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

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.