# Respiratory-swallow assessment protocol for adult dysphagia management

## TL;DR

This paper introduces a standardized protocol for assessing swallowing and breathing patterns in adults with swallowing difficulties.

## Contribution

The paper publishes a new evidence-based cervical auscultation assessment guide and training resources for dysphagia management.

## Key findings

- Five critical aspects of cervical auscultation assessment were identified based on qualitative analysis of expert ratings.
- Supplementary audio samples and reference materials were developed to support training and clinical use.
- The protocol was validated against Flexible Endoscopic Evaluation of Swallowing (FEES).

## Abstract

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.

Extending previous work, the objective is to publish the evidence-based assessment guide used in our earlier research.

Additional qualitative data and recent literature was integrated to update the previously unpublished CA guide.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).

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.

The evidence-based CA guide and training resources are expected to establish clinically important resources for future clinical use and research evaluation.

The online version contains supplementary material available at 10.1186/s13104-025-07509-4.