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Published in: Pediatric Radiology 9/2015

01-08-2015 | Original Article

Analysis of carbonated thin liquids in pediatric neurogenic dysphagia

Authors: Jennifer P. Lundine, David G. Bates, Han Yin

Published in: Pediatric Radiology | Issue 9/2015

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Abstract

Background

Aspiration of liquids is a serious complication of neurological impairments such as traumatic brain injury or stroke. Carbonated liquids have been examined as a possible alternative to thickened liquids to help reduce aspiration in cases of dysphagia in adults, but no published literature to the best of our knowledge has evaluated this technique in children. If carbonated liquids result in safer swallowing in children, they could provide a preferred alternative to thickened liquids.

Objective

This pilot study examined whether carbonated thin liquids (CARB) improved swallowing compared to non-carbonated thin liquids (NOCARB) for children with neurogenic dysphagia.

Materials and methods

Twenty-four children admitted to a level I trauma center for acute neurological injury/disease were evaluated via videofluoroscopic swallow studies. Four descriptive outcome measures were contrasted.

Results

CARB significantly decreased pooling (P = 0.0006), laryngeal penetration/aspiration (P = 0.0044) and Penetration-Aspiration Scale scores (P = 0.0127) when compared to NOCARB. On average, CARB improved scores on the Penetration-Aspiration Scale by 3.7 points for participants who aspirated NOCARB. There was no significant difference in pharyngeal residue noted between CARB and NOCARB (P = 0.0625).

