Are bubbles the future of dysphagia rehabilitation: A systematic review analysing evidence on the use of carbonated liquids in dysphagia rehabilitation.

Abstract

IntroductionDysphagia poses a huge health issue in our ageing population, impacting patients psychologically and through risk of aspiration, malnutrition and airway obstruction. The use of carbonated liquids to provide sensory enhancement as a tool to stimulate neuromuscular activity in dysphagia rehabilitation remains an area with limited research. This article reviews current evidence.MethodA data search of PubMed, CINAHL, EMBASE and Cochrane was undertaken with set search terms. Abstracts were reviewed and selected by two clinicians according to inclusion criteria and papers were assessed using PRISMA methodology8 listed in Fig. 1.ResultsSelected publications (1992–2019) involved a median of 29 participants with predominantly neurogenic dysphagia. Despite the differences in study designs all used videofluroscopy (VF) to assess outcome measures. Majority of studies were small scale but showed encouraging results. However, there was heterogeneity between specific outcome measures. One study surveyed taste which was overall positively received.DiscussionThere continues to remain limited evidence to direct the use of carbonated liquids in rehabilitation of dysphagia, however its role in head and neck tumor recovery shows some promise. The heterogeneity of not just study designs but also study participants seems to be a primary barrier. Whilst evidence is encouraging, further prospective studies standardising patient cohorts, methodologies and standarised quantitative outcome measures must be carried out. Longitudinal studies to look at the role of carbonated liquids in secretion management is another area of potential interest. In conclusion the use of carbonated liquid in dysphagia rehabilitation may have a potential role but without firm evidence based research, successful use in clinical practice cannot be implemented.