Tell Me Your Secrets (Hx and Interview)
This initial step involves reviewing medical records, interviewing patient/caregiver, and gathering information about onset, diet, changes, and symptoms.
What is the clinical interview / history taking?
A quick look at the patient when they arrive — assessing head/neck posture, facial symmetry, dentition status, signs of weakness or atrophy.
What is general observation of head, neck, oral structures?
This simple trial—having the patient swallow water while you observe cough, voice, or throat clearing—helps detect possible airway compromise.
What is Yale Water Swallow Sceening?
Observing speech, voice quality, and phonation may give clues about glottal valving and airway protection.
What is phonation / voice assessment?
This exam uses X‑rays and barium to visually assess oral, pharyngeal, and upper esophageal swallowing phases.
What is a Videofluoroscopic Swallowing Study (VFSS / MBSS)?
Asking these about what makes swallowing worse or better — consistency, posture, time of day, triggers — helps form a clinical hypothesis.
What are questions about bolus consistency and swallow circumstances?
This exam assesses strength, movement, range — e.g., tongue, lips, jaw — to infer potential oral phase problems.
What is oral mechanism exam?
Manual palpation of the hyoid and thyroid during a trial swallow can reveal delays or reduced elevation. This physiologic deficit is being assessed.
What is impaired hyolaryngeal elevation / delayed swallow initiation?
This probe monitors oxygen saturation during swallow trials to watch for desaturation possibly due to aspiration.
What is pulse oximetry probe?
This endoscopic exam allows direct visualization of pharyngeal and laryngeal structures during swallowing — without X‑rays.
What is FEES (Fiberoptic Endoscopic Evaluation of Swallowing)?
This history detail includes past neurological events, head/neck surgeries or radiation, intubation — anything that may raise risk for dysphagia.
What is past medical/surgical and head‑neck history review?
This probe asks the patient to protrude, lateralize, and elevate the tongue against resistance or to move it rapidly. It evaluates tongue strength, range of motion, and coordination, which are critical for bolus formation and propulsion.
What is the tongue range-of-motion and strength assessment, assessing deficits in tongue mobility, strength, or coordination?
Using this simple device during trial swallows may help detect drops in oxygenation that could suggest aspiration or respiratory compromise.
What is pulse oximetry during swallow trials?
If a patient has poor respiratory support or compromised breathing, this factor must be evaluated because it affects swallow–respiration coordination.
What is respiratory health assessment
This is the main advantage of instrumental exams over clinical probes: direct observation of events such as silent aspiration or pharyngeal residue.
What is defining physiologic mechanism and verifying silent aspiration or residue?
If patient is not eating fully orally, this question addresses how they receive nutrition (tube, alternate feeding) and hydration/nutrition adequacy.
What is questions about current oral intake and nutrition status?
Noticing a wet or gurgly voice, drooling, droop, or abnormal posture during rest may all suggest issues relevant to swallowing safety or secretion management.
What is observation of voice quality, drooling, posture, symmetry?
This probe asks the patient to rapidly repeat syllables like /pa/-/ta/-/ka/ as fast and clearly as possible. It assesses oral-motor coordination, speed, and precision, and can reveal deficits in tongue or lip movement relevant to bolus control.
What is the Diadochokinetic (DDK) rate test, assessing impaired oral-motor coordination / reduced articulatory speed?
A wet, gurgly, or breathy voice after swallowing or during trials may indicate possible penetration/aspiration or secretion pooling.
What is post‑swallow voice quality check?
Even though clinical exams are useful, this is a major limitation — they cannot reliably show pharyngeal events or silent aspiration.
What is limitation of clinical exam: lack of visualization of pharyngeal/esophageal phases?
This part of the interview explores the patient’s previous swallowing treatments, therapy history, and responses to interventions to guide current clinical decision-making.
What is past treatment and therapy history review?
This part of the oral mech exam has the clinician assess labial closure, lip rounding, and resistance to movement. Weakness here can lead to poor oral containment, anterior spillage, or reduced pressure generation during swallowing.
What is the labial strength and range-of-motion assessment, assessing deficits in lip closure and oral containment?
This probe compares maximum sustained durations of /s/ versus /z/ sounds to evaluate respiratory support and phonatory efficiency. Reduced ratios may indicate deficits affecting sustained voicing and subglottic pressure during swallowing.
What is the S/Z ratio test, assessing impaired respiratory-phonatory support for airway protection?
This clinical probe measures maximum phonation time (MPT) or uses the S/Z ratio to assess respiratory-phonatory coordination, subglottic pressure, and laryngeal efficiency. Reduced performance may indicate impaired respiratory support or glottal closure, which can compromise airway protection during swallowing.
What is the Maximum Phonation Time (MPT) / S/Z ratio test, assessing deficits in respiratory-phonatory support and glottal closure relevant to safe swallowing?
Choosing between clinical vs. instrumental exam depends on risk, patient stability, resources, and suspected pathology — making this concept essential.
What is clinical judgment / risk–benefit decision for instrumental exam?