Efficacy of Thickened Liquids for Eliminating Aspiration in Head and Neck Cancer

Abstract

Objective To appraise the current videofluoroscopic evidence on the reduction of aspiration using thickened liquids in the head and neck cancer population. Data Sources Search terms relating to deglutition or dysphagia or swallow and neoplasms and oncology or head and neck cancer and viscosity or texture and apira or residu* were combined with honey or nectar, xerostomia, respiratory aspiration using Boolean operators. Review Methods A multi-engine literature search identified 337 non-duplicate articles of which 6 were judged to be relevant. These underwent detailed review for study quality and qualitative synthesis. Results The articles reviewed in detail predominantly described heterogeneous study samples with small sample sizes, making for difficult interpretation and generalization of results. Rates of aspiration were typically not reported by bolus consistency, despite the fact that a variety of stimulus consistencies was used during VFSS. Studies confirmed that aspiration is a major concern in the head and neck cancer population and reported a trend towards more frequent aspiration post-(chemo)radiotherapy. Conclusion Overall, the literature on thickened liquids as an intervention to eliminate aspiration in the head and neck cancer population is limited. Because aspiration is known to be prevalent in the head and neck cancer population and thickened liquids are known to eliminate aspiration in other populations, it is important to determine the effectiveness of thickened liquids for reducing aspiration in the head and neck cancer population.

Evaluation of the natural history of patients who aspirate

“…Little prior data exist to demonstrate the predictive power of VFSS to alter clinical course . Current recommendations for dietary alteration following VFSS include various changes in dietary bolus viscosity to thickened liquids, mechanical consistencies, or full regular diet based on findings on oropharyngeal swallowing evaluation, but data supporting this practice are limited . Studies have also evaluated the ability of the PAS score to predict the ability of the patient to tolerate specific types of diet, but again these data are limited in scope .…”

“…Little is known about the amount of swallowing therapy that is necessary to produce sufficient swallowing improvement to reduce pneumonia and mortality . A recent systematic review has shown that thickened liquids do seem to reduce risk of penetration and aspiration, but are also associated with higher pyriform residuals . Food hardness, cohesiveness (scatter potential), and viscosity are also highly associated with ease of transit through the hypopharynx.…”

“…15,16 Current recommendations for dietary alteration following VFSS include various changes in dietary bolus viscosity to thickened liquids, mechanical consistencies, or full regular diet based on findings on oropharyngeal swallowing evaluation, but data supporting this practice are limited. 11,17 Studies have also evaluated the ability of the PAS score to predict the ability of the patient to tolerate specific types of diet, but again these data are limited in scope. 18 The ability of our clinical interventions (dietary modification, NPO status, and/or gastrostomy tube placement) to reduce pneumonia incidence and mortality is relatively unknown.…”

“…29 A recent systematic review has shown that thickened liquids do seem to reduce risk of penetration and aspiration, but are also associated with higher pyriform residuals. 17 Food hardness, cohesiveness (scatter potential), and viscosity are also highly associated with ease of transit through the hypopharynx. There is noted to be a lack of uniformity in studies in the details of dietary modification recommendation.…”

Addition of Alpha-Amylase and Thickener to Blenderized Rice Provides Suitable Viscosity for Use in Nutritional Support

“…For the patients with head and neck cancers, evidences with thickened liquids are extremely limited [11]. Additionally, not thicken liquid but puree like Nectar was proved to be able to swallow ISSN: 2469-4185 without aspiration [12].…”