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Diagnostic Testing For Vocal Pathologies

Voice and swallowing problems must be accurately diagnosed before they can be treated. Because these problems have myriad causes, it is essential that patients undergo highly advanced diagnostic testing. Temple’s head and neck surgeons are proud to offer leading-edge methods to see inside the throat and pinpoint the cause of dysfunction. These advanced techniques can be performed in the office, minimizing hassle and time away from work. 

Diagnostic tests include:
  • Laryngoscopy
  • Videostroboscopy
  • Flexible Endoscopic Evaluation of Swallowing (FEES)with Sensory Testing (FEESST)
  • Transnasal Esophagoscopy (TNE)
  • Bronchoscopy

Video: Diagnostic Testing for Voice and Swallowing Disorders

Barbara Ebersole, BFA, MA, CCC-SLP, Director of Speech Pathology at the Temple Head & Neck Institute and Fox Chase Cancer Center, explains how laryngoscopy and stroboscopy are used to diagnose voice and swallowing disorders.


Laryngoscopy is a diagnostic test that is used to evaluate the basic anatomy and function of the throat and voice box. It is performed by inserting a flexible endoscope in the nose or a rigid one in the mouth. The patient may be asked to breathe a certain way or make certain sounds in order to carefully examine the throat.


Videostroboscopy is a diagnostic test that is used to examine the form and function of the larynx (voice box) including the vocal folds, as well as the health of the surrounding muscles and tissues.  It is similar to laryngoscopy.This test can pinpoint the underlying causes of a range of vocal symptoms, including hoarseness.

Videostroboscopy may be performed by inserting a flexible telescope in the nose or a rigid telescope into the back of the mouth. The patient is then asked to follow simple vocal instructions that help to assess the health of the larynx and vocal folds.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with Sensory Testing (FEESST)

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with Sensory Testing (FEESST) is a relatively new method of evaluating swallowing function and diagnosing swallowing disorders. Both FEES and FEESST complement the commonly known barium swallowing test, in which patients used to drink an opaque substance to enhance X-rays of the throat.

During FEES, a clinician passes a small scope with a camera through the patient's nose and down into the throat. The first part of the test measures the ability of the voice box to perform certain basic motor functions.  The second part of FEESST measures the patient's ability to swallow. With the camera in place, the patient swallows various foods mixed with food coloring. From the camera's vantage point, the physician can observe the intricacies of the process as the patient attempts to swallow food.  When FEESST is performed, additional testing is performed to test reflexes that are protective of the airway.

FEES and FEESST are performed in the office. It provides immediate results and completely avoids the need for X-rays.

Transnasal Esophagoscopy

Transnasal esophagoscopy is a diagnostic procedure physicians use to examine the esophagus or food pipe. This is performed in a physician's office and takes only about 5-10 minutes to complete. While traditional esophagoscopy requires patients to be sedated, Temple physicians are now able to perform the procedure without sedation, allowing for faster recovery and greater safety.

After applying a numbing spray, the physician inserts the endoscope (a small tube) through the patient's nose, and into the esophagus. While the tube is in place, small amounts of air will be puffed into the esophagus. The patient will then be asked to burp or swallow in order to gauge the health of throat anatomy. Depending on the findings, the physician may also take photos with the camera, or a small tissue sample for testing.


For some patients suspected to have a problem in their windpipe, office-based bronchoscopy (endoscopy of the windpipe and lungs) offers a safe and comfortable screening method without the downtime associated with sedation or general anesthesia. Medications are used to numb a person’s throat and voice box, and a flexible endoscope is inserted through the voice box and into the lungs. This allows for accurate diagnosis and treatment planning for many patients with lesions of the airway. Office-based bronchoscopy is a novel technique that is offered only at advanced voice, airway, and swallowing centers.