A review of Four Key Studies Redefining How We Think about CA in Dysphagia Practice

If you’ve ever reached for your stethoscope during a clinical swallow exam and then second-guessed yourself, you’re not alone. Cervical auscultation (CA) has had a complicated reputation in dysphagia management,  celebrated by some, dismissed by others, and misunderstood by many. But a growing body of research is changing that narrative, and four recent studies deserve a place in every dysphagia clinician’s reading list.

Here’s what the research says and what it means for your clinical practice.

The Problem with Old CA Research

Before diving into the new studies, it’s worth understanding why cervical auscultation got such a mixed reputation in the first place. Early studies examining CA’s validity and reliability produced wildly inconsistent results, with sensitivity figures ranging from 23% to 94%. That kind of spread would make any evidence-based clinician nervous.

But newer research has identified why those results were so variable: methodology. Specifically, early CA studies frequently lacked standardized training for raters, provided no clear definitions of normal versus abnormal swallow-respiratory coordination, used inconsistent comparison parameters against instrumental assessment, and employed poor sound-sampling procedures. In short, the technique wasn’t the problem, the conditions under which it was studied were.

Study 1: Structured Training Makes the Difference

Bergström & Cichero (2022)  International Journal of Speech-Language Pathology, 24(1), 77–87

This prospective study asked a simple but important question: does structured training actually improve how reliably and accurately clinicians perform CA? The answer was yes.

Clinicians who received standardized training, including clear definitions for normal and abnormal swallow-respiratory patterns, direct instruction, and practical identification tasks, demonstrated meaningfully better inter-rater and intra-rater reliability, as well as improved validity compared to an instrumental standard. This finding reframes the debate: the inconsistency in older CA research wasn’t evidence that CA doesn’t work. It was evidence that CA requires proper training to work just like any other clinical skill.

Clinical implication: Before writing off CA or implementing it informally, invest in structured training. The evidence suggests it’s the single biggest factor in whether your CA findings are clinically useful.

Study 2: How Does Trained CA Hold Up Against FEES?

Jaghbeer, Sutt & Bergström (2023) Dysphagia, 38(1), 305–314

This study put trained CA directly to the test against the gold standard. Eight CA-trained SLPs rated 103 swallow-respiratory sequences from 23 patients with heterogeneous conditions, then those ratings were compared against Flexible Endoscopic Evaluation of Swallowing (FEES).

The results were strong. Trained CA demonstrated 85.4% sensitivity and 80.3% specificity for detecting safe swallows. More importantly, the predictive value for detecting UNSAFE swallows exceeded 90% meaning CA was highly reliable at catching the swallows that matter most clinically.

The study also found that viscosity influenced accuracy: thin liquids were harder to assess via CA alone. And importantly, clinicians who used both swallow sounds AND pre- and post-swallow respiratory sounds performed better than those focused only on the swallow sound itself.

Clinical implication: Trained CA is a strong triage and adjunct tool, particularly for flagging unsafe swallows that warrant instrumental referral. It is not a replacement for FEES or VFSS, but these numbers suggest it can meaningfully inform clinical decision-making. Make sure you’re assessing the full respiratory-swallow sequence, not just the swallow click.

Study 3: What Swallowing Sounds Like Across Age and Consistency

Asakura & Miwa (2025)  Sensors and Actuators A: Physical, 383, 116169

This cross-disciplinary study, bringing together vibroacoustic engineers and otolaryngology researchers, examined swallowing sounds recorded simultaneously at two sites: the neck (traditional CA placement) and the ear canal. The researchers analyzed how age and bolus characteristics affected the acoustic parameters of those sounds.

Key findings: the ear canal captured complementary acoustic information that wasn’t always detectable at the neck. Older adults produced distinct swallowing sound profiles compared to younger adults  with longer sound duration and altered frequency characteristics. Bolus viscosity also significantly shaped the acoustic signature, with thicker consistencies producing measurably different sound patterns.

While this research is more experimental than immediately clinical, it matters. It tells us that the acoustic profile of a swallow is shaped by both the physiology of the swallower and the properties of the bolus, reinforcing principles already central to dysphagia practice, now backed by objective acoustic data.

Clinical implication: Normal aging changes the sound of a swallow. Being aware of expected age-related acoustic differences prevents over-pathologizing older adults during CA. This research also points toward a future where multi-site wearable sensors provide richer swallowing data, a technology landscape SLPs should be prepared to navigate.

Study 4: A Standardized CA Protocol…. Finally

Bergström, Cichero, Jaghbeer & Sutt (2026)  BMC Research Notes, 19(1), 60

Perhaps the most practically significant paper of the four. For all the research demonstrating CA’s potential, one thing had been consistently missing: a published, standardized assessment protocol that clinicians could actually use. This paper fills that gap.

Drawing on qualitative analysis of 71 data texts from 12 CA-trained SLPs, describing the specific respiratory-swallow signs that influenced their clinical ratings, alongside updated literature, the research team published the evidence-based CA guide underlying their prior work.

The protocol identifies five critical components of CA assessment:

1. Pre-swallow respiratory sounds
2. The swallow sounds themselves
3. Number of swallows per bolus
4. Post-swallow exhalation
5. Post-swallow respiratory sounds

The paper also includes audio supplementary materials, actual recorded swallowing samples, that function as an introductory training resource. This is the paper to download, read, and integrate into your training toolkit.

Clinical implication: This is the clinical roadmap for implementing CA. If you’ve been doing CA informally or inconsistently, this protocol gives you a structured, evidence-based framework. The open-access publication and audio resources make it genuinely accessible for clinicians and educators alike.

