Advertisement

Dysphagia

, Volume 18, Issue 4, pp 231–241 | Cite as

Effect of Citric Acid and Citric Acid–Sucrose Mixtures on Swallowing in Neurogenic Oropharyngeal Dysphagia

  • Cathy A. PelletierEmail author
  • Harry T. Lawless
Article

Abstract

The ability of sour and sweet–sour mixtures to improve swallowing in 11 nursing home residents with neurogenic oropharyngeal dysphagia was investigated using fiberoptic endoscopic evaluation of swallowing. Citric acid (2.7%) significantly reduced aspiration and penetration compared with water. Teaspoon delivery of liquids significantly reduced aspiration and penetration compared with natural cup drinking. Subjects tended to appropriately self-regulate the cup volume they consumed after the first trial. A significant increase in spontaneous dry swallows was observed after both taste stimuli. The mechanisms for improved swallowing due to citric acid are not understood but may be due to increased gustatory and trigeminal stimulation of acid to the brainstem in neurologically impaired subjects.

Keywords

Dysphagia Sour Taste Gustation Trigeminal Mixture suppression Deglutition Deglutition disorders 

Notes

Acknowledgements

We thank the nursing home administrators, staff, residents, and families who participated in this study. We are especially grateful to the nurses who assisted in the FEES procedures and to the anonymous reviewers for their helpful suggestions. Thanks also to Alina Prokopchuk for assistance in data collection, Karen Grace–Martin for statistical advice, and Joe Murray, Nancy Colodny, and especially Susan Hiss for their invaluable assistance and suggestions throughout the study.

