Medical Speech Pathology

30/04/2026

AI in FEES is moving beyond detection, and into something much more clinically meaningful!
This paper (Araújo et al, 2926) presents a framework that combines anatomical tracking, image enhancement, and pixel-based analysis to objectively identify airway invasion and classify pharyngeal residue.

What’s most interesting isn’t just the accuracy, it’s the shift toward standardising visuoperceptual analysis.

Because we all know:
Two clinicians can look at the same FEES and interpret it differently.

This kind of technology doesn’t replace clinical reasoning, but it has the potential to support it by making our observations more consistent, reproducible, and transparent.

Particularly relevant for:
• clinician training
• consistency across services
• supporting complex decision-making

Still early, but definitely a space worth watching!

REFERENCE (APA)
Araújo, L., Rangel, E., Cotrina-Atencio, A., Santos, V. G., Reis, A. M. C. S., Magalhães, H., Ferreira, L., Dantas, A. F. O. A., & Espírito-Santo, C. C. (2026). Artificial intelligence and image processing framework for automated airway invasion detection and residue classification from swallowing endoscopy. Scientific Reports. https://doi.org/10.1038/s41598-026-44495-4

16/04/2026

This paper isn’t just reminding us to look beyond aspiration,
it’s questioning whether we’re drawing the right conclusions at all from dysphagia research.

In this large trial of HPV-related oropharyngeal cancer, long-term swallowing outcomes were often interpreted as showing “no meaningful difference” between treatment approaches.

But when you look closer, two critical issues emerge:

👉 The dominant impairment wasn’t airway safety,it was inefficient swallowing (residue, incomplete clearance, repeated swallows)
👉 And a substantial number of participants were lost to follow-up over time, likely biasing results toward those with better function

So the real question becomes:
Are we underestimating dysphagia severity and overestimating how “good” outcomes actually are?

Because if:
• we prioritise aspiration as the primary endpoint
• AND the patients with the worst dysphagia are less likely to be captured in
long-term data

👉 then “no difference” may not mean “no impact”
👉 it may mean we’re not measuring or retaining the right things

For clinicians, this isn’t just making sure efficiency is part of your assessment.
It’s about:
• critically appraising outcome data
• recognising survivorship and follow-up bias
• reconsidering what we define as a “good” swallow

Because in this population,
the problem may not be what’s going down the airway, but what’s left behind.

References
Hutcheson, K. A., Flamand, Y., Manduchi, B., et al. (2025).
Functional impact of transoral surgery and risk-based adjuvant therapy in human papillomavirus–associated oropharyngeal cancer: Swallowing outcomes from ECOG-ACRIN E3311. JCO Oncology Advances. https://doi.org/10.1200/OA-25-00092
Rocco, J. W., & Plowman, E. K. (2025).
Reply to: Building on ECOG-ACRIN E3311 to strengthen interpretation of swallowing outcomes. JCO Oncology Advances.

10/04/2026

This paper looks at something we don’t talk about enough, whether dysphagia therapy is actually effective in dementia. The findings are… mixed.

There is some evidence that intervention can improve swallowing safety, intake, and aspiration risk. But overall, the quality of evidence is low, and results are inconsistent. That doesn’t mean therapy isn’t worthwhile.

It means we need to be clear about what we’re trying to achieve.

In dementia, dysphagia management often sits at the intersection of:
• rehabilitation
• compensation
• and quality of life

Rather than aiming for “normal swallowing,” the focus may shift toward:
• maintaining function
• supporting safe intake
• reducing distress
• and working closely with caregivers

A good reminder that this is not a population where a one-size-fits-all approach works. How are you approaching dysphagia management in dementia?

08/04/2026

A new paper by Messina (2026) explores the role of the sphenoid bone in linking the temporomandibular–tongue–hyoid system with the cervical spine.

The key idea is that this is not a set of isolated structures, but a continuous biomechanical chain. The sphenoid sits centrally at the cranial base, meaning forces and positioning at the jaw, tongue and hyoid can influence the cervical spine and overall posture, and importantly, the reverse is also true.

Changes in cervical alignment can influence tongue position, suprahyoid function, and both voice and swallowing mechanics.

Clinically, this helps explain presentations where:
• symptoms don’t match local findings
• voice or swallowing change with posture
• tension patterns extend across the jaw and neck

These patterns don’t always make sense when viewed in isolation - because they’re being driven by the system, not just the structure.

Reference:
Messina, G. (2026). The role of the sphenoid bone in the connection between the temporal-mandible-tongue-hyoid system and the cervical spine. European Journal of Translational Myology. https://doi.org/10.4081/ejtm.2026.14947

24/03/2026

Not all “dry mouth” is the same… and not all of it is being measured

The Challacombe Scale is a simple, evidence-based tool used to objectively assess clinical oral dryness - something that’s often observed, but not consistently quantified in practice.

In Speech Pathology, this matters more than we think.

Oral dryness can impact:
• bolus formation + oral clearance
• saliva management
• voice comfort + effort
• overall oral health over time

And importantly…
👉 what we see doesn’t always match what patients feel

That’s why combining objective measures + patient-reported symptoms is key.

The Challacombe Scale gives us:
✔ a structured way to assess oral dryness
✔ a severity rating we can track over time
✔ stronger clinical reasoning + documentation

✨ We’ve put together a comprehensive clinical handout on how to use the Challacombe Scale in practice (including scoring, interpretation, and integration with other measures). Comment "DRY" and we'll send it through.

