Ultrasound in the evaluation and management of pharyngeal dysphagia: A narrative review

Ultrasonography has gained increasing recognition as a noninvasive tool for evaluating swallowing physiology, providing real-time visualization without radiation exposure. This narrative review synthesizes current evidence on three major domains of sonographic swallowing assessment in pharyngeal phase: hyolaryngeal movement, pharyngeal residue, and penetration-aspiration. Ultrasonography reliably measures hyoid displacement, velocity, and hyoid-thyroid approximation during swallowing, demonstrating strong inter- and intrarater reliability and close agreement with videofluoroscopic reference standards. Pharyngeal residues in the valleculae and pyriform sinuses are visualized as persistent echogenic signals. Sonographic grading of residue severity has shown clinical value in supporting diet adjustments and compensatory swallowing strategies. Penetration-aspiration can be identified sonographically by observing bolus passage relative to the vocal folds and tracheal lumen, with several studies reporting sensitivity and specificity above 80%. The current body of evidence indicates that ultrasonography is a feasible and reproducible tool for dysphagia assessment, with potential applications in bedside assessment, serial follow-up, and swallowing training. Standardization of imaging protocols and validation across diverse patient populations remain important directions for future research.