Effects of Liquid Type,Delivery Method,and Bolus Volume on Penetration-Aspiration Scores in Healthy Older Adults during Flexible Endoscopic Evaluation of Swallowing
Restricted accessResearch articleFirst published online May, 2011
Effects of Liquid Type,Delivery Method,and Bolus Volume on Penetration-Aspiration Scores in Healthy Older Adults during Flexible Endoscopic Evaluation of Swallowing
The type of liquid (eg, water or milk) that should be used during flexible endoscopic evaluation of swallowing (FEES) has received little investigation. Aspiration may vary as a function of the thin liquid type used during FEES.
Methods:
We measured the effects of liquid type (water, skim milk, 2% milk, and whole milk; all dyed with green food coloring), delivery method (cup and straw), and bolus volume (5, 10, 15, and 20 mL) on Penetration-Aspiration Scale (PAS) scores in 14 healthy older adults (mean, 75 years; range, 69 to 85 years). Each participant generated 32 swallows.
Results:
The PAS scores differed significantly by liquid type (p = 0.003) and by bolus volume (p = 0.017), but not by delivery method (p = 0.442). The PAS scores were significantly greater for 2% milk and whole milk than for skim milk and water (p < 0.05), and for 20 mL versus smaller volumes. Penetration and aspiration were observed on 113 (25%) and 15 (3%) of 448 swallows, respectively.
Conclusions:
These findings suggest that both milk and water should be used during FEES for an accurate assessment of aspiration status.
ButlerSGStuartAMarkleyLReesC. Penetration and aspiration in healthy older adults as assessed during endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol2009;118:190–8.
2.
RosenbekJCRobbinsJARoeckerEBCoyleJLWoodJL. A penetration-aspiration scale. Dysphagia1996;11:93–8.
3.
DanielsSKSchroederMFDeGeorgePCCoreyDMRosenbekJC. Effects of verbal cue on bolus flow during swallowing. Am J Speech Lang Pathol2007;16:140–7.
4.
ColodnyN. Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (FEES) using the penetration-aspiration scale: A replication study. Dysphagia2002;17:308–15.
5.
DaggettALogemannJRademakerAPauloskiB. Laryngeal penetration during deglutition in normal subjects of various ages. Dysphagia2006;21:270–4.
6.
LandisJRKochGG. The measurement of observer agreement for categorical data. Biometrics1977;33:159–74.
7.
FleissJLLevinBPaikMC. Statistical methods for rates and proportions. 3rd ed.Hoboken, NJ: John Wiley & Sons, 2003.
8.
HissSGStraussMTreoleKStuartABoutilierS. Effects of age, gender, bolus volume, bolus viscosity, and gustation on swallowing apnea onset relative to lingual bolus propulsion onset in normal adults. J Speech Lang Hear Res2004;47:572–83.
9.
ButlerSGPostmaGNFischerE. Effects of viscosity, taste, and bolus volume on swallowing apnea duration of normal adults. Otolaryngol Head Neck Surg2004;131:860–3.
10.
PelletierCALawlessHT. Effect of citric acid and citric acid–sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia2003;18:231–41.
11.
PelletierCADhanarajGE. The effect of taste and palatability on lingual swallowing pressure. Dysphagia2006;21:121–8.
12.
LogemannJAPauloskiBRColangeloLLazarusCFujiuMKahrilasPJ. Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia. J Speech Hear Res1995;38:556–63.
13.
DingRLogemannJALarsonCRRademakerAW. The effects of taste and consistency on swallow physiology in younger and older healthy individuals: A surface electromyographic study. J Speech Lang Hear Res2003;46:977–89.
14.
BülowMOlssonREkbergO. Videoradiographic analysis of how carbonated thin liquids and thickened liquids affect the physiology of swallowing in subjects with aspiration on thin liquids. Acta Radiol2003;44:366–72.
15.
ButlerSGStuartAKempS. Flexible endoscopic evaluation of swallowing in healthy young and older adults. Ann Otol Rhinol Laryngol2009;118:99–106.
16.
MumaJR. The need for replication. J Speech Hear Res1993;36:927–30.
17.
DanielsSKCoreyDMHadskeyLD. Mechanism of sequential swallowing during straw drinking in healthy young and older adults. J Speech Lang Hear Res2004;47:33–45.
18.
AdnerhillIEkbergOGroherME. Determining normal bolus size for thin liquids. Dysphagia1989;4:1–3.
19.
ButlerSGStuartALengXReesCWilliamsonJKritchevskySB. Factors influencing aspiration during swallowing in healthy older adults. Laryngoscope2010;120:2147–52.
20.
AvivJEMartinJHJonesME. Age-related changes in pharyngeal and supraglottic sensation. Ann Otol Rhinol Laryngol1994;103:749–52.
21.
CalhounKHGibsonBHartleyLMintonJHokansonJA. Age-related changes in oral sensation. Laryngoscope1992;102:109–16.
22.
NgKWooJKwanM. Effect of age and disease on taste perception. J Pain Symptom Manage2004;28:28–34. [Erratum in J Pain Symptom Manage 2004;28:626.]
23.
WardwellLChapman-NovakofskiKBrewerMS. Effects of age, gender, and chronic obstructive pulmonary disease on taste acuity. Int J Food Sci Nutr2009;60:1–14.
24.
KellyAMDrinnanMJLeslieP. Assessing penetration and aspiration: How do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare?. Laryngoscope2007;117:1723–7.
25.
SuiterDMMoorheadMK. Effects of flexible fiberoptic endoscopy on pharyngeal swallow physiology. Otolaryngol Head Neck Surg2007;137:956–8.
26.
HugginsPSTuomiSKYoungC. Effects of nasogastric tubes on the young, normal swallowing mechanism. Dysphagia1999;14:157–61.
27.
LangmoreSESchatzKOlsonN. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol1991;100:678–81.
28.
LederSBSasakiCTBurrellMI. Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia1998;13:19–21.
29.
RaoNBradySLChaudhuriGDonzelliJJWeslingMW. Gold-standard? Analysis of the videofluoroscopic and fiberoptic endoscopic swallowing examinations. J Appl Res2003;3:89–96.