23/03/2026

Pulse oximetry doesn’t detect aspiration - but it still has a role.

This is something that’s been well established in the research for a long time, yet its role as a supportive (not diagnostic) tool isn’t always recognised.

SpO₂ changes during swallowing are:
• inconsistent
• not specific to aspiration
• often absent in silent aspiration

So it can’t be used to rule aspiration in or out.
But that doesn’t make it useless.

When used well, pulse oximetry can provide insight into:
• respiratory load during eating or talking
• fatigue across a meal or task
• breath–swallow coordination
• overall physiological response

The key shift is this:
👉 from diagnostic tool → clinical context tool

Looking at patterns over time, rather than single readings, is where it becomes meaningful.
Like most things in dysphagia and voice, it’s not about one data point - it’s about how everything fits together.

Keep your eye out for the new resources section of our website where you can find clinical guides and resources, including our clinical protocol for the use of pulse oximetry in Speech Pathology

www.medicalspeechpathology.com.au

23/03/2026

23/03/2026

For some people, speaking places unexpected demand on breathing, the nervous system, and voice coordination - especially in conditions like POTS, FND, or voice disorders.

What looks like a simple task can actually push the system past its threshold.

It’s rarely caused by just one thing. More often, it reflects a combination of:
• breathing pattern changes
• inefficient voice use
• autonomic load
• fatigue

Speaking can quietly increase both physical and cognitive demand — and for some people, that’s enough to trigger symptoms.

Importantly, this is a pattern we can assess and actively work on.

17/03/2026

Today is Swallowing Awareness Day.

Dysphagia (difficulty swallowing) can affect safety, nutrition, hydration, respiratory health, confidence, and quality of life.

But one of the most important messages to share is this:
A diagnosis of dysphagia does not automatically mean that support, rehabilitation, and meaningful improvements are out of reach.

While management always depends on the underlying cause, presentation, goals, and overall medical context, Speech Pathology intervention can be broad, active, and highly individualised.

This may include:

• targeted swallowing rehabilitation exercises
• expiratory muscle strength training (EMST)
• sensory stimulation and sensory retraining approaches
• cough retraining and airway protection
• sEMG biofeedback to support timing, coordination, and motor learning
• neuromuscular electrical stimulation (NMES)
• compensatory strategies to improve swallowing safety and efficiency
• texture modification
• optimisation of posture, positioning, and breathing–swallow coordination
• oral sensorimotor treatment and bolus control
• saliva management strategies
• education for the person, family, and support team

For some people, the goal is rehabilitation.
For others, it is compensation, symptom reduction, safer eating and drinking, or preserving comfort and dignity.

But the key message remains the same:

Dysphagia management is not just about restriction. It can also be about rehabilitation, adaptation, and finding ways to help people live well.

At Medical Speech Pathology, we believe swallowing care should be thoughtful, individualised, and grounded in both physiology and quality of life.

16/03/2026

Tomorrow March 18th is Swallowing Awareness Day.

Swallowing is something most people never think about.
Until it becomes difficult.

Eating and drinking are such ordinary parts of daily life that we rarely pause to consider the extraordinary coordination behind them. The movement of food from the mouth to the stomach requires the precise interaction of muscles, nerves, breathing, sensation, and timing across the mouth, throat and oesophagus.

When this system changes, the impact can be significant.

Swallowing difficulties (known as dysphagia) can affect safety, nutrition, hydration, energy levels, and respiratory health. But just as importantly, they can affect confidence, independence, and the simple pleasure of sharing meals with others.

Swallowing Awareness Day is an opportunity to recognise how common these challenges are, and the role Speech Pathologists play in assessing and supporting swallowing function.

At Medical Speech Pathology, we work with adults experiencing complex swallowing difficulties across neurological and medical conditions, with a focus on understanding the underlying causes and helping people maintain comfort, safety and quality of life around eating and drinking. We use clinical and instrumental assessment including Videofluoroscopic Evaluation of Swallowing (VFSS) and Flexible Endoscopic Evaluation of Swallowing (FEES) to guide our evidence-based treatment plans to help people live well with dysphagia.

11/03/2026

It’s a privilege to share this milestone in Martin’s rehabilitation journey.

Martin sustained a severe traumatic brain injury in March 2023. When he commenced with our service 18 months ago, he remained PEG dependent and nil by mouth/NPO almost two years post-injury.

Over the past 18 months we have worked closely with Martin and his family through a structured dysphagia rehabilitation program, guided by the BOLUS framework and a shared decision-making approach to dysphagia management.

This process involved carefully balancing aspiration risk alongside quality of life, autonomy, and Martin’s own goals. Rehabilitation targeted modifiable risk factors and underlying physiological impairments through intensive swallow therapy and progressive reintroduction of oral intake.

2 weeks ago, Martin’s PEG was removed.

Importantly, his imaging findings have not dramatically changed - aspiration is still observed on instrumental assessment. However, dysphagia management is rarely determined by a single measure. Improvements in swallow efficiency, cough strength, mastication, and overall functional swallowing allowed Martin to safely transition back to oral intake - all without a single chest infection.

Martin has approached this process with incredible determination, humour, and persistence. His commitment to rehabilitation - and the support of his family - have been central to this outcome.

Cases like this are an important reminder that recovery potential cannot always be predicted by time post-injury alone. With the right clinical framework, shared decision-making, and targeted rehabilitation, meaningful functional change can still occur.

We couldn’t be happier for Martin as he continues enjoying food again and reclaiming this important part of daily life.

**All photos and details shared with Martin’s permission**