Effects of enhanced bolus flavors on oropharyngeal swallow in patients treated for head and neck cancer

Abstract

Background Treatment for head and neck cancer can reduce peripheral sensory input and impair oropharyngeal swallow. This study examined the effect of enhanced bolus flavor on liquid swallows in these patients. Methods Fifty-one patients treated for head and neck cancer with chemoradiation or surgery and 64 healthy adult control subjects served as subjects. All were randomized to receive sour, sweet, or salty bolus flavor. Patients were evaluated at 7–10 days, 1 month, and 3 months after completion of tumor treatment. Control subjects received 1 assessment. Results All bolus flavors affected oropharyngeal swallow; sour flavor significantly shortened pharyngeal transit time across all evaluations. Conclusions Sour flavor influenced the swallow of patients treated for head and neck cancer, as well as that of control subjects in a manner similar to those with neurologic impairment observed in an earlier study. Sour flavor may improve the speed of pharyngeal transit regardless of whether a patient has suffered peripheral or central sensory damage.

Orosensory contributions to dysphagia: a link between perception of sweet and sour taste and pharyngeal delay time

“…In a study of the effects of enhanced bolus tastes on oropharyngeal swallow in patients treated for head and neck cancer (Pauloski et al. 2013), sour taste significantly shortened PTT across all evaluations. Sour taste administered to the whole mouth during active swallowing appears to be quite robust in augmenting swallow function in healthy control subjects and in improving timing of the pharyngeal swallow in patients with either peripheral or central sensory damage.…”

“…On the other hand, a sweet bolus did shorten PTT in healthy controls and treated head and neck cancer patients when compared to an unenhanced barium bolus (Pauloski et al. 2013). The relationship between sweet taste sensed on the oral tongue and timing of pharyngeal swallow events needs further examination.…”

“…2012; Pauloski et al. 2013). In order to further define the effects of this type of stimulation in isolation, high concentrations also were chosen for this study.…”

“…2012; Pauloski et al. 2013) demonstrated changes in swallow physiology when given a sour stimulus. Specifically, with a sour bolus, subjects demonstrated higher anterior palate pressures and stronger submental electromyographic activity (Palmer et al.…”

The Effect of Barium on Perceptions of Taste Intensity and Palatability

“…This input arises from many characteristics including taste quality (sweet, sour, bitter, salty, umami), taste intensity, chemesthesis (a somatosensory perception triggered by chemical irritation of the mucosa as occurs with chili, menthol, carbonation, high acidity, etc), bolus temperature, and viscosity. A highly sour taste has been associated with increased linguapalatal contact pressure [1], increased swallowing apnea duration (SAD) [2,3], decreased oral transit time [4], decreased pharyngeal transit time [4,5], quicker swallow onset time [4,6], more efficient swallows [4,7], and decreased frequency and severity of penetration-aspiration [3,4,8] in a variety of subject populations. Boluses with high intensity taste qualities of sweet, sour, and salty elicited quicker [7] and stronger [6,9–11] swallow responses compared to plain water boluses.…”