Topical Sprays for FEES: What You Need to Know

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It’s natural to feel a little nervous before a Fibreoptic Endoscopic Evaluation of Swallowing (FEES). The idea of a small camera passing through your nose can sound uncomfortable, and many people ask: “Can I use something to numb it first?”

The short answer is: you usually don’t need to, and numbing sprays can affect the results of the test.

Why numbing sprays aren’t recommended

FEES shows how your throat senses and reacts when food or drink moves through it. Reflexes such as coughing and throat-clearing help protect you from food, liquid, or saliva accidentally “going down the wrong way” into the airway instead of the food pipe. If these protective reflexes are dulled by a numbing spray, the test may not reflect your true swallowing ability.

Research shows that when larger doses of lignocaine (numbing medication) are used, people swallow less safely, sometimes showing aspiration that wouldn’t normally occur (Lester et al., 2013; Fife et al., 2015). Smaller doses used just inside the nose seem safer (O’Dea et al., 2015; Kamarunas et al., 2014), but still need caution.

What the guidelines say

Both Speech Pathology Australia (SPA, 2019) and the Royal College of Speech and Language Therapists (RCSLT, 2020) advise performing FEES without anaesthetic whenever possible. SPA also notes that speech pathologists must not administer or initiate anaesthetic sprays unless they are authorised to do so, and that most patients tolerate FEES well without any sprays.

Safe comfort options

If you’re worried about nasal discomfort, a simple nasal decongestant spray can sometimes help. These sprays reduce swelling in the nose and make the scope pass more easily. They don’t numb the throat or change swallowing responses, so they don’t affect the accuracy of the test.

Before using one:

• Talk with your GP or pharmacist to make sure it’s suitable for you

• Use it exactly as directed, about 10 minutes before your appointment

• Avoid combination products that include steroids or anaesthetics unless prescribed

  
  

Sprays to avoid

Anaesthetic throat sprays contain numbing ingredients. They can reduce normal throat sensation and risk reducing important swallowing responses. If a doctor suggests using one in the nose to ease scope insertion, that would be an off-label use and should only be done under medical guidance and in very small amounts.

Swallow Science Melbourne does not supply or administer medicated sprays. Most people find that with gentle technique and clear explanation, FEES is comfortable without them.

In summary

For most adults, FEES can be completed comfortably without any sprays. If extra comfort is needed, a nasal decongestant alone (after discussion with your doctor or pharmacist) is a safe and evidence-based option.

At Swallow Science Melbourne, a small amount of lubricating gel is used on the scope to make insertion gentle, and we take time to explain each step to help you stay comfortable throughout the procedure.

References:

• Fife, T. A., Carter, R. L., & Walker, A. R. (2015). The effects of topical nasal anesthesia on swallowing safety during FEES in adults with dysphagia. Dysphagia, 30(5), 593–600. https://pubmed.ncbi.nlm.nih.gov/25678379

• Kamarunas, E., McCullough, G. H., Guidry, T. J., & Gallagher, C. (2014). Effects of topical nasal anesthesia on swallowing and sensory testing in healthy adults. Dysphagia, 29(1), 33–41. https://pubmed.ncbi.nlm.nih.gov/23793600

• Lester, R., Fife, T. A., & Carter, R. (2013). Impact of topical nasal anesthesia on swallowing safety during fiberoptic endoscopic evaluation of swallowing (FEES) in healthy adults. Dysphagia, 28(4), 521–528. https://pubmed.ncbi.nlm.nih.gov/23553206

• O’Dea, M. B., Langmore, S. E., & Krisciunas, G. P. (2015). Effect of minimal topical nasal anesthesia on swallowing physiology and comfort during FEES. Dysphagia, 30(3), 272–278. https://pubmed.ncbi.nlm.nih.gov/25380752

• Royal College of Speech and Language Therapists (RCSLT). (2020). Position paper: Fibreoptic Endoscopic Evaluation of Swallowing (FEES). London, UK: RCSLT. https://www.rcslt.org/clinical-resources/

• Speech Pathology Australia. (2019). Clinical guideline: Flexible Endoscopic Evaluation of Swallowing (FEES). Melbourne, Australia: Speech Pathology Australia. https://www.speechpathologyaustralia.org.au

• Therapeutic Goods Administration (TGA). (2023). Product information: Difflam Plus Anaesthetic Sore Throat Spray (benzydamine hydrochloride 390 mcg). Australian Government Department of Health and Aged Care. https://www.ebs.tga.gov.au