Flexible Endoscopic Evaluation of Swallowing in Individuals With Traumatic Brain Injury: A Scoping Review

Purpose: The purpose of this review was to explore the existing literature on the instrumental assessment of swallowing using flexible endoscopic evaluation of swallowing (FEES) in individuals with traumatic brain injury (TBI). Method: A systematic literature search was conducted until March 2025 across the ProQuest, Scopus, and PubMed databases. The Arksey and O'Malley framework for scoping review was utilized. The studies on the TBI population with FEES assessment were screened and extracted by two independent reviewers. Participant characteristics, procedural details, swallowing impairment profiles, and outcome measures were analyzed and reported. Results: The literature search identified 474 studies, and five studies were conclusively included in this review. Major swallowing impairments reported were pharyngeal residue, penetration, aspiration, and silent aspiration. Out of 36% and 45% of participants with TBI who had aspiration, 52.94% and 44%, respectively, were aspirating silently. Heterogeneity was observed across studies in FEES protocol, analytical methods, and reporting. Conclusions: The literature demonstrates the multifaceted nature of TBI, the diverse swallowing impairments, and the multiple assessment tools used in conjunction with FEES in individuals with TBI. One of the major FEES findings across the studies in this patient group was silent aspiration, indicating the importance of instrumental swallowing evaluation in TBI. Future studies are needed to provide elaborate and comparable evaluation protocols and reporting of FEES in individuals with TBI.