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Westemeyer RM, Dietsch AM. Comparing Taste Perception Across Modalities in Healthy Adults: Liquids Versus Dissolvable Taste Strips. Dysphagia 2024; 39:52-62. [PMID: 37243729 PMCID: PMC10221740 DOI: 10.1007/s00455-023-10592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
Taste stimulation has rehabilitative value in dysphagia management, as it activates salient underlying afferent pathways to swallowing which may evoke feedforward effects on swallow biomechanics. Despite its potential beneficial effects on swallow physiology, taste stimulation's clinical application is limited for persons unsafe to orally consume food/liquid. This study aimed to create edible, dissolvable taste strips matched to flavor profiles previously used in research assessing taste's effects on swallowing physiology and brain activity, and to evaluate how similar their perceived intensity and hedonic, or palatability, ratings were between their liquid counterparts. Plain, sour, sweet-sour, lemon, and orange flavor profiles were custom-made in taste strips and liquid modalities. The generalized Labeled Magnitude Scale and hedonic generalized Labeled Magnitude Scale were used to assess intensity and palatability ratings for flavor profiles in each modality. Healthy participants were recruited and stratified across age and sex. Liquids were rated as more intense than taste strips; however, there was no difference in palatability ratings between the modalities. There were significant differences across flavor profiles in intensity and palatability ratings. Collapsed across liquid and taste strip modalities, pairwise comparisons revealed all flavored stimuli were rated as more intense than the plain profile, sour was perceived as more intense and less palatable than all other profiles, and orange was rated as more palatable than sour, lemon, and plain tastants. Taste strips have useful implications for dysphagia management, as they could offer safe and patient-preferred flavor profiles to potentially provide advantageous swallowing and neural hemodynamic responses.
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Affiliation(s)
- Ross M Westemeyer
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, 4075 East Campus Loop, BKC 101W, Lincoln, NE, 68583, USA
| | - Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, 4075 East Campus Loop, BKC 101W, Lincoln, NE, 68583, USA.
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, USA.
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2
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Lee TS, Dietsch AM, Damra RH, Mulheren RW. The Effect of Genetic Taste Status on Swallowing: A Literature Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-12. [PMID: 37257285 DOI: 10.1044/2023_ajslp-22-00384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Swallowing and taste share innervation pathways and are crucial to nutritive intake. Individuals vary in their perception of taste due to factors such as genetics; however, it is unclear to what extent genetic taste status influences swallowing physiology and function. The purpose of this review article is to provide background on genetic taste status, review the evidence on the association between genetic taste status and swallowing, and discuss research and clinical implications. METHOD A comprehensive literature review was conducted using search terms related to swallowing and genetic taste status. Studies were included if they investigated the main effect of genetic taste status on swallowing or the interaction of genetic taste status with other variables. Studies were grouped by participant population (healthy participants or persons with a swallowing disorder), swallowing-related outcome measure, and method of genetic taste status measurement. RESULTS The results were mixed, with five of 10 reviewed studies reporting a statistically significant main or interaction effect on swallowing. Most studies included healthy participants, with only one study investigating participants with dysphagia. Additionally, swallowing-related outcome measures and methods of determining genetic taste status varied greatly between studies conducted on separate cohorts. CONCLUSIONS Few studies have incorporated genetic taste status as a variable in swallowing research, and results are mixed. Future research on sensation and swallowing should consider the potential effect of genetic taste status and follow standardized procedures for its determination. Despite the limited evidence, clinicians may consider how individual differences in perception shape swallowing outcomes.
