If you notice a pattern, encourage your loved one to discuss it with their healthcare provider.

You can also write down what you have observed, how often it happens and whether certain foods or drinks seem more difficult. Those details can be helpful during a medical appointment.

For Referring Providers

Madison County Health Care System offers Flexible Endoscopic Evaluation of Swallowing (FEES) through our Speech Therapy services.

FEES allows direct visualization of pharyngeal and laryngeal structures and can provide valuable information about secretion management, residue, airway protection, swallowing safety and the effectiveness of compensatory strategies.

To refer a patient for a swallow study:

Madison County Health & Rehab Services
Phone: (515) 462-5206
Fax: (515) 462-5108

Please include the appropriate referral/order and relevant clinical information.

Providers with questions about whether FEES may be appropriate for a patient are welcome to contact our Speech Therapy team.

Our Speech-Language Pathologist

**Maddie Heimbaugh, MA, CCC-SLP**
Speech Therapy

Maddie provides speech, language, cognitive-communication and swallowing services through Madison County Health & Rehab Services, including FEES swallow studies.

Our goal is to help patients and their healthcare providers better understand swallowing difficulties and use that information to make informed decisions about care.

Still Have Questions?

If you are experiencing swallowing difficulties but have not yet been referred, start by talking with your healthcare provider. They can evaluate your concerns and determine whether a swallow study or another type of evaluation may be appropriate.

If your provider has already referred you for a swallow study or you have questions about an existing referral, contact:

Madison County Health & Rehab Services
Phone: (515) 462-5206

Swallow studies require a provider referral.

Learn more about our Speech Therapy services and the other rehabilitation services available through Madison County Health & Rehab Services.

Trusted Swallowing Resources

The following resources provide additional general information about swallowing difficulties and swallow evaluations. They should not replace recommendations or instructions provided by your healthcare team.

American Speech-Language-Hearing Association — Swallowing Disorders

Patient-friendly information about signs of swallowing problems, possible causes, swallowing evaluations and treatment.

American Speech-Language-Hearing Association — Flexible Endoscopic Evaluation of Swallowing

Detailed information about FEES, how the procedure works, when it may be used and what clinicians evaluate during the study.

MedlinePlus — Swallowing Disorders

General health information from the National Library of Medicine about swallowing difficulties, possible causes, testing and treatment.