References

  1. 1.
    Linden, P, Siebens, A 1983Dysphagia: predicting laryngeal penetration.Arch Phys Med Rehabil64281284PubMedGoogle Scholar
  2. 2.
    Huckabee, ML, Pelletier, CA 1999Management of Adult Neurogenic Dysphagia.Singular Publishing GroupSan Diego, CAGoogle Scholar
  3. 3.
    Finestone, HM, Foley, NC, Woodbury, MG, Greene–Finestone, L 2001Quantifying fluid intake in dysphagic stroke patients: a preliminary comparison of oral and nonoral strategies.Arch Phys Med Rehabil8217441746CrossRefPubMedGoogle Scholar
  4. 4.
    Logemann, JA, Pauloski, BR, Colangelo, L, Lazarus, C, Fujiu, M, Kahrilas, PJ 1995Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia.J Speech Hear Res38556563PubMedGoogle Scholar
  5. 5.
    Bartoshuk, LM 1975Taste mixtures: Is mixture suppression related to compression?Physiol Behav14643649PubMedGoogle Scholar
  6. 6.
    Lawless, HT 1986Sensory interactions in mixtures.J Sens Stud1259274Google Scholar
  7. 7.
    Curtis, DW, Stevens, DA, Lawless, HT 1984Perceived intensity of the taste of sugar mixtures and acid mixtures.Chem Senses9107120Google Scholar
  8. 8.
    Lawless, HT 1977The pleasantness of mixtures in taste and olfaction.Sens Processes1227237(in press)PubMedGoogle Scholar
  9. 9.
    Pelletier CA, Lawless HT, Horne J: Sweet-sour mixture suppression in older and young adults. Food Quality and Preference. Google Scholar
  10. 10.
    Kroeze, JHA, Bartoshuk, LM 1985Bitterness suppression as revealed by split-tongue taste stimulation in humans.Physiol Behav35779783PubMedGoogle Scholar
  11. 11.
    Lawless, HT 1979Evidence for neural inhibition in bittersweet taste mixtures.J Comp Physiol Psychol93538547PubMedGoogle Scholar
  12. 12.
    Rosenbek, JC, Robbins, J, Roecker, EB, Coyle, JL, Wood, JL 1996A penetration–aspiration scale.Dysphagia119398PubMedGoogle Scholar
  13. 13.
    Pfaff, GA 2000Evaluation of the sourness of a ReaLemonTM/barium sulfate solution.Cornell UniversityIthaca, NYGoogle Scholar
  14. 14.
    McBride, RL, Johnson, RL 1987Perception of sugar–acid mixtures in lemon juice drink.Food Sci Technol22399408Google Scholar
  15. 15.
    Diamont, H, Oakley, BSL, Zotterman, R 1965A comparison of neural and psychophysical responses to taste stimuli in man.Acta Physiol Scand646774PubMedGoogle Scholar
  16. 16.
    Murray, J 1999Manual of Dysphagia Assessment in Adults.Singular Publishing Group, Inc.San Diego, CAGoogle Scholar
  17. 17.
    Palmer, JB, Rudin, NJ, Lara, G, Crompton, AW 1992Coordination of mastication and swallowing.Dysphagia7187200PubMedGoogle Scholar
  18. 18.
    Miller, A, Bieger, D, Conklin, JL 1997Functional controls of deglutition.Perlman, ALSchulze-Delrieu, K eds. Deglutition and its Disorders.San Diego, CASingular Publishing Group4397Google Scholar
  19. 19.
    Shinghai, T, Shimada, K 1976Reflex swallowing elicited by water and chemical substances applied in the oral cavity, pharynx, and larynx of the rabbit.Jpn J Physiol26455469PubMedGoogle Scholar
  20. 20.
    Smith, DV, Vogt, MB 1997The neural code and integrative processes of taste.Beauchamp, GKBartoshuk, LM eds. Tasting and Smelling.Academic PressSan Diego, CA2576Google Scholar
  21. 21.
    Jean, A 2001Brain stem control of swallowing: neuronal network and cellular mechanisms.Physiol Rev81929969PubMedGoogle Scholar
  22. 22.
    Miller, AJ 1999The neuroscientific principles of swallowing and dysphagia.Singular Publishing GroupSan Diego, CAGoogle Scholar
  23. 23.
    Storey, AT 1968A functional analysis of sensory units innervating epiglottis and larynx.Exp Neurol20366383PubMedGoogle Scholar
  24. 24.
    Storey, AT, Johnson, P 1975Laryngeal water receptors initiating apnea in the lamb.Exp Neurol474255PubMedGoogle Scholar
  25. 25.
    Prescott, J, Allen, S, Stephens, L 1993Interactions between oral chemical irritation, taste and temperature.Chem Senses18389404Google Scholar
  26. 26.
    Kajii, Y, Shingai, T, Kitagawa, J, Takahashi, Y, Taguchi, Y, Noda, T, Yamada, Y 2002Sour taste stimulation facilitates reflex swallowing from the pharynx and larynx in the rat.Physiol Behav77321325PubMedGoogle Scholar
  27. 27.