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Affiliation(s)
- Theresa S Lee
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
| | - Rana H Damra
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Rachel W Mulheren
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
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Effects of Food and Liquid Properties on Swallowing Physiology and Function in Adults. Dysphagia 2022; 38:785-817. [PMID: 36266521 DOI: 10.1007/s00455-022-10525-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Abstract
Foods and liquids have properties that are often modified as part of clinical dysphagia management to promote safe and efficient swallowing. However, recent studies have questioned whether this practice is supported by the evidence. To address this, a scoping review was conducted to answer the question: "Can properties of food and liquids modify swallowing physiology and function in adults?" Online search in six databases yielded a set of 4235 non-duplicate articles. Using COVIDENCE software, two independent reviewers screened the articles by title and abstract, and 229 full-text articles were selected for full-text review. One-hundred eleven studies met the inclusion criteria for qualitative synthesis and assessment of risk of bias. Three randomized controlled trials and 108 non-randomized studies were analyzed. Large amounts of variability in instrumental assessment, properties of food and liquids, and swallowing measures were found across studies. Sour, sweet, and salty taste, odor, carbonation, capsaicin, viscosity, hardness, adhesiveness, and cohesiveness were reported to modify the oral and pharyngeal phase of swallowing in both healthy participants and patients with dysphagia. Main swallow measures modified by properties of food and liquids were penetration/aspiration, oral transit time, lingual pressures, submental muscle contraction, oral and pharyngeal residue, hyoid and laryngeal movement, pharyngeal and upper esophageal sphincter pressures, and total swallow duration. The evidence pooled in this review supports the clinical practice of food texture and liquid consistency modification in the management of dysphagia with the caveat that all clinical endeavors must be undertaken with a clear rationale and patient-specific evidence that modifying food or liquid benefits swallow safety and efficiency while maintaining quality of life.
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Mulheren R, Westemeyer RM, Dietsch AM. The effect of taste on swallowing: A scoping and systematic review. Crit Rev Food Sci Nutr 2022; 64:1256-1282. [PMID: 36036968 DOI: 10.1080/10408398.2022.2115003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Consuming foods and liquids for nutrition requires the coordination of several muscles. Swallowing is triggered and modified by sensory inputs from the aerodigestive tract. Taste has recently received attention as a potential modulator of swallowing physiology, function, and neural activation; additionally, taste impairment is a sequela of COVID-19. This review presents factors impacting taste and swallowing, systematically summarizes the existing literature, and assesses the quality of included studies. A search was conducted for original research including taste stimulation, deglutition-related measure(s), and human participants. Study design, independent and dependent variables, and participant characteristics were coded; included studies were assessed for quality and risk of bias. Forty-eight articles were included after abstract and full-text review. Synthesis was complicated by variable sensory components of stimuli (taste category and intensity, pure taste vs. flavor, chemesthesis, volume/amount, consistency, temperature), participant characteristics, confounding variables such as genetic taster status, and methods of measurement. Most studies had a high risk of at least one type of bias and were of fair or poor quality. Interpretation is limited by wide variability in methods, taste stimulation, confounding factors, and lower-quality evidence. Existing studies suggest that taste can modulate swallowing, but more rigorous and standardized research is needed.
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Affiliation(s)
- Rachel Mulheren
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ross M Westemeyer
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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5
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Shapira-Galitz Y, Levy A, Madgar O, Shpunt D, Zhang Y, Wang B, Wolf M, Drendel M. Effects of carbonation of liquids on penetration-aspiration and residue management. Eur Arch Otorhinolaryngol 2021; 278:4871-4881. [PMID: 34292401 PMCID: PMC8297430 DOI: 10.1007/s00405-021-06987-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/06/2021] [Indexed: 12/23/2022]
Abstract
Objective Carbonation as a sensory enhancement strategy for prevention of aspiration of thin liquids has not been thoroughly studied. The aim of our study was to examine the effect of carbonation on penetration–aspiration and pharyngeal residue in dysphagia patients using Fiber-Optic Endoscopic Evaluation of Swallowing (FEES) and to identify parameters associated with a response to carbonation. Methods A cross-sectional study of patients undergoing FEES in a dysphagia clinic. Patients were offered 100 cc of dyed water. Penetration–aspiration was scored using the penetration–aspiration scale (PAS). Residue was scored using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). Patients with a PAS ≥ 2 for water were subsequently offered 100 cc of carbonated water. PAS, YPR-SRS and residue clearance were compared between thin and carbonated liquids. Multivariate logistic regression analysis was used to identify predictors for good response to carbonation. Results 84 patients were enrolled, 77.4% males, with diverse dysphagia etiologies (58.3% neurogenic, 11.9% radiation-induced, 23.8% deconditioning-induced, and 6% neck surgery induced). Median PAS was 7 (IQR 4–8) for thin liquids and 4.5 (IQR 2–8) for carbonated liquids (P = 0.0001). YPR-SRS was reduced for carbonated compared to thin liquids in the vallecula (1.58 ± 0.83 vs 1.76 ± 0.93, P = 0.001) and piriform sinuses (1.5 ± 0.87 vs 1.67 ± 0.9, P = 0.002). 31 patients had improvement in PAS with carbonation. Deconditioning as a dysphagia etiology was found to predict good response to carbonation on multivariate logistic regression analysis. Conclusion Carbonation may prevent aspiration and improve residue management for some patients with dysphagia for liquids. Level of evidence IV.
