On this episode, Theresa sits down with Julie Cichero BA, BSpThy(Hons), PhD, a clinician, researcher, and one of the foremost experts in dysphagia with over 30 years of experience, to talk about something that has had a complicated reputation in our field: cervical auscultation. If you trained in the 90s, you probably learned it. If you trained more recently, you might have been told to ignore it. The truth, as it turns out, is a lot more nuanced than either camp wants to admit.
Dr. Cichero breaks down what the evidence actually shows, including sensitivities of around 91% and negative predictive values that should genuinely change how we think about using this tool at the bedside. She explains why it’s not really about the “clink and clunk” sounds at all, and why the breathing pattern after the swallow is where the real clinical information lives. She also shares what proper training looks like, how cervical auscultation fits alongside instrumental assessment (not instead of it), and two clinical stories involving pharyngeal pouches that are honestly pretty wild.
If you’ve ever had to triage 20 patients for two fluoro spots, worked somewhere with limited instrumental access, or just wanted to feel more confident at the bedside, this one is for you.
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Additional Links:
https://eatdrinkswallowsafe.com.au/
https://about.uq.edu.au/experts/3477
Julie Cichero, PhD is a clinician (SLP), researcher and research professional with more than 30 years’ experience in dysphagia. Julie is an Honorary Associate Professor with the School of Pharmacy and Pharmaceutical Sciences, University of Queensland and Director of Eat Drink Swallow Safe. She has made significant contributions to the evidence base for standardised terminology for texture modified food and thick liquids, diagnostic use of swallow-respiratory sounds, medication swallowing issues and characterisation of thick fluids. Julie holds workshops on dysphagia throughout Australia and is an invited international speaker across Asia, Europe, Canada and the USA. Recognised nationally and internationally, Julie is a consultant to professional societies, government organisations, academia, Coroners, boards and healthcare organisations. As Co-Founder of IDDSI (Global), Julie co-led development of the IDDSI Framework, an initiative to reduce choking risk in vulnerable populations. The IDDSI Framework is used in more than 50 countries around the world. Julie has served as a clinical expert to the Aged Care Standards Expert Working Group for the Australian Commission on Safety and Quality in Health Care and as a consultant for the Australian Stroke Foundation, Speech Pathology Australia, Dietitians Australia and the Society of Hospital Pharmacists of Australia. Julie has authored 80 journal articles and co-authored four books. She is based in Brisbane, Australia.
Bergstrom L & Cichero JAY (2022) Dysphagia management: Does structured training improve the validity and reliability of cervical auscultation? International Journal of Speech-Language Pathology, 24 (1):77-87. DOI: 10.1080/17549507.2021.1953592
Bergstrom L, Cichero J, Jaghbeer M, Sutt A-L (2025) Respiratory-swallow assessment protocol for adult dysphagia management. BMC Research Notes 19(1): 60. doi: 10.1186/s13104-025-07509-4.
