Skip to main content
SpringerLink
Log in

Analysis of carbonated thin liquids in pediatric neurogenic dysphagia

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

An Erratum to this article was published on 24 April 2015

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Morgan AT (2010) Dysphagia in childhood traumatic brain injury: a reflection on the evidence and its implications for practice. Dev Neurorehabil 3:192–203

    Article  Google Scholar 

  2. 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

    Google Scholar 

  3. 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

    Google Scholar 

  4. Dodds WJ, Logemann JA, Stewart E (1990) Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol 5:965–974

    Article  Google Scholar 

  5. 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 3:239–251

    Article  Google Scholar 

  6. Arvedson J, Rogers B, Buck G et al (1994) Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol 2-3:173–181

    Article  Google Scholar 

  7. Weir K, McMahon S, Barry L et al (2007) Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol 11:1024–1031

    Article  Google Scholar 

  8. Dusick A (2003) Investigation and management of dysphagia. Semin Pediatr Neurol 4:255–264

    Article  Google Scholar 

  9. Carrau RL, Murry T (eds) (1999) Comprehensive management of swallowing disorders. Plural Publishing, San Diego

    Google Scholar 

  10. Arvedson JC (2008) Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev 2:118–127

    Article  Google Scholar 

  11. Rogers B, Arvedson J (2005) Assessment of infant oral sensorimotor and swallowing function. Ment Retard Dev Disabil Res Rev 1:74–82

    Article  Google Scholar 

  12. Tutor JD, Gosa MM (2012) Dysphagia and aspiration in children. Pediatr Pulmonol 4:321–337

    Article  Google Scholar 

  13. 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–168S

    Article  PubMed  Google Scholar 

  14. Robey RR (2004) A five-phase model for clinical-outcome research. J Commun Disord 5:401–411

    Article  Google Scholar 

  15. Rosenbek JC, Robbins JA, Roecker EB et al (1996) A penetration-aspiration scale. Dysphagia 2:93–98

    Article  Google Scholar 

  16. 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 44:366–372

    Article  CAS  PubMed  Google Scholar 

  17. Sdravou K, Walshe M, Dagdilelis L (2012) Effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia. Dysphagia 2:240–250

    Article  Google Scholar 

  18. 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 3:585–594

    Article  Google Scholar 

  19. 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. 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 178:393–398

    Article  PubMed  Google Scholar 

  21. Gravetter FJ, Wallnau LB (2009) Statistics for the behavioral sciences. Wadsworth Cengage Learning, Belmont

    Google Scholar 

  22. Arvedson JC (1998) Management of pediatric dysphagia. Otolaryngol Clin N Am 3:453–476

    Article  Google Scholar 

  23. Prasse JE, Kikano GE (2009) An overview of pediatric dysphagia. Clin Pediatr (Phila) 48:247–251

    Article  Google Scholar 

  24. 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 46:977–989

    Article  PubMed  Google Scholar 

  25. 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 32:119–128

    Article  CAS  PubMed  Google Scholar 

  26. Todd JT, Butler SG, Plonk DP (2012) Effects of chemesthetic stimuli mixtures with barium on swallowing apnea duration. Laryngoscope 10:2248–2251

    Article  Google Scholar 

  27. 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 38:556–563

    Article  CAS  PubMed  Google Scholar 

  28. Pelletier CA, Lawless HT (2003) Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia 4:231–241

    Article  Google Scholar 

  29. 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 5:393–400

    Article  Google Scholar 

  30. Pelletier CA, Dhanaraj GE (2006) The effect of taste and palatability on lingual swallowing pressure. Dysphagia 2:121–128

    Article  Google Scholar 

  31. 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

  32. Bradley RM (2000) Sensory receptors of the larynx. Am J Med 108:47S–50S

    Article  PubMed  Google Scholar 

  33. Mastan A, Michou E, Mistry S et al (2011) Evidence for an enhancing effect of carbonated liquids on complex human swallowing behavior. Gut 60:A162