Conclusion

These findings support the hypothesis that carbonated thin liquids may provide an alternative to thickened liquids for children with neurogenic dysphagia. Implications for future research and clinical practice are discussed.
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Literature
1.
go back to reference Morgan AT (2010) Dysphagia in childhood traumatic brain injury: a reflection on the evidence and its implications for practice. Dev Neurorehabil 3:192–203CrossRef Morgan AT (2010) Dysphagia in childhood traumatic brain injury: a reflection on the evidence and its implications for practice. Dev Neurorehabil 3:192–203CrossRef
2.
go back to reference Plowman EK, Mehdizadeh O, Leder SB et al (2012) A bibliometric review of published abstracts presented at the dysphagia research society: 2001-2011. Dysphagia 28:128–130 Plowman EK, Mehdizadeh O, Leder SB et al (2012) A bibliometric review of published abstracts presented at the dysphagia research society: 2001-2011. Dysphagia 28:128–130
3.
go back to reference Ylvisaker M, Logemann JA (1985) Therapy for feeding and swallowing disorders following head injury. In: Ylsivaker M (ed) Head injury rehabilitation: children and adolescents. College-Hill Press, Boston, pp 195–215 Ylvisaker M, Logemann JA (1985) Therapy for feeding and swallowing disorders following head injury. In: Ylsivaker M (ed) Head injury rehabilitation: children and adolescents. College-Hill Press, Boston, pp 195–215
4.
go back to reference Dodds WJ, Logemann JA, Stewart E (1990) Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol 5:965–974CrossRef Dodds WJ, Logemann JA, Stewart E (1990) Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol 5:965–974CrossRef
5.
go back to reference Morgan A, Ward E, Murdoch B et al (2003) Incidence, characteristics, and predictive factors for dysphagia after pediatric traumatic brain injury. J Head Trauma Rehabil 3:239–251CrossRef Morgan A, Ward E, Murdoch B et al (2003) Incidence, characteristics, and predictive factors for dysphagia after pediatric traumatic brain injury. J Head Trauma Rehabil 3:239–251CrossRef
6.
go back to reference Arvedson J, Rogers B, Buck G et al (1994) Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol 2-3:173–181CrossRef Arvedson J, Rogers B, Buck G et al (1994) Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol 2-3:173–181CrossRef
7.
go back to reference Weir K, McMahon S, Barry L et al (2007) Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol 11:1024–1031CrossRef Weir K, McMahon S, Barry L et al (2007) Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol 11:1024–1031CrossRef
8.
go back to reference Dusick A (2003) Investigation and management of dysphagia. Semin Pediatr Neurol 4:255–264CrossRef Dusick A (2003) Investigation and management of dysphagia. Semin Pediatr Neurol 4:255–264CrossRef
9.
go back to reference Carrau RL, Murry T (eds) (1999) Comprehensive management of swallowing disorders. Plural Publishing, San Diego Carrau RL, Murry T (eds) (1999) Comprehensive management of swallowing disorders. Plural Publishing, San Diego
10.
go back to reference Arvedson JC (2008) Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev 2:118–127CrossRef Arvedson JC (2008) Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev 2:118–127CrossRef
11.
go back to reference Rogers B, Arvedson J (2005) Assessment of infant oral sensorimotor and swallowing function. Ment Retard Dev Disabil Res Rev 1:74–82CrossRef Rogers B, Arvedson J (2005) Assessment of infant oral sensorimotor and swallowing function. Ment Retard Dev Disabil Res Rev 1:74–82CrossRef
12.
go back to reference Tutor JD, Gosa MM (2012) Dysphagia and aspiration in children. Pediatr Pulmonol 4:321–337CrossRef Tutor JD, Gosa MM (2012) Dysphagia and aspiration in children. Pediatr Pulmonol 4:321–337CrossRef
13.
go back to reference Smith Hammond CA, Goldstein LB (2006) Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest 129:154S–168SPubMedCrossRef Smith Hammond CA, Goldstein LB (2006) Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest 129:154S–168SPubMedCrossRef
14.
go back to reference Robey RR (2004) A five-phase model for clinical-outcome research. J Commun Disord 5:401–411CrossRef Robey RR (2004) A five-phase model for clinical-outcome research. J Commun Disord 5:401–411CrossRef
15.
go back to reference Rosenbek JC, Robbins JA, Roecker EB et al (1996) A penetration-aspiration scale. Dysphagia 2:93–98CrossRef Rosenbek JC, Robbins JA, Roecker EB et al (1996) A penetration-aspiration scale. Dysphagia 2:93–98CrossRef
