Dysphagia Evaluation Specialists

Dysphagia Evaluation Specialists Our guarantees include:

1. Arrival within 24-72 hours of receiving a consult request. Call or email us today to schedule an in-service or demonstration!
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Valeria Krivelevich, MA, CCC-SLP, BCS-S
FEES Educator | Book Author | Mobile FEES Owner | Trusted endoscopy education for SLPs

🎉Enhance Your Scope!👇

https://lnk.bio/dysphagia.eval.specialists Dysphagia Evaluation Specialists is the leading provider of mobile Flexible Endoscopic Evaluation of Swallowing (FEES) services to skilled nursing facilities throughout New York State and New Jersey. We st

and behind the principles of excellence, quality of life, and service to our community and work diligently to elevate the quality of dysphagia care for our patients by providing a safe, cost effective diagnostic tool directly to skilled nursing facilities. In cases of emergency we will come on the same day or morning immediately following receiving a consult request.

2. Arrival at a time that is convenient for your Speech-Pathologist so that they can take part in important decision making during the diagnostic process.

3. A highly detailed evaluation report with color images printed and handed in before we leave the facility.

4. Strong support for your Speech-Pathology staff in assisting them with development of a sound plan of care for their patients based on objective findings.

09/03/2026

How many times have we heard, “It’s just postnasal drip”?

I know I have, but as SLPs we know that coughing during meals deserves a closer look, especially when there are other risk factors or clinical concerns.

The family may have heard that cough for months or even years and understandably have an explanation for it. Our job isn’t to dismiss that explanation. It’s to investigate whether swallowing might also be contributing.

That’s where an instrumental assessment can be so valuable. FEES or MBS can help us move beyond assumptions and actually see what is happening during the swallow.

And when we do identify something concerning, part of our job is helping families understand what we’re seeing without making them feel like they were “wrong” all along.

Sometimes that “usual cough” is telling us something.

And there are times when an instrumental assessment is particularly warranted:
Recurrent pneumonia, unexplained respiratory decline, persistent coughing during meals, unintentional/unexplained weight loss, prolonged mealtimes, or a significant change in swallowing all deserve further investigation.

Sometimes an instrumental assessment will pinpoint an oropharyngeal, pharyngeal or even an esophageal cause for a patient’s dysphagia (as seen in this video). This will determine the type of referrals and ongoing care the patient can benefit from. That “usual cough,” is always trying to tell us its origin story.

09/02/2026

What clinicians should avoid during FEES: gasping or otherwise reacting to an aspiration event, pe*******on event, or an anomaly.

Reacting by gasping can be reflexive when we see something concerning that we fear may jeopardize our patient’s health and safety. However, being a competent and professional endoscopist entails maintaining control of our facial expressions and emotional reactions.

Why is that? Well, there are 2 primary reasons:
1. Reacting may alert the patient to the fact that something is not as it should be. This may cause the patient to experience increased anxiety during and after the assessment. We want to avoid this to ensure that our patients have as calm an experience as possible during a FEES.

It is also possible that something we initially think is concerning may turn out to be less significant once we continue the assessment and gather more information.

Staying calm also allows us to manage the situation more effectively should the aspiration event be concerning for airway obstruction.
1. A gasp or other reaction may cause us to intervene before we have had the opportunity to observe the patient’s spontaneous response to a pe*******on or aspiration event.

It is often best to stay calm and wait briefly to see the patient’s reaction. Do they cough? Throat clear? Re-swallow? Have no response at all?

If no response is present, you can then provide cueing to cough or throat clear as clinically appropriate.

Do you agree or disagree?

08/30/2026

FEES books, but make them actually useful. đź‘€

Detailed Surface Anatomy of the Pharynx and Larynx for the SLP-Endoscopist and Describing Laryngeal & Pharyngeal Anomalies for the SLP-Endoscopist were created by an SLP, for SLPs to help you recognize what you’re actually seeing during FEES (and Videostroboscopy), describe it more confidently, and build a stronger visual reference for the findings that don’t always look textbook-perfect.

The perfect, lightweight books to refer to anytime and/or keep on your FEES cart.

Prefer digital? Comment DUO and I’ll send you a link to the e-book version (at the BEST price!).

More of a physical-book person? Comment BOOKS and I’ll send you the link to the printed copies.

Because sometimes the best FEES resource is the one you can actually reach for while you’re reviewing a study.

08/27/2026

Texture modification is not always linear.
We often think of dysphagia diets as a hierarchy: if one texture is not “safe” or is more difficult to manage, we move down to something “easier.”
(I know, I know... we don’t love these terms. Bear with me for illustrative purposes.)

But that hierarchy does not always reflect what we see physiologically.

During this FEES, the patient had airway invasion with puréed solids, his current diet consistency. When I trialed minced/moist solids, no airway invasion was seen.
So why did I trial the higher-level consistency?

1. The patient and family were motivated for a diet upgrade.
2. The swallow responds to the bolus we give it. Changes in bolus characteristics can alter swallowing physiology, including pressure, bolus-driving forces, timing, and UES function. I could not assume the response I saw with purée would be the same with a different texture.
3. If we don’t test it, we don’t know. When clinically appropriate, instrumental assessment allows us to directly observe how the swallowing system responds to different textures.

In this case, I’m glad I did.

Texture modification should not be viewed as a simple ladder. “Safer,” “easier,” and “more difficult” do not always predict what an individual patient’s physiology will do.

Have you ever seen a patient perform better with a more advanced texture?

References:
Raut et al., 2001. Eur Arch Otorhinolaryngol.
Sia et al., 2018. Neurogastroenterol Motil.
Ferris et al., 2021. Am J Physiol Gastrointest Liver Physiol.

08/24/2026

FEES competency is so much more than being able to pass the scope.