    Article  Google Scholar 

  34. 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 37:799–807

    Article  PubMed  Google Scholar 

  35. 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 16:146–150

    Article  Google Scholar 

  36. Krival K, Bates C (2012) Effects of club soda and ginger brew on linguapalatal pressures in healthy swallowing. Dysphagia 2:228–239

    Article  Google Scholar 

  37. Matsuo K, Palmer JB (2008) Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am 4:691–707, vii

    Article  Google Scholar 

  38. 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 4:266–272

    Article  Google Scholar 

  39. Marik PE (2001) Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 9:665–671

    Article  Google Scholar 

  40. 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 2:211–217

    Article  Google Scholar 

  41. 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. 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. Weir KA, McMahon S, Taylor S et al (2011) Oropharyngeal aspiration and silent aspiration in children. Chest 140:589–597

    Article  PubMed  Google Scholar 

  44. Osborn AJ, de Alarcon A, Tabangin ME et al (2014) Swallowing function after laryngeal cleft repair: more than just fixing the cleft. Laryngoscope 124:1965–1969

    Article  PubMed  Google Scholar 

  45. 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 3:347–356

    Article  Google Scholar 

  46. Pearson WG, Molfenter SM, Smith ZM et al (2013) Image-based measurement of post-swallow residue: the normalized residue ratio scale. Dysphagia 28:167–177

    Article  PubMed Central  PubMed  Google Scholar 

  47. Amis ES, Butler PF, Applegate KE et al (2007) American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 4:272–284

    Article  PubMed  Google Scholar 

  48. 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 36:110–112

    Article  PubMed Central  PubMed  Google Scholar 

  49. Cohen MD (2007) Are we doing enough to minimize fluoroscopic radiation exposure in children? Pediatr Radiol 37:1020–1024

    Article  PubMed  Google Scholar 

  50. Cohen MD (2009) Can we use pulsed fluoroscopy to decrease the radiation dose during video fluoroscopic feeding studies in children? Clin Radiol 64:70–73

    Article  CAS  PubMed  Google Scholar 

  51. 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 28:528–538

    Article  PubMed  Google Scholar 

  52. 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

Download references

Acknowledgments

This project was funded in part by the Maternal and Child Health Bureau Grant T73MC00049 and CTSA grant UL1TR001070.

Jennifer P. Lundine would like to thank the following people for their support with the organization and analysis of this study: Kelsey Egelhoff, PhD, Michael Trudeau, PhD, Linda Lowes, PhD, Adriane Baylis, PhD, Tamela Thompson, MA, Stephanie Oswald, MA, and Caitlin Sirois, MS. Much gratitude to Brad Hoehne in the Department of Radiology for his assistance with the video edits required for this study.

Conflicts of interest

None

Author information

Authors and Affiliations

  1. Department of Speech Pathology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Jennifer P. Lundine

  2. Children’s Radiological Institute, Nationwide Children’s Hospital, Columbus, OH, USA

    David G. Bates

  3. School of Medicine & Public Health, Ohio State University, Columbus, OH, USA

    David G. Bates

  4. Biostatistics Core, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Han Yin

Authors
  1. Jennifer P. Lundine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David G. Bates
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Han Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer P. Lundine.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

NOCARB via spoon, slowed by 50%. Vallecular/pyriform pooling prior to swallow. Aspiration on last swallow. (MP4 21102 kb)

ESM 2

CARB via spoon, slowed by 50%. Residue from aspiration with NOCARB present on surface of vocal folds prior to first swallow. No pyriform pooling prior to swallow. No new laryngeal penetration or aspiration observed. (MP4 14505 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lundine, J.P., Bates, D.G. & Yin, H. Analysis of carbonated thin liquids in pediatric neurogenic dysphagia. Pediatr Radiol 45, 1323–1332 (2015). https://doi.org/10.1007/s00247-015-3314-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-015-3314-z

Keywords

Search

Navigation