16.
go back to reference Bulow M, Olsson R, Ekberg O (2003) Videoradiographic analysis of how carbonated thin liquids and thickened liquids affect the physiology of swallowing in subjects with aspiration on thin liquids. Acta Radiol 44:366–372PubMedCrossRef Bulow M, Olsson R, Ekberg O (2003) Videoradiographic analysis of how carbonated thin liquids and thickened liquids affect the physiology of swallowing in subjects with aspiration on thin liquids. Acta Radiol 44:366–372PubMedCrossRef
17.
go back to reference Sdravou K, Walshe M, Dagdilelis L (2012) Effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia. Dysphagia 2:240–250CrossRef Sdravou K, Walshe M, Dagdilelis L (2012) Effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia. Dysphagia 2:240–250CrossRef
18.
go back to reference Martin-Harris B, Brodsky MB, Michel Y et al (2007) Delayed initiation of the pharyngeal swallow: normal variability in adult swallows. J Speech Lang Hear Res 3:585–594CrossRef Martin-Harris B, Brodsky MB, Michel Y et al (2007) Delayed initiation of the pharyngeal swallow: normal variability in adult swallows. J Speech Lang Hear Res 3:585–594CrossRef
19.
go back to reference Krival CR (2007) Effects of carbonated vs. thin and thickened liquids on swallowing in adults with neurogenic oropharyngeal dysphagia. Dissertation, University of Cincinnati. http://etd.ohiolink.edu Krival CR (2007) Effects of carbonated vs. thin and thickened liquids on swallowing in adults with neurogenic oropharyngeal dysphagia. Dissertation, University of Cincinnati. http://​etd.​ohiolink.​edu
20.
go back to reference Eisenhuber E, Schima W, Schober E et al (2002) Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. AJR Am J Roentgenol 178:393–398PubMedCrossRef Eisenhuber E, Schima W, Schober E et al (2002) Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. AJR Am J Roentgenol 178:393–398PubMedCrossRef
21.
go back to reference Gravetter FJ, Wallnau LB (2009) Statistics for the behavioral sciences. Wadsworth Cengage Learning, Belmont Gravetter FJ, Wallnau LB (2009) Statistics for the behavioral sciences. Wadsworth Cengage Learning, Belmont
22.
go back to reference Arvedson JC (1998) Management of pediatric dysphagia. Otolaryngol Clin N Am 3:453–476CrossRef Arvedson JC (1998) Management of pediatric dysphagia. Otolaryngol Clin N Am 3:453–476CrossRef
23.
go back to reference Prasse JE, Kikano GE (2009) An overview of pediatric dysphagia. Clin Pediatr (Phila) 48:247–251CrossRef Prasse JE, Kikano GE (2009) An overview of pediatric dysphagia. Clin Pediatr (Phila) 48:247–251CrossRef
24.
go back to reference Ding R, Logemann JA, Larson CR et al (2003) The effects of taste and consistency on swallow physiology in younger and older healthy individuals: a surface electromyographic study. J Speech Lang Hear Res 46:977–989PubMedCrossRef Ding R, Logemann JA, Larson CR et al (2003) The effects of taste and consistency on swallow physiology in younger and older healthy individuals: a surface electromyographic study. J Speech Lang Hear Res 46:977–989PubMedCrossRef
25.
go back to reference Leow LP, Huckabee ML, Sharma S et al (2007) The influence of taste on swallowing apnea, oral preparation time, and duration and amplitude of submental muscle contraction. Chem Senses 32:119–128PubMedCrossRef Leow LP, Huckabee ML, Sharma S et al (2007) The influence of taste on swallowing apnea, oral preparation time, and duration and amplitude of submental muscle contraction. Chem Senses 32:119–128PubMedCrossRef
26.
go back to reference Todd JT, Butler SG, Plonk DP (2012) Effects of chemesthetic stimuli mixtures with barium on swallowing apnea duration. Laryngoscope 10:2248–2251CrossRef Todd JT, Butler SG, Plonk DP (2012) Effects of chemesthetic stimuli mixtures with barium on swallowing apnea duration. Laryngoscope 10:2248–2251CrossRef
27.
go back to reference Logemann JA, Pauloski BR, Colangelo L et al (1995) Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia. J Speech Hear Res 38:556–563PubMedCrossRef Logemann JA, Pauloski BR, Colangelo L et al (1995) Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia. J Speech Hear Res 38:556–563PubMedCrossRef
28.
go back to reference Pelletier CA, Lawless HT (2003) Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia 4:231–241CrossRef Pelletier CA, Lawless HT (2003) Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia 4:231–241CrossRef
29.
