What test is commonly used after the initial assessment to further evaluate swallowing?

• A. Endoscopy
• B. Barium swallow
• C. FEES or VFSS as indicated
• D. Manometry

Answer: (C)

After an initial bedside swallow screen, you want direct visualization of how the swallow is working and where the problem occurs. That's why instrumental swallow studies are used next, with FEES (fiberoptic endoscopic evaluation of swallowing) or VFSS (video fluoroscopic swallow study) as indicated. FEES involves passing a small endoscope through the nose to view the pharynx and larynx during swallowing, letting you see airway protection, secretions, and whether there is residue or penetration/aspiration after a swallow. VFSS is a dynamic X-ray study where the patient swallows barium-containing boluses, so you can watch the entire swallow in real time—from the oral phase through the pharyngeal phase and into the upper esophagus—to identify timing problems, bolus flow issues, and the point at which aspiration occurs. These tests provide concrete, observable evidence that guides management, such as swallowing maneuvers, texture modifications, or compensatory strategies.

Endoscopy in general can image anatomy but isn’t always the best way to gauge swallowing function. A standard barium swallow emphasizes the esophagus and may miss pharyngeal dysfunction, and manometry measures pressure patterns rather than visualizing the swallow itself. Hence FEES or VFSS as indicated is the most appropriate next step after the initial assessment.