What you see on the surface is only one part of it.

There is also knowing how to recognize subtle abnormalities, interpret what you are seeing, identify patterns, connect findings to physiology, and make sound clinical decisions.

And underneath all of that is the foundation:

A strong understanding of normal anatomy and physiology.

Because before you can recognize what is abnormal, you need to really know what normal looks like.

And I have to mention that none of this can be accomplished without a strong FEES mentor.

FEES competency is built in layers. The technical skill matters, but so does everything happening beneath the surface.

If you’re learning FEES, what part of competency has been the hardest to develop?

08/22/2026

One of the things I love about FEES is that the interpretation develops as the study unfolds.

On the initial 3 purée trials, there was pharyngeal residue, some shallow and transient laryngeal pe*******on over the aryepiglottic folds and no aspiration.

Had I looked at those puree trials in isolation, I might have concluded that the patient was managing that consistency relatively well.

Then we moved to a ground consistency.

I watched residue within the lateral channels gradually migrate toward the laryngeal vestibule and ultimately result in aspiration.

That made me go back.

Was this really a problem with the ground consistency? Or was I starting to recognize a pattern in the patient’s ability to manage accumulating pharyngeal residue?

So I tested purée again.
With additional trials and additional residue, the same pattern began to emerge.

And this is where another important part of FEES comes in: knowing when to do nothing.

Rather than immediately cueing a cleansing swallow, I paused and gave the patient an opportunity to manage the residue independently.

That pause allowed me to see the purée residue migrate into the laryngeal vestibule deeper, and reach the level of the vocal folds during a swallow.

Some of the most valuable information in a FEES study comes from recognizing a pattern, questioning your initial interpretation, going back to test it again, and occasionally resisting the urge to intervene long enough to see what the patient actually does on their own.

08/19/2026

I searched high and low for practical resources that would help SLP endoscopists recognize detailed laryngeal and pharyngeal surface anatomy, identify what may be outside the range of normal, and accurately describe the anomalies they observe during FEES.

I combed through heavy textbooks and dense journal articles. I wanted something tangible, something in one reference, something I and clinicians could turn to when writing reports.

I couldn’t find the references I was looking for, so I created them.

Today, these books are helping SLP endoscopists develop the language, knowledge, and confidence to better recognize, describe, and document what they see.

Kinda chic, actually 🙂

*When I use the word “only,” I mean to the best of my knowledge. I truly believe these are the only reference books currently on the market dedicated specifically to teaching SLP endoscopists this information. I searched extensively before creating them because I was trying to find these resources for myself. If a comparable reference exists, please let me know. I would be genuinely happy to review it and update my claim.

If you’re interested in checking out my e-books at the best price they will ever be, comment the word DUO

If physical books are more up your alley, comment the word BOOKS

08/18/2026

If passing the endoscope through the naris feels awkward, here’s one tip that can make entry much smoother.

When entering the naris, angle the endoscope slightly upward and toward the nasal septum. This helps you avoid bumping into the nasal vestibule, making insertion smoother and often more comfortable for your patient

Here’s a helpful orientation tip:
* Septum on the right side of your screen = you’re in the patient’s right naris.
* Septum on the left side of your screen = you’re in the patient’s left naris.

How familiar are you with nasal anatomy?

A strong endoscopist should be able to navigate the nasal passages efficiently, and also be able to name the structures of the nose, nasopharynx, pharynx and larynx.

Comment the word DUO to check out my two bestselling anatomy and anomalies ebooks at the best price!

08/17/2026

There is one word I rarely write a FEES report without:

Judged

Instead of writing:
“Aspiration occurred during the swallow.”

I might document:
“Aspiration was noted, judged to have occurred during the swallow secondary to…”

Why do I use the word judged?

Although we often refer to instrumental swallowing assessments as objective, interpretation of the findings still requires clinical judgment.

We observe what occurs during the study, consider the timing and possible contributing factors, and use those findings to determine what we believe occurred physiologically.

The word judged acknowledges that clinical interpretation.

It also gives me the opportunity to clearly document the reasoning behind my conclusion, particularly when the timing or mechanism of a finding requires interpretation.

If my report is ever reviewed, I want it to reflect not only what I observed, but how I arrived at my clinical conclusion.

Do you use the word judged in your FEES or MBS reports?

08/14/2026

Which muscles work together for velopharyngeal closure?

Velopharyngeal closure requires coordinated movement of the velum and pharyngeal walls.

🔹 Levator veli palatini (LVP): The principal elevator of the velum and primary muscle responsible for the velar component of closure. The paired LVP muscles form a functional sling that elevates the velum superiorly and posteriorly.
🔹 Palatopharyngeus: Works in coordination with the LVP and superior pharyngeal constrictor, contributing to positioning of the velum and narrowing of the velopharyngeal port.
🔹 Superior pharyngeal constrictor: Contributes to the pharyngeal component of closure and narrowing of the pharyngeal isthmus. Its contribution varies with individual closure patterns.
🔹 Musculus uvulae: Contributes bulk to the central velum and is thought to help create an effective contact surface during closure.
What about the tensor veli palatini?
It tenses the soft palate but is not the primary muscle responsible for velar elevation. Its major recognized function is opening the pharyngotympanic (Eustachian) tube.

Bottom line: Velopharyngeal closure is a coordinated muscular event, not the action of a single muscle.

And an important FEES distinction: We can observe velopharyngeal movement and closure endoscopically, but we should not infer isolated weakness or dysfunction of a specific muscle from the endoscopic image alone.

References
Perry JL. Semin Speech Lang. 2011;32:83–92.
Fukino K, et al. JPRAS Open. 2026;48:817–827.
Di W, et al. Plast Reconstr Surg. 2021;148:389e–397e.

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