go back to reference Chee C, Arshad S, Singh S et al (2005) The influence of chemical gustatory stimuli and oral anaesthesia on healthy human pharyngeal swallowing. Chem Senses 5:393–400CrossRef Chee C, Arshad S, Singh S et al (2005) The influence of chemical gustatory stimuli and oral anaesthesia on healthy human pharyngeal swallowing. Chem Senses 5:393–400CrossRef
30.
go back to reference Pelletier CA, Dhanaraj GE (2006) The effect of taste and palatability on lingual swallowing pressure. Dysphagia 2:121–128CrossRef Pelletier CA, Dhanaraj GE (2006) The effect of taste and palatability on lingual swallowing pressure. Dysphagia 2:121–128CrossRef
31.
go back to reference Swank Nixon T (1997) Use of carbonated liquids in the treatment of dysphagia. In: Network: a newsletter of dietetics in physical medicine and rehabilitation. American Dietetic Association, New York Swank Nixon T (1997) Use of carbonated liquids in the treatment of dysphagia. In: Network: a newsletter of dietetics in physical medicine and rehabilitation. American Dietetic Association, New York
33.
go back to reference Mastan A, Michou E, Mistry S et al (2011) Evidence for an enhancing effect of carbonated liquids on complex human swallowing behavior. Gut 60:A162CrossRef Mastan A, Michou E, Mistry S et al (2011) Evidence for an enhancing effect of carbonated liquids on complex human swallowing behavior. Gut 60:A162CrossRef
34.
go back to reference Michou E, Mastan A, Ahmed S et al (2012) Examining the role of carbonation and temperature on water swallowing performance: a swallowing reaction-time study. Chem Senses 37:799–807PubMedCrossRef Michou E, Mastan A, Ahmed S et al (2012) Examining the role of carbonation and temperature on water swallowing performance: a swallowing reaction-time study. Chem Senses 37:799–807PubMedCrossRef
35.
go back to reference Newman L, Armstrong R, Rogers T et al (2001) The effect of carbonation on sensory dysphagia in the pediatric population: abstracts of scientific papers presented at the Ninth Annual Dysphagia Research Society Meeting, Savannah, Georgia, USA, October 26-28, 2000. Dysphagia 16:146–150CrossRef Newman L, Armstrong R, Rogers T et al (2001) The effect of carbonation on sensory dysphagia in the pediatric population: abstracts of scientific papers presented at the Ninth Annual Dysphagia Research Society Meeting, Savannah, Georgia, USA, October 26-28, 2000. Dysphagia 16:146–150CrossRef
36.
go back to reference Krival K, Bates C (2012) Effects of club soda and ginger brew on linguapalatal pressures in healthy swallowing. Dysphagia 2:228–239CrossRef Krival K, Bates C (2012) Effects of club soda and ginger brew on linguapalatal pressures in healthy swallowing. Dysphagia 2:228–239CrossRef
37.
go back to reference Matsuo K, Palmer JB (2008) Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am 4:691–707, viiCrossRef Matsuo K, Palmer JB (2008) Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am 4:691–707, viiCrossRef
38.
go back to reference Stephen JR, Taves DH, Smith RC et al (2005) Bolus location at the initiation of the pharyngeal stage of swallowing in healthy older adults. Dysphagia 4:266–272CrossRef Stephen JR, Taves DH, Smith RC et al (2005) Bolus location at the initiation of the pharyngeal stage of swallowing in healthy older adults. Dysphagia 4:266–272CrossRef
39.
go back to reference Marik PE (2001) Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 9:665–671CrossRef Marik PE (2001) Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 9:665–671CrossRef
40.
go back to reference Hind JA, Gensler G, Brandt DK et al (2009) Comparison of trained clinician ratings with expert ratings of aspiration on videofluoroscopic images from a randomized clinical trial. Dysphagia 2:211–217CrossRef Hind JA, Gensler G, Brandt DK et al (2009) Comparison of trained clinician ratings with expert ratings of aspiration on videofluoroscopic images from a randomized clinical trial. Dysphagia 2:211–217CrossRef
41.
go back to reference Rosenbek JC, Power M, Lefton-Greif M et al (2006) Translation to treatment: the clinical implications of penetration/aspiration. Clinical presentation at the Annual Convention of the American Speech Hearing Association, Miami, Florida, 16-18 Nov 2006 Rosenbek JC, Power M, Lefton-Greif M et al (2006) Translation to treatment: the clinical implications of penetration/aspiration. Clinical presentation at the Annual Convention of the American Speech Hearing Association, Miami, Florida, 16-18 Nov 2006
