Effects of Carbonated Liquids on Oropharyngeal Swallowing Measures in People with Neurogenic Dysphagia
First Online: 06 August 2011 Received: 15 January 2011 Accepted: 19 July 2011 DOI:
Cite this article as: Sdravou, K., Walshe, M. & Dagdilelis, L. Dysphagia (2012) 27: 240. doi:10.1007/s00455-011-9359-8 Abstract
Aspiration is common in adults with neurogenic dysphagia and pharyngeal delay. This can lead to dehydration, malnutrition, and aspiration pneumonia. Diet modifications aimed at reducing thin liquid aspiration are partially successful or unpalatable or both. Carbonated liquids show some potential in influencing swallowing behavior. However, there is a paucity of evidence to support this intervention. This study compares the effects of carbonated thin liquids (CTL) with that of noncarbonated thin liquids (NCTL) on oropharyngeal swallowing in adults with neurogenic dysphagia and examines the palatability of the CTL stimulus. Seventeen people with pharyngeal delay attended for videofluoroscopy (VFSS). Outcome measures were oral transit time (OTT), pharyngeal transit time (PTT), stage transition duration (STD), initiation of the pharyngeal swallow (IPS), penetration-aspiration scale (PENASP), and pharyngeal retention (PR). A modification of Quartermaster Hedonic Scale (AQHS) was employed to assess palatability of the CTL. CTL vs. NCTL significantly decreased penetration and aspiration on 5-ml (
P = 0.028) and 10-ml ( P = 0.037) swallows. CTL had no significant effect on OTT, PTT, IPS, and PR for any volume of bolus. Only one participant disliked the CTL stimulus. These findings support the hypothesis that oropharyngeal swallowing can be modulated in response to sensory stimuli. Implications for research and clinical practice are discussed. Keywords Deglutition Deglutition disorders Oropharyngeal dysphagia Carbonated liquids Sensory stimulation Neurogenic dysphagia References
Gates J, Hartnell GG, Gramigna GD. Videofluoroscopy and swallowing studies for neurologic disease: a primer. RadioGraphics. 2006;26:e22.
Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1991;30:744–8.
Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63.
Campbell-Taylor I. Oropharyngeal dysphagia in long-term care: misperceptions of treatment efficacy. J Am Med Dir Assoc. 2008;9:523–31.
Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;16:119–22.
Finestone HM, Foley NC, Woodbury GM, Greene-Finestone L. Quantifying fluid intake in dysphagic stroke patients: a preliminary comparison of oral and nonoral strategies. Arch Phys Med Rehabil. 2001;82:1744–6.
Logemann J, Lindbald AS, Brandt D, et al. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. J Speech Lang Hear Res. 2008;51:173–83.
Bartoshuk L, Duffy V, Leder S, Snyder D. Oral sensation: genetic and pathological sources of variation. Dysphagia. 2003;14:3–9.
Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001;81:929–69.
Logemann JA. Pre-swallow sensory input: its potential importance to dysphagic patients and normal individuals. Dysphagia. 1996;11:9–10.
Martin RE. Neuroplasticity and swallowing. Dysphagia. 2009;24:218–29.
Miller AJ. The neurobiology of swallowing and dysphagia. Dev Disabil Res Rev. 2008;14:77–86.
Mistry S, Hamdy S. Neural control of feeding and swallowing. Phys Med Rehabil Clin N Am. 2008;19:709–28.
Robbins J, Butler SG, Daniels SK, et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res. 2008;51:S276–300.
Buettner A, Beer A, Hannig C, Settles M, Schieberle P. Physiological and analytical studies on flavor perception dynamics as induced by the eating and swallowing process. Food Qual Pref. 2002;13:497–504.
Carstens E, Carstens MI, Dessirier JM, O’Mahony M, Simons CT, Sudo M, Sudo S. It hurts so good: oral irritation by spices and carbonated drinks and the underlying neural mechanisms: Short communication. Food Qual Pref. 2002;13:431–43.
Chandrashekar J, Yarmolinsky D, Buchholtz L, Oka Y, Sly W, Ryba NJP, Zuker CS. The taste of carbonation. Science. 2009;326:443–5.
Duffy VB. Variation in oral sensation: implications for diet and health. Curr Opin Gastroenterol. 2007;23:171–7.
Green BG. Oral chemesthesis: an integral component of flavor. In: Taylor A, Roberts D, editors. Flavor perception. Oxford: Blackwell Publishing; 2004. p. 151–71.
Negoias S, Visschers R, Boelrijk A, Hummel T. New ways to understand aroma perception. Food Chem. 2008;108:1247–54.
Logemann JA, Pauloski BR, Colangelo L, Lazarus C, Fujiu M, Kahrilas PJ. Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia. J Speech Hear Res. 1995;38:556–63.
