Patients undergoing tracheostomy may recover enough to be weaned from mechanical ventilation but continue to need the tracheostomy tube for airway toilet. When feeding a patient with a tracheostomy tube in place, it is unclear if the cuff should be inflated or not. This study was undertaken to determine whether cuff status has any impact on aspiration of feedings. Selected patients with tracheostomies who were weaned from the ventilator underwent fluoroscopic swallowing studies with the tracheostomy cuff inflated and deflated. Patients were fluoroscopically observed swallowing contrast-enhanced thin liquids, thick liquids, pureed food, and solid food. Each patient was to have undergone a total of 8 different swallowing studies. A radiologist blinded to cuff status was present to assess the degree of aspiration, which was graded from 0 (no aspiration) to 4 (aspiration of more than 10% of the ingested material with coughing). The study included 12 patients who had a total of 91 different swallowing studies. The full battery of eight swallowing studies could not be completed on every patient. When the cuff was inflated, the aspiration rate was 2.7 times higher (17.8% versus 6.5%). Logistic regression analysis revealed that cuff status and type of substance ingested were both predictors of aspiration ( P = 0.032 and P = 0.025, respectively). Although the sample size was small, the nearly threefold increase in the aspiration rate associated with cuff inflation suggests feeding with the cuff deflated may be the preferred method. Solid foods are the safest. Swallowing studies may be the best method of assessing which substances will be tolerated by an individual patient.