42.
go back to reference Gosa MM, Suiter DM (2011) Reliability of the penetration-aspiration scale for use with pediatric populations. Paper presented at the Annual Convention of the American Speech Hearing Association, San Diego, 16-19 Nov 2011 Gosa MM, Suiter DM (2011) Reliability of the penetration-aspiration scale for use with pediatric populations. Paper presented at the Annual Convention of the American Speech Hearing Association, San Diego, 16-19 Nov 2011
43.
go back to reference Weir KA, McMahon S, Taylor S et al (2011) Oropharyngeal aspiration and silent aspiration in children. Chest 140:589–597PubMedCrossRef Weir KA, McMahon S, Taylor S et al (2011) Oropharyngeal aspiration and silent aspiration in children. Chest 140:589–597PubMedCrossRef
44.
go back to reference Osborn AJ, de Alarcon A, Tabangin ME et al (2014) Swallowing function after laryngeal cleft repair: more than just fixing the cleft. Laryngoscope 124:1965–1969PubMedCrossRef Osborn AJ, de Alarcon A, Tabangin ME et al (2014) Swallowing function after laryngeal cleft repair: more than just fixing the cleft. Laryngoscope 124:1965–1969PubMedCrossRef
45.
go back to reference Daniels SK, Schroeder MF, McClain M et al (2006) Dysphagia in stroke: development of a standard method to examine swallowing recovery. J Rehabil Res Dev 3:347–356CrossRef Daniels SK, Schroeder MF, McClain M et al (2006) Dysphagia in stroke: development of a standard method to examine swallowing recovery. J Rehabil Res Dev 3:347–356CrossRef
46.
go back to reference Pearson WG, Molfenter SM, Smith ZM et al (2013) Image-based measurement of post-swallow residue: the normalized residue ratio scale. Dysphagia 28:167–177PubMedCentralPubMedCrossRef Pearson WG, Molfenter SM, Smith ZM et al (2013) Image-based measurement of post-swallow residue: the normalized residue ratio scale. Dysphagia 28:167–177PubMedCentralPubMedCrossRef
47.
go back to reference Amis ES, Butler PF, Applegate KE et al (2007) American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 4:272–284PubMedCrossRef Amis ES, Butler PF, Applegate KE et al (2007) American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 4:272–284PubMedCrossRef
48.
go back to reference Strauss KJ, Kaste SC (2006) The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: Striving to keep radiation dose as low as possible during fluoroscopy of pediatric patients – a white paper executive summary. Pediatr Radiol 36:110–112PubMedCentralPubMedCrossRef Strauss KJ, Kaste SC (2006) The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: Striving to keep radiation dose as low as possible during fluoroscopy of pediatric patients – a white paper executive summary. Pediatr Radiol 36:110–112PubMedCentralPubMedCrossRef
49.
go back to reference Cohen MD (2007) Are we doing enough to minimize fluoroscopic radiation exposure in children? Pediatr Radiol 37:1020–1024PubMedCrossRef Cohen MD (2007) Are we doing enough to minimize fluoroscopic radiation exposure in children? Pediatr Radiol 37:1020–1024PubMedCrossRef
50.
go back to reference Cohen MD (2009) Can we use pulsed fluoroscopy to decrease the radiation dose during video fluoroscopic feeding studies in children? Clin Radiol 64:70–73PubMedCrossRef Cohen MD (2009) Can we use pulsed fluoroscopy to decrease the radiation dose during video fluoroscopic feeding studies in children? Clin Radiol 64:70–73PubMedCrossRef
51.
go back to reference Bonilha HS, Blair J, Carnes B et al (2013) Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations. Dysphagia 28:528–538PubMedCrossRef Bonilha HS, Blair J, Carnes B et al (2013) Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations. Dysphagia 28:528–538PubMedCrossRef
52.
go back to reference Ohio Administrative Code (2011) Chap5101:3-10-26: medical supplies, durable medical equipment, orthoses, and prosthesis providers: enteral nutritional products. http://codesohiogov/oac/5101%3A3-10-26, 2011. Accessed 20 Jan 2013 Ohio Administrative Code (2011) Chap5101:3-10-26: medical supplies, durable medical equipment, orthoses, and prosthesis providers: enteral nutritional products. http://​codesohiogov/​oac/​5101%3A3-10-26, 2011. Accessed 20 Jan 2013
Metadata
Title
Analysis of carbonated thin liquids in pediatric neurogenic dysphagia
Authors
Jennifer P. Lundine
David G. Bates
Han Yin
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 9/2015
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-015-3314-z

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