The complexity of swallowing has been long appreciated and was described before the development of a sophisticated modality for direct viewing of the swallowing process. This article reviews the history of the discovery of the physiologic principles of swallowing and the development of the evaluation and management of dysphagia. Appropriate diagnostic and treatment tools are described for various environments of care, including acute-care hospitals, subacute facilities, rehabilitation hospitals, ambulatory clinics, and home care. Differences in the delivery of dysphagia services in each setting are discussed. The author challenges dysphagia clinicians to provide care on the basis of patient need rather than reimbursement structure.
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