**2. Instruments and settings**

In daily practice, an instrumental procedure is indicated in the face of any suspected dysphagia or when a definition in differential diagnostic terms of the oro-pharyngeal situation is required. An instrumental procedure is also indicated for patients with pathologies that carry a high risk of complications even if they are apparently asymptomatic or when there is a discrepancy between the subjective signs and the outcome of a bedside evaluation. Even the clinical onset of dysphagia with complications makes an instrumental investigation of swallowing necessary [4-13].

So: which tool ?

The local availability of resources conditions the management of these patients but the possibility of a specialistic evaluation (carried out by a deglutologist) or the evaluation by trained carers has to be guaranteed in all the settings where elderly or dysphagic patients are recovered [1]. The tools, which are chosen, will be the available ones in our setting, aware that the "human factor" is the key to the success or failure of the clinical outcome. In our experience, the best way to manage dysphagic patients is represented by the evaluation of their swallowing abilities by means of a non instrumental clinical evaluation (clinical swallowing assessment, CSA) [14] and an instrumental endoscopic evaluation [15].
