Swallowing Program
A swallowing disorder, or dysphagia, is difficulty moving food or liquid safely from the mouth to the stomach. It can make eating slow, unpleasant, or unsafe, and when material enters the airway it becomes a risk to the lungs.
Your pathway
Instrumented assessment
FEES and, where needed, videofluoroscopy.
Diagnosis
Where the swallow fails, and how unsafe it is.
Treatment
Therapy, diet strategies, or a procedure for a specific cause.
Review
Progress measured, and the plan adjusted.
Our approach
Swallowing sits at the same crossroads as voice: the larynx protects the airway during every swallow. That shared anatomy is why a voice and swallowing institute treats the two together, and why we assess swallowing by looking directly at what happens during it rather than by inference. Our approach is to diagnose precisely first, with instrumented evaluation, and then to match treatment to the specific breakdown, whether that is rehabilitation with a therapist, a procedure, or a change in how a patient eats.
We work alongside the neurologists, oncologists, and other physicians who often refer these patients, and we are clear about what can be improved and what can only be managed.
Who this program is for
Dysphagia is common after stroke, in Parkinson's disease, ALS, and other neurological conditions, after head and neck cancer treatment, and with age. It also occurs after vocal fold paralysis, when airway protection is weakened. Patients and referring physicians come with coughing or choking during meals, food sticking, recurrent chest infections, or weight loss from eating difficulty.
Swallowing evaluation
Two instrumented tests anchor the assessment. Flexible endoscopic evaluation of swallowing (FEES) passes a thin endoscope through the nose to watch the swallow directly while the patient eats and drinks. Videofluoroscopy uses moving X-ray to see the whole swallow, including phases the endoscope cannot show. The two are complementary, and the choice depends on the question. The result identifies where the swallow is failing and how unsafe it is.
Cricopharyngeal dysfunction
The cricopharyngeus is the muscle that forms the upper oesophageal sphincter. When it fails to relax or open fully during a swallow, food and tablets stick at the level of the throat. Depending on the cause, treatment ranges from therapy to botulinum toxin injection, dilation, or division of the muscle (cricopharyngeal myotomy). The same muscle is at the centre of R-CPD, where it fails to relax in the other direction, for air.
Cricopharyngeal bar
A cricopharyngeal bar is a visible prominence of this muscle on a swallow study. It is common and does not always explain the symptoms, so we interpret the finding alongside the history and the instrumented assessment rather than treating an image on its own.
Zenker's diverticulum
A Zenker's diverticulum is a pouch that forms above a tight cricopharyngeus muscle. It can cause food sticking, regurgitation of undigested food, bad breath, and cough, particularly when lying down. When symptoms warrant treatment, the muscle and the wall between the pouch and the oesophagus are divided, most often endoscopically through the mouth; an open approach is used in selected cases.
Swallowing therapy
Many patients improve with swallowing therapy, targeted exercises, and adjustments to food texture and eating strategy, guided by what the assessment showed. Some causes are progressive, and here the goal shifts to keeping eating as safe and comfortable as possible for as long as possible. We are honest about which situation a patient is in, and we set the plan and the expectations accordingly.
Evidence and experience
Instrumented swallowing assessment is standard practice in dysphagia care, and swallowing function is one of the institute's published research areas, including work in neurological and post-laryngectomy populations and on the diagnostic accuracy of swallowing screening in vocal fold paralysis.
Medically reviewed by
Associate Professor Necati Enver, MD
Laryngologist · Founder and Director, Istanbul Voice Center · Reviewed September 2026
General information only. It does not replace an individual assessment. Medical disclaimer
Frequently asked questions
What is dysphagia?
Dysphagia is difficulty moving food or liquid safely from the mouth to the stomach. It can make eating slow or unpleasant, and when material enters the airway it becomes a risk to the lungs.
What is a FEES test?
Flexible endoscopic evaluation of swallowing, or FEES, passes a thin endoscope through the nose to watch the swallow directly while the patient eats and drinks. It shows where the swallow is failing and how unsafe it is.
What is the difference between FEES and videofluoroscopy?
FEES gives a direct endoscopic view of the swallow, while videofluoroscopy uses moving X-ray to show the whole swallow, including phases the endoscope cannot see. They are complementary, and the choice depends on the clinical question.
What is a Zenker's diverticulum?
A pouch that forms in the throat above a tight cricopharyngeus muscle. It can cause food sticking, regurgitation of undigested food, bad breath and cough. When symptoms warrant it, treatment divides the muscle, most often endoscopically through the mouth.
Can swallowing problems be cured?
Many improve substantially with therapy, targeted exercises, and adjustments to food texture and eating strategy. Some causes are progressive, and there the goal is to keep eating as safe and comfortable as possible for as long as possible.
Eating should not be a risk
If swallowing has become difficult or unsafe, an instrumented assessment is the first step.