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Affiliation(s)
- Yael Shapira-Galitz
- Otolaryngology-Head and Neck Surgery Department, Kaplan Medical Center, #1 Pasternak St., Rehovot, Israel. .,Hadassah School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Audrey Levy
- The Hearing, Speech and Language Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ory Madgar
- Otorhinolaryngology-Head and Neck Surgery Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dina Shpunt
- The Hearing, Speech and Language Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yan Zhang
- Division of Statistics, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Binhuan Wang
- Division of Statistics, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Michael Wolf
- Otorhinolaryngology-Head and Neck Surgery Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Drendel
- Otorhinolaryngology-Head and Neck Surgery Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hossain MZ, Ando H, Unno S, Kitagawa J. Targeting Chemosensory Ion Channels in Peripheral Swallowing-Related Regions for the Management of Oropharyngeal Dysphagia. Int J Mol Sci 2020; 21:E6214. [PMID: 32867366 PMCID: PMC7503421 DOI: 10.3390/ijms21176214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022] Open
Abstract
Oropharyngeal dysphagia, or difficulty in swallowing, is a major health problem that can lead to serious complications, such as pulmonary aspiration, malnutrition, dehydration, and pneumonia. The current clinical management of oropharyngeal dysphagia mainly focuses on compensatory strategies and swallowing exercises/maneuvers; however, studies have suggested their limited effectiveness for recovering swallowing physiology and for promoting neuroplasticity in swallowing-related neuronal networks. Several new and innovative strategies based on neurostimulation in peripheral and cortical swallowing-related regions have been investigated, and appear promising for the management of oropharyngeal dysphagia. The peripheral chemical neurostimulation strategy is one of the innovative strategies, and targets chemosensory ion channels expressed in peripheral swallowing-related regions. A considerable number of animal and human studies, including randomized clinical trials in patients with oropharyngeal dysphagia, have reported improvements in the efficacy, safety, and physiology of swallowing using this strategy. There is also evidence that neuroplasticity is promoted in swallowing-related neuronal networks with this strategy. The targeting of chemosensory ion channels in peripheral swallowing-related regions may therefore be a promising pharmacological treatment strategy for the management of oropharyngeal dysphagia. In this review, we focus on this strategy, including its possible neurophysiological and molecular mechanisms.
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Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Hiroshi Ando
- Department of Biology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Shumpei Unno
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
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7
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Wierenga MR, Crawford CR, Running CA. Older US adults like sweetened colas, but not other chemesthetic beverages. J Texture Stud 2020; 51:722-732. [PMID: 32594514 DOI: 10.1111/jtxs.12549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/18/2020] [Accepted: 06/18/2020] [Indexed: 11/28/2022]
Abstract
Many older adults suffer from difficulty swallowing thin beverages like water or coffee. To improve swallowing safety, beverages are typically thickened. This creates a new problem: the thickened beverages can be disgusting. New research suggests chemesthesis, particularly spiciness, carbonation, or intense sourness, could improve swallowing without the need for thickeners. Yet, whether such beverages would be liked by older adults is unknown. We thus conducted this experiment to establish older adults' sensory perception and liking/disliking of commercially available chemesthetic beverages. We recruited participants to rate sweetness, sourness, fizziness, stinging, and liking/disliking of unsweetened carbonated waters (1 plain, 5 flavored), sour orange juice, spicy ginger beer, and colas (sugar or aspartame-sweetened). Initial tests (N = 30 older adults) indicated sour orange juice, spicy ginger beer, and two of the flavored waters were not well-liked, so other beverages were selected for a second test (N = 94, 30 younger adults, 64 older adults). Sweetened, carbonated colas were the best-liked of the beverages. The unsweetened, flavored carbonated waters were in general not liked. Regarding comparisons of sensory ratings between older and younger adults, only sweetness differed between age groups. In particular, intensity ratings for the chemesthetic aspects of the beverages (stinging/burning/spiciness, fizziness) and the sour taste did not differ by age. As the chemesthetic properties are the most likely reason the beverages could aid in swallowing safety, observing no suppression of these sensations in older adults is encouraging for the potential of these products as a treatment option.
