Respiratory-swallow assessment protocol for adult dysphagia management

Cervical auscultation (CA) analyzes respiratory-swallow patterns to enhance the clinical swallow examination. A growing body of research demonstrates CA’s strong psychometric properties for detecting unsafe swallows. However, to date, no standard CA assessment protocol or training resources have been published. Extending previous work, the objective is to publish the evidence-based assessment guide used in our earlier research. Additional qualitative data and recent literature was integrated to update the previously unpublished CA guide. Qualitative content analysis was performed on 71 data texts from 12 CA-trained Speech-Language Pathologists describing CA respiratory-swallow signs that influenced their ratings of six swallow sound recordings. The CA ratings were compared against Flexible Endoscopic Evaluation of Swallowing (FEES). Qualitative results, describing the swallow and respiratory characteristics of dysphagic swallows, were integrated into the CA assessment guide (Appendix A). Five critical aspects to CA assessment include: (1) pre-swallow respiratory sounds, (2) swallow sounds, (3) number of swallows, (4) post-swallow exhalation, and (5) post-swallow respiratory sounds. Additional audio sound files and reference samples are provided (Appendix B) to facilitate an introductory training resource. The evidence-based CA guide and training resources are expected to establish clinically important resources for future clinical use and research evaluation.