Dysphagia Management and Cervical Auscultation: Reliability and Validity Against FEES.
Mariam Jaghbeer, Anna-Liisa Sutt, Liza Bergström
PMID 35838785WHAT IT FOUND
Trained clinicians listening to swallow sounds correctly identified unsafe swallows with high accuracy, especially for thin liquids.
However, they frequently flagged safe patients as dysphagic. Use this as an adjunct to clinical exams, not a standalone diagnosis.
Key findings
01Cervical auscultation showed high sensitivity (85.4%) and specificity (80.3%) for detecting if a swallow was safe compared to FEES, with the highest accuracy for thin liquids.
02While accurate for safety, cervical auscultation had low specificity (22.9%) for diagnosing dysphagia, meaning it frequently identified patients as dysphagic when they were not.
03Inter-rater reliability for determining swallow safety was only moderate (Kappa 0.58), indicating that different clinicians listening to the same sounds often disagreed.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study used a small sample of 23 patients. Raters were blinded to all clinical information (history, diagnosis), which is not how CA is used in practice; this may have artificially lowered their accuracy for diagnosing dysphagia. Raters listened to single swallows, whereas FEES assessors reviewed multiple boluses and consistencies. Results only apply to clinicians who have received specific CA training and use a structured protocol. Inter-rater reliability was only moderate, meaning two trained therapists listening to the same recording might disagree.
Declared interests
Funding was provided by Stiftelserna Wilhelm och Martina Lundgrens, NU-Hospital Group Research and Development, Anders & Carl Erikssons Foundation for Medical Research, and the University of Gothenburg. No conflicts of interest were declared.
The easy way to misread this
Do not interpret the high accuracy for detecting unsafe swallows as evidence that cervical auscultation can diagnose dysphagia. The test had very low specificity for dysphagia diagnosis (22.9%), meaning it incorrectly flagged most non-dysphagic patients as having the condition.