Which swallowing assessment may miss aspiration due to a period of whiteout during the pharyngeal swallow?

• A. FEES
• B. Videofluoroscopy
• C. Clinical bedside swallow evaluation
• D. Ultrasonography

Answer: (A)

During FEES, the endoscopic view is obscured for a brief moment at the peak of the pharyngeal swallow, a whiteout when tissues close over the airway. If aspiration occurs exactly during that swallow, the camera is unable to visualize what’s happening, so a portion of aspiration can be missed. This specific blind window is unique to FEES, which is why it’s the best answer. In contrast, videofluoroscopy records the swallow radiographically in real time and shows aspiration as it occurs; bedside clinical exams rely on observable signs and may miss silent aspiration; ultrasonography isn’t reliable for visualizing the airway during swallowing.