Swallowing Test

The Swallowing Test (or swallowing assessment) is a clinical and sometimes instrumental procedure used to evaluate the function and safety of the swallowing mechanism (deglutition). It aims to identify dysphagia (difficulty swallowing), risk of aspiration, and any abnormality in the oral, pharyngeal, or esophageal phases of swallowing. While primarily the domain of speech-language pathologists (SLPs) or medical professionals, awareness of swallowing assessment is important for massage therapists working with clients experiencing neck, jaw, or throat complaints.

How the Test is Performed

Clinical/Bedside Swallowing Assessment

  • Verbal screening: The provider asks about swallowing difficulties and reviews medical history.

  • Observation: Inspect for signs of difficulty (coughing, throat clearing, voice changes, drooling, food residue in mouth).

  • Oral motor check: Evaluate function of teeth, lips, tongue, soft palate, cheeks, jaw, and throat.

  • Swallowing water/foods of different consistency: The client is given sips of water and various foods, while the provider observes for safe swallowing, timing, and whether choking or throat clearing occurs.

  • Instrumental evaluation: In some cases, a videofluoroscopic swallowing study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) may be used to provide a direct view of swallowing mechanics with imaging or endoscopy.

Typical Observations

  • Difficulty initiating a swallow, coughing/choking, “wet” voice after swallowing, prolonged chewing, or regurgitation.

  • Signs of aspiration (food/drink entering airway) or incomplete clearance.

Clinical Significance

  • Swallowing tests help diagnose dysphagia due to neurologic disease, head/neck cancer, muscle disorder, or post-surgical/post-radiation changes.

  • Early detection helps prevent complications such as choking, aspiration pneumonia, malnutrition, or dehydration.

  • Repeated assessment helps monitor progress in rehabilitation and recovery, providing valuable information for the care team.

Assessment

  • If a client reports difficulty swallowing, a history of stroke, neurological disease, radiation/surgery to the neck, or persistent throat discomfort, encourage appropriate referral to an SLP or provider for a swallowing assessment.

  • Be aware that neck, jaw, or upper chest dysfunction (muscle tension, scarring, myofascial restriction) may impact swallowing, as can cranial nerve dysfunction.

  • Document any client-reported swallowing difficulties, observations of cough/choke during sessions, or complaints of “sticking” sensation in the throat.

  • Massage therapists should not perform formal swallowing tests, but must know referral standards and red flags.

Treatment

  • Never perform intraoral, pharyngeal, or aggressive neck/throat work if dysphagia is known or suspected, unless specifically cleared by a provider.

  • Focus on gentle, supportive external manual therapy to adjacent myofascial tissues, posture, and relaxation if appropriate and safe.

  • Educate the client about the importance of thorough evaluation for unexplained swallowing difficulty.

Safety and Referral

  • Urgently refer if the client experiences sudden, recurrent, or severe difficulty swallowing, aspiration, or significant weight loss.

  • Always defer to an SLP or physician for assessment, management, and rehabilitation of dysphagia.