Cervical Auscultation

Purpose

• Evaluating the pharyngeal swallow non invasively.
• A stethoscope is used to listen to the breathing/ swallow sounds heard at the laryngopharynx level.
• Can be done on all patients including COPD/ Tracheostomy patients.

Procedure (Stroud, 1999)

1. Tap the Stethoscope to test. Use the concave bell to hear breathing sounds and the flat diaphragm to hear swallow sounds. 
2. Place on the lateral junction between the cricoid cartilage and the trachea. Listen for normal breathing sounds to get a baseline (hollow/tubular sounding) and listen to a dry saliva swallow to get a swallow baseline.
3. Give the patient the trial fluid/solid. Listen to the swallow-breath pattern. Inhalation, Exhalation, Apnea, 2 swallow clicks (VF closure), Expiratory burst. Listen to both sides to check for asymmetrical pooling. A disordered swallow may sound less clear/ bubbly if aspiration occurred. 

Normal Swallow (Zenner et al 1995)

• Swallow occurs promptly after oral transit.
• Apneic period occurs during the swallow.
• Exhalation at the end.

Disordered Swallow

Listen for:

• Premature spillage of the bolus before the pharyngeal swallow is triggered.
• 2 clicks of VF closing - are they absent?
• Exhalation - absent?
• A clearing swallow may be heard,
• Pooling/penetration - e.g. gurgling/ wet breath sounds.

Impaired pharyngeal Swallow

• Tracheal Aspiration = suspected when flushing fluid sound is heard prior to the pharyngeal swallow, or when wet breath sounds/stridor/coughing/throat clearing/voice distortion is heard.
• Dysphagia - different respiratory pattern, more variable, swallow apnea is less consistent, inspiration at the end of the swallow.