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Cervical Auscultations
Cervical auscultation is an assessment of the sounds of swallowing and its related respiration (Cichero et. al, 2006). The exact nature of the sounds is under scrutiny and therefore literature suggests that it should not be used if the sounds themselves are not understood (Cichero & Murdoch, 1998). This tool should not be used in isolation, but like pulse oximetry, is a useful adjunct tool for the clinician; it can confirm suspicions of dysphagia and may be used to flag patients who should be referred for an instrumental examination.
This particular tool may be useful for the COPD population as the tool aids in the identification of in- coordination in the swallow-respiratory cycle and allows the clinician to hear the duration and control of the apnoeic period during swallow. The clinician must however be comfortable with the sounds of a normal swallow.
Helpful hints for the clinician:

· Place the bell of the stethoscope at the lateral border of the trachea , immediately inferior to the cricoids cartilage or at the centre of the cricoid cartilage (Takahashi, Groher, Michi, 1994)
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Note the location of the cricoid cartlidge

· Listen for three distinct sounds. Cichero and Murdoch (1998) believe that:
o the first sound is the closure of the laryngeal valve which includes the adduction of the arytenoids and the closure of the epiglottis whilst the base of tongue delivers the bolus to the posterior pharyngeal wall.
o The second sound represents the opening of the cricophayngeaus with the clearing of the pharynx.
o The third sound is the “glottal release” or the unvalving of the respiratory system. The sound represents the short puff of air being released after the apnoeic period which occurs during the swallow.
· Listen for wheezing, altered respiration, stridor or grunting

· Pay attention to oro-phayngeal transit time. Healthy individuals experience an oral transit time of 1.6 -1.9 seconds whereas those experiencing dysphagia and/or aspiration will have longer oral-pharyngeal transit time (Cichero et. al, 2006).
· Those experiencing dysphagia pr aspiration will have softer swallowing sounds than the healthy population

References

Cichero, J. (2006). Clinical Assessment, Cervical Ausculation and Pulse Oximetry. In J.A.Y. Cichero & B.E. Murdoch (Eds). Dysphagia: Foundation, Theory and Practice. Chichester: Wiley.

Cichero, J. A. Y., & Murdoch, B. E. (1998). The Physiologic Cause of Swallowing Sounds: Answers from Heart Sounds and Vocal Tract Acoustics. Dysphagia, 13(1), 39-52.