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Affiliation(s)
- Madison R Wierenga
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Ciera R Crawford
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Cordelia A Running
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
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8
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Dafiah PM, Swapna N. Variations in the amplitude and duration of hyolaryngeal elevation during swallow: Effect of sour and carbonated liquid bolus. Physiol Behav 2020; 224:113028. [PMID: 32590092 DOI: 10.1016/j.physbeh.2020.113028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Altering sensory properties of food is relevant to the management of swallowing disorders. The current investigation aimed to examine the influence of sour and carbonated stimuli on measures of hyolaryngeal elevation. METHOD Sixty healthy adults in the age range of 18 to 35 years were assessed using Digital Accelerometry Swallowing Imaging (DASI) while swallowing 5 ml of neutral, sour and carbonated liquid bolus. RESULTS Sour stimulus was significantly different with higher amplitude and longer durational measures of hyolaryngeal elevation compared to the two other stimuli. CONCLUSION Sour stimulus facilitates better hyolaryngeal elevation, which implicates its usage in dysphagia management.
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Affiliation(s)
- P M Dafiah
- All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006, Karnataka, India.
| | - N Swapna
- Department of Speech-Language Pathology, All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006, Karnataka, India
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9
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A “mouthfeel wheel” terminology for communicating the mouthfeel attributes of medical nutrition products (MNP). Food Qual Prefer 2020. [DOI: 10.1016/j.foodqual.2019.103822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Dietsch AM, Westemeyer RM, Pearson WG, Schultz DH. Genetic Taster Status as a Mediator of Neural Activity and Swallowing Mechanics in Healthy Adults. Front Neurosci 2019; 13:1328. [PMID: 31920497 PMCID: PMC6927995 DOI: 10.3389/fnins.2019.01328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/26/2019] [Indexed: 01/05/2023] Open
Abstract
As part of a larger study examining relationships between taste properties and swallowing, we assessed the influence of genetic taster status (GTS) on measures of brain activity and swallowing physiology during taste stimulation in healthy men and women. Twenty-one participants underwent videofluoroscopic swallowing study (VFSS) and functional magnetic resonance imaging (fMRI) during trials of high-intensity taste stimuli. The precisely formulated mixtures included sour, sweet-sour, lemon, and orange taste profiles and unflavored controls. Swallowing physiology was characterized via computational analysis of swallowing mechanics plus other kinematic and temporal measures, all extracted from VFSS recordings. Whole-brain analysis of fMRI data assessed blood oxygen responses to neural activity associated with taste stimulation. Swallowing morphometry, kinematics, temporal measures, and neuroimaging analysis revealed differential responses by GTS. Supertasters exhibited increased amplitude of most pharyngeal movements, and decreased activity in the primary somatosensory cortex compared to nontasters and midtasters. These preliminary findings suggest baseline differences in swallowing physiology and the associated neural underpinnings associated with GTS. Given the potential implications for dysphagia risk and recovery patterns, GTS should be included as a relevant variable in future research regarding swallowing function and dysfunction.
