Tracheostomy is associated with increased aspiration rates, and swallowing disorders have not been well-studied in trauma patients with tracheostomy. Swallowing evaluations were conducted in 224 patients (102 trauma and 122 nontrauma patients). Half of the patients in each group had tracheostomies. Bedside swallow studies were conducted in 40 patients, videofluoroscopy swallow studies in 100 patients, and both studies in 84 patients. χ2, Fisher's exact test, Cramer's V, and descriptive statistics were used for data analysis. Aspiration occurred in 35 per cent (36 of 102) of trauma patients with or without tracheostomy and in 36 per cent (22 of 61) of nontrauma patients with tracheostomy. Aspiration with and without penetration was observed in 54 per cent of trauma patients (55% with tracheostomy) compared with 67 per cent of all nontrauma patients (61% with tracheostomy). Trauma patients with head injuries exhibited 41 per cent (26 of 63) aspiration and 68 per cent (43 of 63) dysphagia compared with 26 per cent (10 of 39) and 59 per cent (23 of 39) in trauma patients with other injuries. There was a lower incidence of dysphagia in trauma patients (65% versus 81% in nontrauma) and in patients with tracheostomy (71% versus 77% without tracheostomy). Tracheostomy was not associated with increased dysphagia or aspiration.