Respiratory-swallow assessment protocol for adult dysphagia management

INTRODUCTION: 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. OBJECTIVE: Extending previous work, the objective is to publish the evidence-based assessment guide used in our earlier research. METHOD: Additional qualitative data and recent literature was integrated to update the previously unpublished CA guide.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). RESULTS: Qualitative results, describing the swallow and respiratory characteristics of dysphagic swallows, were integrated into the CA assessment guide (Supplementary Material 9). 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 sounds (Supplementary Material 1–8) and reference samples are provided (Supplementary Material 9) to facilitate an introductory training resource. CONCLUSION: The evidence-based CA guide and training resources are expected to establish clinically important resources for future clinical use and research evaluation.