Pelletier CA, Lawless HT. Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia. 2003;18:231–41.
Pelletier CA, Dhanaraj GE. The effect of taste and palatability on lingual swallowing pressure. Dysphagia. 2006;21:1–8.
Bulow M, Olsson R, Ekberg O. Videoradiographic analysis of how carbonated thin liquids and thickened liquids affect the physiology of swallowing in subjects with aspiration of thin liquids. Acta Radiol. 2003;44:366–72.
Jennings KS, Siroky D, Jackson CG. Swallowing problems after excision of tumors of the skull base: diagnosis and management in 12 patients. Dysphagia. 1992;7:40–4.
Krival CR. Effects of carbonated vs. thin and thickened liquids on swallowing in adults with neurogenic oropharyngeal dysphagia. Doctoral dissertation, University of Cincinnati; 2007. Available at
. Retrieved February 5, 2009.
Miura Y, Morita Y, Koizumi H, Shingai T. Effects of taste solutions, carbonation, and cold stimulus on the power frequency content of swallowing submental surface electromyography. Chem Senses. 2009;34:325–31.
Newman L, Armstrong R, Rogers T, et al. The effect of carbonation on sensory dysphagia in the pediatric population. Dysphagia. 2001;16:146–50.
Nixon TS. Use of carbonated liquids in the treatment of dysphagia. Network: a newsletter of dietetics in physical medicine and rehabilitation. New York: American Dietetic Association; 1997.
Steele CM, Miller AJ. Sensory input pathways and mechanisms in swallowing: a review. Dysphagia. 2010;25:323–33.
Robey R. A five-phase model for clinical-outcome research. J Commun Disord. 2004;37:401–11.
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.
Gothoskar AV, Kshirsagar SJ. A review of patents on effervescent granules. E-J Pharmaceut Rev. 2004;2. Available at
. Accessed March 23, 2010.
Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin, TX: Pro-Ed; 1998.
Kim Y, McCullough GH, Asp CW. Temporal measurements of pharyngeal swallowing in normal populations. Dysphagia. 2005;20:290–6.
Kim Y, McCullough GH. Stage transition duration in patients poststroke. Dysphagia. 2007;22:299–305.
Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23:392–405.
Rosenbek JC, Robbins J, Roecker EV, Coyle JL, Woods JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.
Eisenhuber E, Schima W, Schober E, Pokieser P, Stadler A, Scharitzer M, et al. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. Am J Roentgenol. 2002;178:393–8.
Jones LV, Peryam DR, Thurstone LL. Development of a scale for measuring soldiers’ food preferences. Food Res. 1955;20:512–20.
Krosnick JA, Tahk A. The optimal length of rating scales to maximize reliability and validity. Available at
. Retrieved February 1, 2010.
Daniels SK, Schroeder MF, McClain M, Corey D, Rosenbek JC, Foundas AL. Dysphagia in stroke: development of a standard method to examine swallowing recovery. J Rehabil Res Dev. 2006;43:347–56.
Daniels SK, Schroeder MF, DeGeorge PC, Corey DM. Defining and measuring dysphagia following stroke. Am J Speech Lang Pathol. 2009;18:74–81.
Corbin-Lewis K, Liss JM, Sciortino KL. Clinical anatomy and physiology of the swallow mechanism. Clifton Park, NY: Thomson Delmar Learning; 2005.
Dessirier JM, Simons CT, O’Mahony M, Carstens E. The oral sensation of carbonated water: cross-desensitization by capsaicin and potentiation by amiloride. Chem Senses. 2001;26:639–43.
Dessirier JM, Simons CT, Carstens MI, O’Mahony M, Carstens E. Psychophysical and neurobiological evidence that the oral sensation elicited by carbonated water is of chemogenic origin. Chem Senses. 2000;25:277–84.
Green BG. The effects of temperature and concentration on the perceived intensity and quality of carbonation. Chem Senses. 1992;17:435–50.
Hewson L, Hollowood T, Chandra S, Hort J. Gustatory, olfactory and trigeminal interactions in a model carbonated beverage. Chemosens Percept. 2009;2:94–107.
Yau NJN, McDaniel MR. The effect of temperature on carbonation perception. Chem Senses. 1991;16:337–48.
Sasaki CT, Leder SB. Comments on selected recent dysphagia literature. Dysphagia. 2008;23:208–12.
Simons CT, Dessirier JM, Carstens M, O’Mahony M, Carstens E. Neurobiological and psychophysical mechanisms underlying the oral sensation produced by carbonated water. J Neurosci. 1999;19:8134–44.
Bradley RM. Sensory receptors of the larynx. Am J Med. 2000;108:47S–50S.
PubMed CrossRef Copyright information
© Springer Science+Business Media, LLC 2011