Dysphagia is one of the most common problems affecting head and neck cancer (HNC) survivors. There are few studies investigating late-onset dysphagia post-treatment. The authors set out to investigate the prevalence of dysphagia-related diagnoses and procedures five years’ post-treatment, changes in rates over varying time periods and risk factors. They conducted a retrospective study of cases identified from the Utah Population Database from 1992 to 2012. For each case, up to five cancer-free controls were matched based on birth year, sex and state of birth. The study cohort included 1901 HNC survivors and 7796 controls. At diagnosis, 23.4% were stage I, 13.8% stage II, 14.0% stage III, 35.6% stage IV and 13.3% had stage information missing; 90.2% had squamous histology. The most common primary sites were oropharynx 33.3%, oral cavity 29.8% and larynx 24.5%. A third were treated with surgery alone, 20.9% with surgery and radiotherapy, and 11.2% with chemoradiotherapy. There was persistently elevated prevalence of new dysphagia-related diagnoses (e.g. dysphagia, malnutrition, oesophageal stricture) or procedures (e.g. gastrostomy, fluoroscopic evaluation of swallowing) at zero to two years, two to five years (15.4% prevalence) and over five years (27.6%) in the HNC group compared to controls. Aspiration pneumonia prevalence was 3.1% at two to five years and 6.8% at more than five years. Gastrostomy prevalence was 2.8% at two to five years and 3.3% at more than five years. Increasing stage of cancer was associated with an increased risk of dysphagia-related diagnoses in the initial two years following HNC diagnosis but this effect did not persist over time.