Taste Manipulation and Swallowing Mechanics in Trauma-Related Sensory-Based Dysphagia

Authors

Angela M. Dietsch, University of Nebraska-LincolnFollow
H. Duncan Dorris, Medical College of Georgia, Augusta University
William Pearson, Medical College of Georgia, Augusta University
Katie E. Dietrich-Burns, Walter Reed National Military Medical Center
Nancy Pearl Solomon, Walter Reed National Military Medical CenterFollow

ORCID IDs

Dietsch 0000-0003-4554-5365

Document Type

Article

Date of this Version

8-2019

Citation

Journal of Speech, Language, and Hearing Research (August 2019) 62: 2,703–2,712

Comments

United States government work

Abstract

Purpose: This study explored the effects of highconcentration taste manipulation trials on swallow function in persons with sensory-based dysphagia.

Method: Dysphagia researchers partnered with clinical providers to prospectively identify traumatically injured U.S. military service members (N = 18) with sensorybased dysphagia as evidenced by delayed initiation and/or decreased awareness of residue/penetration/ aspiration. Under videofluoroscopy, participants swallowed trials of 3 custom-mixed taste stimuli: unflavored (40% weight/volume [wt/vol] barium sulfate in distilled water), sour (2.7%wt/vol citric acid in 40% wt/vol barium suspension), and sweet–sour (1.11% wt/vol citric acid plus 8% wt/vol sucrose in 40% wt/vol barium suspension). Trials were analyzed and compared via clinical rating tools (the Modified Barium Swallow Impairment Profile [Martin-Harris et al., 2008] and the Penetration-Aspiration Scale [Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996]). Additionally, a computational analysis of swallowing mechanics (CASM) was applied to a subset of 9 swallows representing all 3 tastants from 3 participants.

Results: Friedman’s tests for the 3 stimuli revealed significantly (p < .05) improved functional ratings for Penetration-Aspiration Scale and pharyngoesophageal opening. CASM indicated differences in pharyngeal swallowing mechanics across all tastant comparisons (p ≤ .0001). Eigenvectors revealed increased tongue base retraction, hyoid elevation, and pharyngeal shortening for sweet–sour and, to a lesser extent, sour than for unflavored boluses.

Conclusion: Advantageous changes in certain parameters of oropharyngeal swallowing physiology were noted with high-intensity tastants per both clinical ratings and subsequent CASM, suggesting potential therapeutic application for taste manipulation.