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Affiliation(s)
- Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, NE, United States.,Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Ross M Westemeyer
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - William G Pearson
- Department of Cellular Biology & Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Douglas H Schultz
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, NE, United States
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11
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Turkington L, Ward EC, Farrell AM. An Investigation of Taste Intensity, Palatability, Effervescence, and Sip Volumes of Carbonated Liquid Stimuli for Use in Videofluoroscopic Studies. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1248-1256. [PMID: 31340132 DOI: 10.1044/2019_ajslp-19-0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Existing studies examining the effect of carbonated fluids on swallow physiology under videofluoroscopy (videofluoroscopic swallowing studies [VFSSs]) have significant variability across the fluids tested and limited consideration of the stability of the carbonation or fluid palatability. This study compared the effervescence behavior, carbonation intensity (sour, bite, bubble), palatability, and sip volumes of carbonated liquids as used in VFSSs and control samples. Method Forty-two healthy women (20 supertasters, 22 nontasters; 20-61 years old) took sips of 4 different liquids (water, carbonated water, barium sulfate with sodium bicarbonate granules, and barium sulfate with carbonated water) across 2 time conditions (on preparation and 5 min postpreparation). The 8 conditions were presented in 100-ml amounts, in randomized order. At presentation of each fluid, participants immediately rated effervescence via visual inspection. Then after sips of each fluid, participants rated perceived intensity of sour, "bubbles" and "bite," and palatability. Sip size was derived from residual volumes. Participant perceptions of fluids were also collected. Results The effervescence of barium sulfate with sodium bicarbonate granules, as used in the majority of published studies, was most impacted by time (p < .05), rated poorly for palatability, and had the largest impact on sip size (p < .05). Participant comments regarding the VFSS fluids were grouped in 4 themes: (a) adverse/other reactions, (b) awareness of sensory properties, (c) physiological reactions, and (d) swallow changes. Conclusions The significant differences between liquids regarding effervescence behavior, impact of preparation time, palatability, impact on naturalistic sipping, and patient perceptions warrant consideration when testing carbonated fluids during videofluoroscopy.
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Affiliation(s)
- Leisa Turkington
- Speech Pathology Department, Royal Brisbane and Women's Hospital, Queensland Health, Herston, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
| | - Anna M Farrell
- Speech Pathology Department, Royal Brisbane and Women's Hospital, Queensland Health, Herston, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
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12
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Mulheren RW, Humbert IA, Cappola AR, Fried LP, González-Fernández M. Taste Perception and Water Swallow Screen Results in Old-Old Women. Geriatrics (Basel) 2018; 3:geriatrics3040083. [PMID: 31011118 PMCID: PMC6371139 DOI: 10.3390/geriatrics3040083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022] Open
Abstract
Changes in both swallowing and taste commonly occur in advanced age, though the relationship between the two is unknown. This study examined the association between a water swallow screen test and taste identification and intensity rating. Participants included 47 community-dwelling women aged 85–94 years. Participants completed three trials of a water swallow screen and were observed for signs of aspiration, which, if present, indicated failure. Four pure taste stimuli at low and high concentrations and water were presented, and participants selected one of five taste labels and rated their intensity on the generalized Labeled Magnitude Scale. Ratios of intensity ratings were computed for each taste stimulus to compare the perception of low and high concentrations. The association between water swallow screen failure, correct taste identification, and taste intensity ratio was evaluated with logistic regression modeling, with mediating factors of frailty and number of comorbidities. Failure of three water swallow screen trials was associated with a higher taste intensity ratio for caffeine (bitter) and a lower taste intensity ratio for sucrose (sweet). Correct identification of taste, frailty, and number of comorbidities were not associated with failure of any number of water swallow screen trials. Intensity ratings of certain tastes may be associated with swallowing in old-old women. Heightened vigilance in this population may be necessary to prevent complications related to dietary intake.
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Affiliation(s)
- Rachel W Mulheren
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Ianessa A Humbert
- Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL 32612, USA.
- Rehabilitation Sciences, College of Health and Health Professions, University of Florida, Gainesville, FL 32612, USA.
- Department of Neurology, University of Florida, Gainesville, FL 32612, USA.
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Linda P Fried
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | - Marlís González-Fernández
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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13
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Lazarus CL. History of the Use and Impact of Compensatory Strategies in Management of Swallowing Disorders. Dysphagia 2017; 32:3-10. [PMID: 28130600 DOI: 10.1007/s00455-016-9779-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/30/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Cathy L Lazarus
- Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, NY, 10003, USA. .,Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. .,THANC Foundation, 10 Union Square East, New York, NY, 10003, USA.
