OBJECTIVE: This study aims to characterize the relationship of esophageal dysmotility on modified barium swallow (MBS) and esophagram studies with high-resolution manometry (HRM), the gold standard of esophageal dysmotility diagnosis, in head and neck cancer (HNC) survivors with dysphagia. STUDY DESIGN: Retrospective diagnostic accuracy study. SETTING: Specialty dysphagia clinic at a tertiary care center. METHODS: A retrospective analysis of 30 patients treated for dysphagia between 2020 and 2023 was conducted. Inclusion criteria required HNC survivors aged 18 years or older who were diagnosed with dysphagia, treated in a HNC dysphagia clinic, and completed at least one HRM study. Data were collected on patient demographics, cancer history, MBS, esophagram, and HRM studies. MBS and esophagram results were reviewed for evidence of esophageal dysmotility. HRM studies were assessed with the Chicago Classification Version 4.0. Data were summarized and analyzed using test for continuous variables and a chi-square test for categorical variables. McNemar's test and diagnostic odds ratios were calculated to compare diagnostic test results. RESULTS: Of the 30 patients reviewed, 20 (67%) showed dysmotility on HRM, 15 (50.0%) completed MBS only, 2 (6.7%) completed esophagram only, and 13 (43.3%) completed both MBS and esophagram. MBS and esophagram accurately identified dysmotility in 66.7% and 76.9% of patients with confirmed dysmotility on HRM, respectively. CONCLUSION: Esophageal dysmotility is an understudied comorbidity of dysphagia in the HNC survivor population. Our study suggests that MBS and esophagram have limited predictive value in the assessment of dysmotility in HNC survivors with dysphagia. Thus, future studies should aim to better understand the relationship between other aspects of post-HNC dysphagia and esophageal dysmotility.