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Cervical Auscultation

 

What is Cervical Auscultation?

Using Cervical Auscultation (CA) involves the use of a stethoscope, placed on the throat to “listen” to the sounds of the swallow.

Clinicians often use CA to assess swallow sounds and airway sounds.  Judgements are made on the normality of the swallow or the degree of impairment of swallowing.

Cervical Auscultation and Swallowing

In theory, “there are specific sounds related to events of the swallow.”   Some clinicians indicate that a swoosh, a click or a clunk can indicate physiologic events such as premature spillage, aspiration, laryngeal vestibule closure, penetration, etc.

Many clinicians swear by cervical auscultation, even replacing imaging with auscultation.

There is also an argument that there is no evidence on what causes swallowing sounds or whether these sounds correspond to physiological swallowing events.

The evidence tells us that CA may not be all it’s cracked up to be.

What does the Evidence Tell Us? 

A systematic review of cervical auscultation by Legarde et al 2016, reviewed 90 articles.  Using inclusion and exclusion criteria 6 articles were included in the review as the other articles did not meet criteria to be included.   (Full article can be accessed at the link below.)

The review found that the reliability of Cervical Auscultation is insufficient to be used as a stand-alone tool in dysphagia in adults.  There is no evidence of reliability or validity in Cervical Auscultation in the pediatric population.   Cervical Auscultation should not be used as a stand-alone tool in the diagnosis of dysphagia.

When CA was synchronized with endoscopy (Leslie, et al, 2007), they found that there was a wide-spread degree of the timing of swallowing sounds and physiologic events.  No individual sounds was consistently associated with any physiologic event.  There was no link between:

  • Pre-Click and onset of apnea
  • Pre-Click and the start of epiglottic excursion
  • Click and the epiglottis returning to rest
  • Click and the end of swallow apnea

They also found that the absence of a swallowing sound was not a sign of pathologic swallowing but that a repeated abnormal pattern may indicate an impairment.

In conclusion there is no robust evidence to support CA in dysphagia and judgement between SLP interpretation of sounds or absence of sound was poor.

Do You have an Opinion?

What do you think?  Are you for or against CA?  Maybe you have no opinion either way.  Let me know in the comments!

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 rehabilitation30(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 systems45(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. Dysphagia22(4), 290-298.

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. Dysphagia22(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. Dysphagia19(4), 231-240.

Borr, C., Hielscher-Fastabend, M., & Lücking, A. (2007). Reliability and validity of cervical auscultation. Dysphagia22(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 rehabilitation16(6), 640-645.

3 thoughts on “Cervical Auscultation

  1. I had read years ago that the only validity to AC was to hear the UES open. Was that discussed in any of the articles? thanks, Deborah

    1. According to research we are unable to detect any specific sounds related to swallowing.

  2. Hi! Just adding to the CA discussion, particularly recent articles that are more methodologically robust than several of the articles mentioned above.
    (1) https://www.tandfonline.com/doi/full/10.1080/17549507.2021.1953592
    (2) https://pubmed.ncbi.nlm.nih.gov/27402004/

    Also to add:
    Yes, research has identified swallow sounds and swallow-respiratory coordination sounds, see summary in (a) Cichero, J., & Murdoch, B. (2006). Dysphagia: Foundation, theory and practice; and
    (b) https://www.tandfonline.com/doi/abs/10.3109/17549507.2013.855259

    Regarding the points above and the Leslie 2007 study with respect to:
    Pre-Click and onset of apnea
    Pre-Click and the start of epiglottic excursion
    Click and the epiglottis returning to rest
    Click and the end of swallow apnea.

    This study used a modified stethoscope with a microphone inserted into the bifurcation with tube length and recording quality modified iteratively until the consensus of two medical physicists and an experienced clinician agreed that the sound was as close as possible to the sound heard via the stethoscope. (=methodological issues).
    Also, clicks are not heard via stethoscope, yes, microphone recordings, but NOT stethoscopes.

    International clinical researchers agree that CA should not be used as a stand-alone tool. It is an important adjunct to the clinical swallow exam (CSE). Likewise the CSE will not ever replace instrumental assessment, however the importance of the CSE/ongoing review for holistic, person-centered dysphagia management is underscored in the first article listed above (Bergström & Cichero, 2021). I cannot agree more with the words of Dr Ianessa Humbert,

    CSE, MBS, FEES: Better together, Complement each other, Serve different purposes!

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