What is the primary purpose of assessing the cough reflex in a dysphagia evaluation?

• A. To evaluate vocal quality during speech
• B. To assess airway-protective reflex integrity; impaired cough reflex increases aspiration risk and influences safety planning and need for instrumental assessment
• C. To measure swallowing speed
• D. To determine laryngeal sensation

Answer: (B)

The cough reflex assessment in a dysphagia evaluation centers on airway protection. It gauges whether the cough reflex is intact and able to expel material that enters the larynx or airway during or after swallowing. When this reflex is impaired, the risk of aspiration increases, which informs safety planning (diet texture, supervision, postures) and whether instrumental assessment is needed to observe airway invasion and swallow safety. This measure is distinct from vocal quality, swallowing speed, or laryngeal sensation, which reflect different aspects of—respectively—phonation, transit times, and sensory function, not the protective airway response.