Patients with tracheostomy tubes have altered motor and sensory functions that may decrease their swallowing efficiency. Failure to recognize disorders in deglutition may result in dangerous complications including aspiration and death. Assessment of dysphagia is especially important in the patient transferred from the intensive care unit to the ward--where resources are less abundant. We present six cases in which cuff deflation or change of tracheostomy tube were undertaken without documented swallowing assessment. In these cases each patient was found to be aspirating and required the cuff to be reinflated, or a cuffed tube to be reinstated when assessed by the multidisciplinary team. Dysphagia management in the patient with a tracheostomy should be approached from a multidisciplinary point of view so that appropriate decisions can be made regarding changes in management and the decannulation process.