What About Foods? The Influence of Food Texture on the Safety, Timing, Kinematics, and Efficiency of Pharyngeal Phase Swallowing in Healthy Adults.

PURPOSE: Solid food stimuli (e.g., crackers) are commonly used in videofluoroscopic swallowing studies (VFSS). A variety of additional food textures may be included when exploring the benefit of compensatory strategies. However, interpretation regarding these textures is hindered by a lack of data outlining expected values for measures of swallowing safety, kinematics, timing, and efficiency. We report preliminary data for quantitative VFSS measures with International Dysphagia Diet Standardisation Initiative (IDDSI) food levels MM5 (minced and moist), SB6 (soft-and-bite-sized), and RG7 (regular) in healthy young adults. METHOD: VFSS were performed at 30 frames per second in 20 participants (10 men, 10 women; M_age = 28 years, range: 23-55) who swallowed two boluses each of MM5 (teaspoon), SB6 (cube 1.5 cm³), and RG7 (bite) barium stimuli. Blinded duplicate rating identified key frames on the initial swallow of each bolus, from which timing measures were derived relative to hyoid burst (HYB) and end of aggregation (EOA). Safety was scored using the 8-point Penetration-Aspiration Scale. Anatomically normalized pixel-based measures of pharyngeal area at maximum pharyngeal constriction (PhAMPC), upper esophageal sphincter maximum distention (UESMAX), and residue were obtained. Intraclass correlations were calculated for reliability; discrepancies were resolved by consensus. Friedman's tests explored differences by texture. The results were compared to previously reported reference data for teaspoons of EX4/PU4 using one-sample t tests. RESULTS: Timing measures relative to HYB increased across textures: MM5 < SB6 < RG7 and were significantly longer than reported values for EX4/PU4. Timing measures calculated relative to EOA did not differ by texture. UES opening duration was significantly longer for MM5 than SB6, RG7, and EX4/PU4. UESMAX distention was significantly smaller for RG7 and EX4/PU4 than MM5 and SB6. PhAMPC was larger for MM5, SB6, and RG7 than EX4/PU4. Total pharyngeal residue was significantly greater for MM5 and RG7 than for SB6 and EX4/PU4. CONCLUSIONS: These data suggest that variations in some pharyngeal phase parameters should be expected across IDDSI levels EX4/PU4, MM5, SB6, and RG7. Additional research is needed to elucidate interactions of bolus size and cohesiveness with these texture-related differences. Teaspoons of EX4/PU4 stimuli are insufficient to predict swallowing physiology with higher food texture levels. RG7 stimuli are recommended to test pharyngeal constriction and swallowing efficiency. SB6 stimuli can provide additional insights regarding the benefits of altering bolus properties in terms of swallowing efficiency. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.31592143.