The Big Picture

Taken together, these four studies tell a coherent story. Cervical auscultation is a valid, reliable, and clinically meaningful tool, when clinicians are properly trained, use standardized definitions, and assess the complete respiratory-swallow sequence rather than isolated sound events. The new CA assessment protocol provides a foundation for that consistency, and emerging acoustic technology is expanding what’s possible in the future.

For SLPs working in acute care, long-term care, or outpatient settings, the message is clear: CA deserves a place in your dysphagia toolkit. The evidence is there. The protocol is published. The training resources now exist. What happens next is up to us.

….The Original Blog Post

Have you ever seen an SLP with a stethoscope pressed to someone’s neck and wondered, “What in the world are they listening for?”

Well, welcome to the world of Cervical Auscultation (CA), the technique of using a stethoscope on the throat to listen to the swallow. Sounds intriguing, right? Let’s break it down.

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What Is Cervical Auscultation?

Cervical Auscultation involves placing a stethoscope (usually on the lateral neck over the trachea or just above the sternum) to listen for both swallowing and airway sounds.

SLPs may use CA to make judgments about:

• Whether a swallow was completed
• The timing or sequence of the swallow
• Possible signs of aspiration, penetration, or other impairments

You might hear terms like “click,” “clunk,” or “swoosh” associated with certain events. Some clinicians believe these sounds may reflect physiologic events like:

• Premature spillage
• Laryngeal vestibule closure
• Penetration or aspiration
• Epiglottic movement

Sounds impressive in theory… but what does the evidence say?

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The Evidence Behind Cervical Auscultation

Despite its use in clinical practice, CA is a hot topic in the world of dysphagia and not always for the best reasons.

1. Legarde et al. (2016): Systematic Review

In this review of 90 articles, only 6 met the inclusion criteria. The verdict?

The reliability of Cervical Auscultation is insufficient to support its use as a stand-alone tool in adult dysphagia evaluation.
There is no evidence to support its reliability or validity in pediatric populations.

So, in other words: it’s not quite the diagnostic hero we hoped it would be.

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2. Leslie et al. (2007): Synchronized CA + Endoscopy

This study paired cervical auscultation with endoscopic swallowing evaluations to see if sound matched swallow physiology.

Key findings:

• No consistent association between swallowing sounds and physiological events.
• For example, there was no correlation between:
  • A “pre-click” and onset of apnea
  • A “click” and return of the epiglottis to rest
  • A “click” and the end of swallow apnea

They did find that an absence of swallow sound doesn’t necessarily indicate impairment, but a repeated abnormal sound pattern may suggest dysfunction.

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3. Other Studies Say the Same

Across multiple studies:

• Intra- and inter-rater reliability is poor.
• Validity remains questionable.
• The clinical interpretation of sounds varies wildly from one clinician to the next.

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So… Should We Still Be Using It?

Here’s the thing: CA may have some value as a screening or adjunctive tool when paired with a comprehensive clinical swallow evaluation. It might help you track changes, especially if you know your patient well.

But let’s be clear, Cervical Auscultation should never replace instrumental evaluation. It’s not a substitute for MBSS or FEES.

As SLPs, we are not diagnosing based on neck sounds alone  and the research backs that up.

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What’s Your Take?

Are you Team CA? Think it’s helpful when used wisely? Or are you staunchly Team Instrumental Only?

I want to hear from you! 👇

Drop your thoughts in the comments and let’s talk about it.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation?   Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care?  You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes.   You can get your copy here.  

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References

Lagarde, M. L., Kamalski, D. M., & Van Den Engel-Hoek, L. E. N. I. E. (2016). The reliability and validity of cervical auscultation in the diagnosis of dysphagia: A systematic review. Clinical Rehabilitation, 30(2), 199–207.

Dudik, J. M., Coyle, J. L., & Sejdić, E. (2015). Dysphagia screening: Contributions of cervical auscultation signals and modern signal-processing techniques. IEEE Transactions on Human-Machine Systems, 45(4), 465–477.

Leslie, P., Drinnan, M. J., Zammit-Maempel, I., Coyle, J. L., Ford, G. A., & Wilson, J. A. (2007). Cervical auscultation synchronized with images from endoscopy swallow evaluations. Dysphagia, 22(4), 290–298.

Leslie, P., Drinnan, M. J., Finn, P., Ford, G. A., & Wilson, J. A. (2004). Reliability and validity of cervical auscultation: A controlled comparison using videofluoroscopy. Dysphagia, 19(4), 231–240.

Borr, C., Hielscher-Fastabend, M., & Lücking, A. (2007). Reliability and validity of cervical auscultation. Dysphagia, 22(3), 225–234.

Stroud, A. E., Lawrie, B. W., & Wiles, C. M. (2002). Inter- and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia. Clinical Rehabilitation, 16(6), 640–645.

New References:

Bergström, L., & Cichero, J. A. (2022). Dysphagia management: Does structured training improve the validity and reliability of cervical auscultation? International Journal of Speech-Language Pathology, 24(1), 77–87. https://doi.org/10.1080/17549507.2021.1953592

Jaghbeer, M., Sutt, A. L., & Bergström, L. (2023). Dysphagia management and cervical auscultation: Reliability and validity against FEES. Dysphagia, 38(1), 305–314. https://doi.org/10.1007/s00455-022-10468-8

Asakura, T., & Miwa, M. (2025). Effect of age and bolus characteristics on the acoustic parameters of ear and neck swallowing sounds. Sensors and Actuators A: Physical, 383, 116169. https://doi.org/10.1016/j.sna.2024.116169

Bergström, L., Cichero, J., Jaghbeer, M., & Sutt, A. L. (2026). Respiratory-swallow assessment protocol for adult dysphagia management. BMC Research Notes, 19(1), 60. https://doi.org/10.1186/s13104-025-07509-4 (Open Access)