Why Are You Strangling the Patient?

Relax… You’re not witnessing a throat-related assault during a Clinical Swallow Evaluation (CSE). You may have walked in on an SLP with three fingers planted firmly on someone’s neck as they swallow. Don’t panic—we’re not strangling anyone.

What in the World Are They Doing?

It’s called laryngeal palpation.

Here’s the breakdown:

• Index finger: Hyoid bone
• Middle finger: Thyroid cartilage (aka Adam’s Apple)
• Ring finger: Cricoid cartilage

As the patient swallows, the SLP feels for hyolaryngeal movement to judge the speed and completeness of elevation. It’s a technique that’s been around for a while—but how reliable is it?

What in the Heck is Hyolaryngeal Excursion?

Let’s unpack this.

Hyolaryngeal excursion refers to the movement of the hyoid bone and larynx during a swallow. We’re talking:

• The “hyoid burst”
• Superior and anterior movement of the hyolaryngeal complex

To really see what’s going on? You need instrumental assessment. Frame-by-frame videofluoroscopy (MBSS) is the gold standard to quantify that movement.

What Does the Evidence Say?

A 2019 study by Brates and colleagues looked at 87 patients and compared bedside palpation with Modified Barium Swallow Studies (MBSS).

• In 16 patients, palpation felt normal—but MBSS revealed reduced hyolaryngeal excursion.
• In 17 others, it felt reduced—but MBSS showed it was actually normal.
• Only 29 patients were judged as having normal excursion both by palpation and MBSS.

Yikes. That’s quite a bit of disagreement.

The authors stated:

“Perceptual judgment is typically used in clinical settings to assess adequacy of hyolaryngeal excursion (HE), though the validity of perceptual techniques… has not been established.” (Brates et al., 2019)

Wait… Is It Even Useful?

It can be.

McCullough & Martino (2013) suggest palpation is useful for assessing:

• Timing
• Completeness
• Number of swallows

They add that poor elevation on palpation, especially when paired with coughing or a wet voice, may indicate problems with laryngeal elevation or closure.

Earlier, Bretan & Henry (1997) also found palpation to be a noninvasive way to assess dysphagia severity and monitor its progression. They noted that palpation could help differentiate normal from disordered swallows.

So Should We Be Palpating?

Sure—just don’t rely on it.

Use palpation as a tool in your clinical swallow assessment toolbox. It may give you helpful cues, especially if you’re tracking progress over time. But remember:

You can’t treat what you can’t see.

To truly evaluate hyolaryngeal excursion, you need to visualize the swallow. That means advocating for instrumental assessment like an MBSS.

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

Brates, D., Molfenter, S. M., & Thibeault, S. L. (2019). Assessing hyolaryngeal excursion: comparing quantitative methods to palpation at the bedside and visualization during videofluoroscopy. Dysphagia, 34(3), 298–307.

McCullough, G. H., & Martino, R. (2013). Clinical evaluation of patients with dysphagia: Importance of history taking and physical exam. In Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition (pp. 11–30). Springer.

Bretan, O., & Henry, M. A. (1997). Laryngeal mobility and dysphagia. Arquivos de Gastroenterologia, 34(3), 134–138.