Effects of Food Type on Pharyngeal Residue, Penetration, and Aspiration: A Prospective Study of 50 Dysphagic Adults.

Abstract

Introduction: Flexible endoscopic evaluation of swallowing (FEES) is a procedure used widely to assess pharyngeal residue, penetration, and aspiration in people with dysphagia. While the type of liquids and purees used during FEES are known to significantly affect swallowing outcomes during FEES, it is unknown if similar effects are observed with regular chewable foods. Therefore, the primary aim of this study was to assess the effects of food type on ratings of pharyngeal residue, penetration, and aspiration during FEES. As a secondary aim, we assessed the effects of food type on oral processing, as measured by number of masticatory cycles.

Methods: Pharyngeal residue, penetration, and aspiration were assessed in consecutive outpatient dysphagic adults undergoing routine FEES. Patients were presented with four types of foods (one trial each in a randomized order): saltine cracker, graham cracker, shortbread cookie, and shortbread cookie with pudding. Foods were matched by volume. All data were blindly analyzed by pairs of independent raters using the Visual Analysis of Swallowing Efficiency and Safety (VASES). Multilevel statistical models were used to examine the effects of food type on oropharyngeal residue, hypopharyngeal residue, Penetration-Aspiration Scale scores (PAS), and number of masticatory cycles.

Results: A total of 193 food trials were analyzed across 50 FEES. Oropharyngeal residue was greatest with saltine crackers compared to all other food types. Hypopharyngeal residue was greater for shortbread cookies compared to saltine crackers, and for shortbread cookies with pudding compared to saltine cracker and graham cracker. Shortbread cookies with pudding required fewer masticatory cycles compared to all other food types.

Conclusion: This study identified significant differences in oropharyngeal residue, hypopharyngeal residue, and oral processing, but not penetration or aspiration, across food types in this group of outpatient dysphagic adults. These data suggest that clinicians and researchers should consider standardizing the type of regular chewable foods used during FEES. Future research should examine generalizability of findings in people with more severe swallow impairments and in more specific patient populations.