The COVID-19 pandemic accelerated the adoption of telehealth across virtually every clinical specialty, and dysphagia management was no exception. Between 2020 and 2022, speech-language therapists (SLTs) worldwide pivoted rapidly to video-based consultations, developing remote assessment frameworks that are now part of the permanent clinical toolkit. This article reviews what telehealth can and cannot achieve in dysphagia management, the platforms available in Hong Kong, and the evidence base for remote practice.
Before COVID, dysphagia management was almost entirely in-person, for understandable reasons: swallowing is a physiological process that traditionally required direct observation, physical examination, and instrumental assessment (VFSS or FEES). Telehealth appeared incompatible with these requirements.
The pandemic forced a re-evaluation. When in-person visits became impossible, SLTs and patients adapted — and discovered that a meaningful subset of dysphagia management tasks could be performed remotely without compromising safety. Post-pandemic, these remote capabilities have been retained because they address real structural problems: geographic access (patients in rural areas or New Territories lacking local SLT services), mobility barriers (care home residents who cannot travel), waitlist management (remote follow-up reduces demand on face-to-face appointment slots), and caregiver convenience.
The EAT-10 (Eating Assessment Tool) is a 10-item patient-reported outcome measure that can be completed entirely remotely — by the patient directly, by a caregiver on the patient’s behalf, or by an SLT administering the tool verbally via video. Each item is scored 0–4; a total score of 3 or above is considered a positive screen for dysphagia risk. The EAT-10 has been validated in multiple languages including Cantonese and Mandarin, making it suitable for HK clinical practice.
Remote administration protocol: The EAT-10 can be emailed to the patient or caregiver before the video appointment and reviewed together during the consultation. Results can be compared longitudinally (from previous telephone or video visits) to monitor symptom trajectory without requiring physical attendance.
The Sydney Swallowing Questionnaire and the SWAL-QOL (Swallowing Quality of Life) questionnaire can similarly be administered remotely and provide quality-of-life data that inform management decisions.
A video consultation with a good quality camera — smartphone quality is typically sufficient — enables observation of:
Validated remote oral motor protocols: Multiple research groups published remote oral motor screening protocols during the COVID period. The most widely cited is the Swallowing Remote Patient Monitoring (S-RPM) framework developed by Australian SLT researchers, which provides structured observation tasks and a scoring rubric suitable for video administration.
An SLT can observe a meal via live video — the caregiver holds the phone or positions a tablet at the table — and assess:
This is not equivalent to a structured clinical mealtime observation with positioning assessment and instrumental confirmation, but it provides clinically meaningful information that can guide recommendations and flag deterioration.
Perhaps the highest-value telehealth application in dysphagia is remote caregiver education and training. An SLT can:
This type of training was previously limited by travel time and scheduling. Telehealth makes it possible to provide brief, frequent training contacts that improve caregiver competency without requiring clinic attendance.
The limitations of telehealth in dysphagia are significant and must be stated clearly.
Instrumental assessment: Videofluoroscopic Swallowing Study (VFSS) and Fibreoptic Endoscopic Evaluation of Swallowing (FEES) cannot be performed remotely. These remain the gold standard for assessing silent aspiration, the timing and extent of pharyngeal phase dysfunction, and residue. Any patient where aspiration risk is uncertain — particularly silent aspiration, which produces no observable cough — requires in-person instrumental assessment.
Physical examination: Palpation of the larynx during swallowing, cervical auscultation, and manual assessment of oral structures (mucosal condition, dentition, palatal integrity) cannot be adequately replicated via video.
New presentations with high uncertainty: A patient presenting with new or rapidly changing dysphagia, unexplained weight loss, or suspected structural pathology (tumour, stricture, Zenker’s diverticulum) requires urgent in-person assessment. Telehealth is not appropriate as the primary assessment modality for new complex presentations.
Patients unable to cooperate with video: Severe cognitive impairment, hearing loss without amplification, or technological barriers (no device, no broadband access) limit telehealth applicability in elderly populations in HK.
The Hospital Authority launched formal telehealth services during the COVID-19 pandemic, extending access to outpatient services including allied health. As of 2025, HA telehealth access for SLT services varies by cluster:
Telehealth via HA for new referrals remains uncommon — most new dysphagia referrals still enter the in-person outpatient queue. Remote sessions are more typically used for follow-up of established patients with documented swallowing function.
For patients unable or unwilling to use HA public services, private SLT telehealth options in HK include:
The evidence for telehealth dysphagia management has grown rapidly since 2020. Key findings:
International guidelines consistently emphasise that telehealth is appropriate for monitoring and follow-up of stable patients with established diagnoses, but not as a replacement for instrumental assessment in uncertain or new presentations.
Incorporate EAT-10 into routine remote follow-up for all established dysphagia patients. It is validated, brief (5 minutes), and enables longitudinal tracking without clinic attendance.
Use video mealtime observation for caregiver-supported community patients where travel is a barrier. Structure the observation using a published remote observation protocol.
Set clear criteria for in-person escalation: Any new symptom (weight loss, aspiration events, voice change, increased coughing at meals) should trigger in-person or instrumental review. Document these escalation triggers in the telehealth care plan.
Address the digital divide: Older patients and care home residents may not have reliable video call access. Telephone-only options for simple EAT-10 administration and caregiver counselling are acceptable for patients without video access.
Coordinate with HA systems: For HA patients, enquire with the cluster SLT department about remote follow-up pathways before the patient is discharged — establishing the remote care pathway at discharge avoids a gap in service while waiting for a new outpatient slot.
Telehealth has permanently expanded the toolkit of dysphagia management in HK and globally. Remote assessment of screening scores, oral motor function, and caregiver-observed mealtime behaviour is clinically valid for monitoring established patients. The limitations are firm: instrumental assessment, new complex presentations, and physical examination cannot be adequately replicated remotely. Within these boundaries, telehealth improves access, reduces burden on patients and families, and enables more frequent clinical contact — a meaningful quality-of-care improvement for a population that has historically been limited by service geography and mobility.