Videoradiographic Analysis of How Carbonated Thin Liquids and Thickened Liquids Affect the Physiology of Swallowing in Subjects with Aspiration on Thin Liquids

Abstract

Purpose: To analyze how carbonated thin liquids affected the physiology of swallowing in dysphagic patients. Material and Methods: 40 patients were analyzed; 36 were neurologically impaired. During a therapeutic videoradiographic swallowing examination the patients had to swallow liquids with the following consistencies three times: thin, thickened and carbonated. The liquids were given in doses of 3 × 5 ml. The swallows were analyzed regarding penetration/aspiration, pharyngeal transit time and pharyngeal retention. Results: Significant difference was found regarding penetration/aspiration when comparisons were made between thin liquid and carbonated thin liquid (p<0.0001). Carbonated liquid reduced the penetration to the airways. The comparison between thin liquid and thickened liquid (p<0.0001) showed significant less penetration with thickened liquids. Pharyngeal transit time was reduced both when comparing thin liquid with thin carbonated liquid (p<0.0001) and thickened liquid (p<0.0001). Pharyngeal retention was significantly reduced (p<0.0001) with carbonated thin liquid compared to thickened liquid. The comparison of thin liquids and carbonated thin liquids showed p = 0.0013, thin and thickened liquids p = 0.0097. Conclusions: Carbonated liquids reduced penetration/aspiration into the airways, reduced pharyngeal retention and pharyngeal transit time became shorter. Therefore, carbonated liquids are a valuable treatment option for patients with penetration/aspiration. Thickened liquids may still be an option for patients who cannot tolerate carbonated liquids and liquids with this consistency are safer than thin liquids.

Effects of Club Soda and Ginger Brew on Linguapalatal Pressures in Healthy Swallowing

“…Our finding of greater peak linguapalatal swallowing amplitudes in response to Ginger Brew and sometimes to Club Soda compared with water is consistent with the effects of other chemesthetic stimuli on swallowing pressures [27]. Our results were also consistent with other findings, suggesting that greater chemosensory input is associated with greater recruitment, or effort, in swallowing [21][22][23][24][25][26][27]. However, when we considered our results together with recent work describing lingual movement features in response to thin vs. thickened liquids, we noticed interesting similarities and contrasts that may have clinical implications.…”

“…A steadily growing literature suggests that boluses that yield a sour taste or an oral chemesthesis influence swallowing physiology in ways that reflect greater neuromuscular recruitment [21][22][23][24][25][26][27][28]. Kagel and Leopold [12] observed that a cold, tart (i.e., Italian lemon ice) stimulus mixed with food appeared to facilitate faster swallowing in patients with Huntington's chorea.…”

“…However, Miura et al [30] reported that healthy adults exhibited greater high-frequency content of submental sEMG signals in swallows of 60 ml of carbonated liquids compared with water, reflecting more organized recruitment of suprahyoid musculature. In adults with dysphagia, carbonated barium was associated with improved temporal parameters of pharyngeal swallowing and reduced penetration of material to the airway when compared to noncarbonated thin-liquid solutions, and was proposed as an alternative to thickened liquids in patients who aspirate thin liquids [23,28].…”

Variability of Swallow-associated Sounds in Adults and Infants

“…Comparisons were made between the accelerometric and acoustic durations of the signals. Previous authors have shown that carbonated beverages have different swallow-associated properties than other thin liquids [4]. We do not have enough subjects in this study to explore these differences.…”

“…This is advantageous as long as the target signal is in the frequency range where the curve is above zero. For most microphones, the frequency response curve is positive in the range of audible human hearing (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). At frequencies at which the curve is less than zero, the signal is attenuated or not detected.…”