Eleven patients were tested for swallowing dysfunction after prolonged orotracheal intubation. Ten had a tracheostomy tube. Mean duration of orotracheal intubation was 19.9 days, mean age 65 yr, and no patient had a concomitant neurologic deficit. All patients had a modified barium swallow with videofluoroscopy. All patients had at least one defect of 11 defects characterized. There was a mean of six defects/patient. The most common defects were delayed triggering of the swallow response (present in all patients) and pharyngeal pooling of contrast material (n = 9). Follow-up videofluoroscopy was performed in five patients (all had improved) with mean defects decreasing from 6.1 to 2.8/patient. With one exception, no patient had any defect that was worse than mild in severity. We concluded that prolonged orotracheal intubation with or without tracheostomy may cause prolonged and severe swallowing dysfunction. The deficits improve with time. The presence of a gag reflex does not confer protection against aspiration of pharyngeal contrast.