Background Screening of dysphagia by 3 ounce water swallow test (WST) is one of the most common screening tools especially among stroke patients worldwide and it is very important to avoid serious complications as pneumonia, guide starting oral alimentation. Aim of the work to compare the effectiveness of 3 ounce WST to the FEES results in determination of aspiration in order to guide oral feeding recommendation. Patients and Method This study included 39 patients recruited from the Phoniatric out-patient clinics of Ain Shams University Hospitals and Banha University Hospitals. They were subjected to doing 3 ounce WST after complete assessment according to protocol of dysphagia Ain Shams University and then doing FEES which used as the gold standard to compare the results of 3 ounce WST. Results Sensitivity of 3 ounce WST was 72%, specificity was 100%, false negative rate was 28% among patients of different diagnostic categories while Sensitivity of 3 ounce WST was 87.5 %, specificity was 100%, false negative rate was 12.5 % among stroke patients. Conclusion Although being simple, inexpensive and quick to perform, the 3 ounce WST is not sensitive enough to detect cases of silent aspirations. A large false negative rate exists. In addition, it does not differentiate between penetration or aspiration, if cough occurs, and thus not truly helpful in oral feeding recommendations.