OBJECTIVES/HYPOTHESIS: Swallowing dysfunction is a devastating complication of chemoradiation therapy (CRT) for head and neck squamous cell carcinoma. We have previously demonstrated that pretreatment swallowing exercises improve posttreatment swallowing-related quality of life. This study evaluates the effect of pretreatment swallowing exercises on posttreatment swallow function as measured by videofluoroscopy. STUDY DESIGN: Retrospective case control. METHODS: Eighteen patients with advanced squamous cell carcinoma of the oropharynx, hypopharynx, and larynx treated at University of Alabama at Birmingham with CRT were included in the study. Nine patients received pretreatment swallowing exercises prior to CRT, and nine patients received swallowing exercises during routine posttreatment management. Approximately 3 months after completing treatment, standard videofluoroscopy examinations were conducted. Outcomes measured by the videofluoroscopy examinations included hyoid elevation, epiglottis inversion, tongue base movement, cricopharyngeal opening, and Rosenbeck aspiration score. Percutaneous endoscopic gastrostomy (PEG) tube use was assessed at 12 months after treatment. RESULTS: Epiglottis inversion was better maintained (P = .05) in patients receiving pretreatment swallowing therapy. The position of the tongue base during swallowing was also significantly closer to the posterior pharyngeal wall (P = .025) for patients receiving pretreatment exercises. PEG tube removal rates did not significantly differ between groups. CONCLUSIONS: Performing pretreatment swallowing exercises produces measurable improvements in posttreatment swallowing function in patients who undergo organ-preservation CRT for head and neck cancer. This study provides an initial foundation for the development of noninvasive, cost-effective, evidence-based interventions in this group of vulnerable patients. © The American Laryngological, Rhinological & Otological Society, Inc.