Is Swallowing of All Mixed Consistencies Dangerous for Penetration-Aspiration?

Abstract

Swallowing of MIX is not dangerous, and it is safer for not inducing penetration-aspiration as compared with the swallowing of LIQUID. The risk of penetration-aspiration may be judged depending on not only a food's consistency but also on various factors that affect airway protection, including the texture of food.

The Influence of Food Texture and Liquid Consistency Modification on Swallowing Physiology and Function: A Systematic Review

“…Of the 29 studies describing swallowing or oral processing in adults, 27 reported data for healthy adult participants [19–45], with two studies restricting their focus to denture wearers [46, 47]. A total of 10 studies reported data for adults with dysphagia [20–24, 48–52]. Four of these studies described swallowing in stroke patients in comparison to healthy controls [21–24] and a 5th paper described a group of patients with dysphagia secondary to Chagas’ disease, again with comparison to a group of healthy controls [20].…”

“…Two papers reported data for individuals with dysphagia related to head and neck cancer, in one case following surgical resection of the soft palate [48] and the second exploring post-radiation dysphagia in patients treated for nasopharyngeal carcinoma [49]. The remaining papers described swallowing in patients with Parkinson’s disease [50], in unspecified neurogenic dysphagia [51], or in unspecified dysphagia [52]. Sample sizes ranged from 3 [25] to 205 [24] participants.…”

“…A total of 13 articles described swallowing measures for a narrower contrast, i.e., thin liquid compared to either a mildly thick liquid (also known as nectar-thick) [17, 19, 23, 26, 28–30, 32, 35, 48, 51, 53] and/or a moderately thick liquid (also known as honey-thick) [28–30, 32, 33, 35, 53], with six of these articles including both mildly thick and moderately thick liquids [28–30, 32, 35, 53]. In terms of solid stimuli, which were explored in a total of 18 studies (Table 5) [18, 19, 21, 24, 27, 31, 39–48, 51, 52], there were effectively no stimuli that were the same in any two or more studies. Solid foods ranged from items that were described by authors as being softer (i.e., banana with barium paste [31]; cooked rice mixed with barium [52]; corned beef [45]; gummy bears [19]; konjac jelly [27], or gelatin cubes [18]) to items at the harder end of the continuum (e.g., fresh raw carrots [27]; biscuits or cookies [24, 31, 48, 51] or peanuts [31]).…”

A review of diet standardization and bolus rheology in the management of dysphagia

“…There is also evidence of negative outcomes associated with increased thickness: the IDDSI review [26**] identified greater vallecular residue for thicker consistencies [39,41,50,51] and Troche et al [40] observed a greater number of tongue pumps required to swallow a pudding-thick consistency than a thin liquid. This trend was also recently observed for starch-but not gum-based thickeners [37*] (with equal apparent viscosity) with significantly more oral and pharyngeal residue was apparent for starch vs gum at thicker consistencies.…”

“…Thicker liquids were reported to increase the duration of swallowing events in accelerometry [29], electromagnetic articulography [30], ultrasound [31] and surface electromyography signals [32], [33], [34], and also on videofluoroscopy for pharyngeal transit time measures [35], [36], although more recently a study found no effect of thickening on bolus velocity [37]. Regarding dysphagia, several videofluoroscopic studies provided evidence of texture modification having a measurable effect on swallowing efficacy [38], [39], [40], [41], e.g. reduced penetration-aspiration with increasing viscosity [36].…”