    O’Doherty, J, Rolls, ET, Francis, S, Bowtell, R, McGlone, F 2001Representation of pleasant and aversive taste in the human brain.J Neurophysiol8513151321PubMedGoogle Scholar
  28. 28.
    Bujas, Z, Ajdukovic, D, Szabo, S, Mayer, D, Vodanovic, M 1995Central processes in gustatory adaptation.Physiol Behav57875880PubMedGoogle Scholar
  29. 29.
    Lawless, HT 1982Paradoxical adaptation to taste mixtures.Physiol Behav25149152CrossRefGoogle Scholar
  30. 30.
    Lawless, HT 1982Adapting efficiency of salt–sucrose mixtures.Percept Psychophys32419422PubMedGoogle Scholar
  31. 31.
    Langmore, SE 2001Endoscopic Evaluation and Treatment of Swallowing Disorders.ThiemeNew YorkGoogle Scholar
  32. 32.
    McCutcheon, B, Tennissen, AM 1989Acid and NaCl self-adaptation with microdrop stimulation of fungiform papillae.Physiol Behav46613618PubMedGoogle Scholar
  33. 33.
    Zotterman, Y 1967The neural mechanism of taste.Sensory Mechanisms: Progress in Brain Research139154Google Scholar
  34. 34.
    O’Mahony M: Taste: media and method. Dissertation, Bristol University, 1971Google Scholar
  35. 35.
    Chauncey, HH, Feller, RP, Shannon, IL 1963Effect of acid solutions on human gustatory chemoreceptors as determined by parotid gland secretion rate.Proc Soc Exp Bio Med112917923Google Scholar
  36. 36.
    Hughes, CV, Baum, B, Fox, PC, Marmary, Y, Yeh, CK, Sonies, BC 1987Oral–pharyngeal dysphagia: a common sequela of salivary gland dysfunction.Dysphagia1173177Google Scholar
  37. 37.
    Närhi, TO, Meurman, JH, Ainamo, A, Nevalainen, JM, Schmidt–Kaunisaho, KG, Siukosaari, P 1992Association between salivary flow rate and the use of systemic medication among 76-, 81-, and 86-year-old inhabitants in Helsinki, Finland.J Dent Res7118751880PubMedGoogle Scholar
  38. 38.
    Hamlet, S, Choi, J, Zormeier, M, Shamsa, F, Stachler, R, Muz, J, Jones, L 1996Normal adult swallowing of liquid and viscous material: scintigraphic data on bolus transit and oropharyngeal residues.Dysphagia114147PubMedGoogle Scholar
  39. 39.
    Steele CM, Van Lieshout PHHM: Estimates of normal sip-size revisited. Tenth Annual Dysphagia Research Society Meeting, Albuquerque, NM, 2001Google Scholar
  40. 40.
    Adnerhill, L, Ekberg, O, Groher, ME 1989Determining normal bolus size for thin liquids.Dysphagia413PubMedGoogle Scholar
  41. 41.
    Langmore, SE, Schatz, K, Olson, N 1991Endoscopic and videofluoroscopic evaluations of swallowing and aspiration.Ann Otol Rhinol Laryngol100678681PubMedGoogle Scholar
  42. 42.
    Leder, SB, Sasaki, CT, Burrell, MI 1998Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration.Dysphagia131921PubMedGoogle Scholar
  43. 43.
    Wu, C, Hsiao, T, Chen, J, Chang, Y, Lee, S 1997Evaluation of swallowing safety with fiberoptic endoscope: Comparison with videofluoroscopic technique.Laryngoscope107396401PubMedGoogle Scholar
  44. 44.
    McCullough, GH, Rosenbek, JC, Robbins, J, Coyle, JL, Wood, J 1998Ordinality and intervality of a penetration–aspiration scale.J Med Speech Lang Pathol66572Google Scholar
  45. 45.
    Colodny, N 2002Interjudge and intrajudge reliability in fiberoptic endoscopic evaluation of swallowing (FEES) using the penetration–aspiration scale: a replication study.Dysphagia17308315PubMedGoogle Scholar
  46. 46.
    Gill, G, Hind, J, Robbins, J 2001Protocol 201: A NIDCD funded multisite clinical trial in swallowing—a progress report.ASHA Special Interest Division 13, Swallowing and Swallowing Disorders101719Google Scholar
  47. 47.
    Murphy, C, Gilmore, MM, Seely, CS, Salmon, DP, Lasker, BR 1990Olfactory thresholds are associated with degree of dementia in Alzheimer’s disease.Neurobiol Aging11465469PubMedGoogle Scholar
  48. 48.
    Murphy, C, Nordin, S, Jinich, S 1999Very early decline in recognition memory for odors in Alzheimer’s disease.Aging Neuropsychol Cognition6229240CrossRefGoogle Scholar
  49. 49.
    Nordin, S, Murphy, C 1996Impaired sensory and cognitive olfactory function in questionable Alzheimer’s disease.Neuropsychology10113119CrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 2003

Authors and Affiliations

  1. 1.Department of Food Science & TechnologyCornell University, Ithaca, New YorkUSA

Personalised recommendations