American journal of speech-language pathology · 2025
The Effects of High-Coating White Water, Low-Coating White Water, and Milk on the Identification of Swallowing Safety and Efficiency in Healthy Adults as Assessed via Flexible Endoscopic Evaluation of Swallowing: A Pilot Study.
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Cline Kristen G, Butler Susan G, Lundgren Kristine, Love Kim R
Аннотация
PURPOSE: The best liquid bolus protocol to use that accurately identifies penetration, aspiration, and residue on flexible endoscopic evaluation of swallowing (FEES) remains unclear. Recently, the use of high-coating white food dye-colored water has been recommended; however, evidence to support its use is limited. In this study, penetration/aspiration and residue as a function of high-coating white water, low-coating white water, and milk were systematically evaluated.
METHOD: The effects of liquid type (i.e., high-coating white water, low-coating white water, and milk) and volume (i.e., 15, 20, and 90 ml) on penetration-aspiration scale (PAS) scores (i.e., 1-2 vs. 3-8) and residue (i.e., present vs. not present) were assessed in 20 healthy adults ages 22-53 years during FEES.
RESULTS: PAS scores, vallecular residue, and pyriform sinus residue differed significantly by liquid type (p < .001, p = .002, and p < .001, respectively). PAS scores also differed significantly by bolus volume (p = .045). In general, high-coating white water yielded a significantly greater probability of penetration events than low-coating white water and milk; however, raw PAS data revealed aspiration events (PAS 6-8) were only identified in the low-coating white water and milk conditions. Vallecular residue and pyriform sinus residue were observed in 100% of the high-coating white water swallows with markedly less residue in the low-coating white water and milk conditions.
CONCLUSION: High-coating white water resulted in increased observed penetration events (likely due to its coating effect) compared to low-coating white water and milk while still underidentifying aspiration seen more frequently with milk test boluses in healthy adults.
METHOD: The effects of liquid type (i.e., high-coating white water, low-coating white water, and milk) and volume (i.e., 15, 20, and 90 ml) on penetration-aspiration scale (PAS) scores (i.e., 1-2 vs. 3-8) and residue (i.e., present vs. not present) were assessed in 20 healthy adults ages 22-53 years during FEES.
RESULTS: PAS scores, vallecular residue, and pyriform sinus residue differed significantly by liquid type (p < .001, p = .002, and p < .001, respectively). PAS scores also differed significantly by bolus volume (p = .045). In general, high-coating white water yielded a significantly greater probability of penetration events than low-coating white water and milk; however, raw PAS data revealed aspiration events (PAS 6-8) were only identified in the low-coating white water and milk conditions. Vallecular residue and pyriform sinus residue were observed in 100% of the high-coating white water swallows with markedly less residue in the low-coating white water and milk conditions.
CONCLUSION: High-coating white water resulted in increased observed penetration events (likely due to its coating effect) compared to low-coating white water and milk while still underidentifying aspiration seen more frequently with milk test boluses in healthy adults.