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14
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Mulheren RW, Kamarunas E, Ludlow CL. Sour taste increases swallowing and prolongs hemodynamic responses in the cortical swallowing network. J Neurophysiol 2016; 116:2033-2042. [PMID: 27489363 PMCID: PMC5102316 DOI: 10.1152/jn.00130.2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 08/01/2016] [Indexed: 01/16/2023] Open
Abstract
Sour stimuli have been shown to upregulate swallowing in patients and in healthy volunteers. However, such changes may be dependent on taste-induced increases in salivary flow. Other mechanisms include genetic taster status (Bartoshuk LM, Duffy VB, Green BG, Hoffman HJ, Ko CW, Lucchina LA, Weiffenbach JM. Physiol Behav 82: 109-114, 2004) and differences between sour and other tastes. We investigated the effects of taste on swallowing frequency and cortical activation in the swallowing network and whether taster status affected responses. Three-milliliter boluses of sour, sour with slow infusion, sweet, water, and water with infusion were compared on swallowing frequency and hemodynamic responses. The sour conditions increased swallowing frequency, whereas sweet and water did not. Changes in cortical oxygenated hemoglobin (hemodynamic responses) measured by functional near-infrared spectroscopy were averaged over 30 trials for each condition per participant in the right and left motor cortex, S1 and supplementary motor area for 30 s following bolus onset. Motion artifact in the hemodynamic response occurred 0-2 s after bolus onset, when the majority of swallows occurred. The peak hemodynamic response 2-7 s after bolus onset did not differ by taste, hemisphere, or cortical location. The mean hemodynamic response 17-22 s after bolus onset was highest in the motor regions of both hemispheres, and greater in the sour and infusion condition than in the water condition. Genetic taster status did not alter changes in swallowing frequency or hemodynamic response. As sour taste significantly increased swallowing and cortical activation equally with and without slow infusion, increases in the cortical swallowing were due to sour taste.
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Affiliation(s)
- Rachel W Mulheren
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, Virginia
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, Virginia
| | - Christy L Ludlow
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, Virginia
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Pauloski BR, Nasir SM. Orosensory contributions to dysphagia: a link between perception of sweet and sour taste and pharyngeal delay time. Physiol Rep 2016; 4:4/11/e12752. [PMID: 27302989 PMCID: PMC4908483 DOI: 10.14814/phy2.12752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/07/2016] [Indexed: 01/17/2023] Open
Abstract
Pharyngeal delay is a significant swallowing disorder often resulting in aspiration. It is suspected that pharyngeal delay originates from sensory impairment, but a direct demonstration of a link between oral sensation and pharyngeal delay is lacking. In this study involving six patients with complaints of dysphagia, taste sensation of the oral tongue was measured and subsequently related to swallowing kinematics. It was found that a response bias for sour taste was significantly correlated with pharyngeal delay time on paste, highlighting oral sensory contributions to swallow motor dysfunctions. Investigating the precise nature of such a link between oral sensation and dysphagia would constitute a basis for understanding the disorder. The results of this study highlight oral sensory contributions to pharyngeal swallow events and provide impetus to examine this link in larger samples of dysphagic patients.
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Affiliation(s)
- Barbara R Pauloski
- Department of Communication Sciences and Disorders, University of Wisconsin-Milwaukee, Wisconsin
| | - Sazzad M Nasir
- Department of Communication Sciences and Disorders, Northwestern University, Illinois
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Turkington LG, Ward EC, Farrell AM. Carbonation as a sensory enhancement strategy: a narrative synthesis of existing evidence. Disabil Rehabil 2016; 39:1958-1967. [PMID: 27646052 DOI: 10.1080/09638288.2016.1213894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Sensory enhancement techniques, like other compensatory strategies, aim to reduce dysphagia symptoms. The use of carbonated liquids has been proposed as a possible sensory technique, however to date, there is limited information of its efficacy or guidance for clinical implementation. A narrative synthesis was completed to determine the quality and strength of the evidence base for use of carbonation as a compensatory strategy in dysphagia rehabilitation. METHODS From 101 articles initially identified, 14 articles met the study criteria. Eleven papers described the effects of carbonation on swallowing in healthy participants whereas three described the impact of carbonation in dysphagic populations. A narrative synthesis of papers was undertaken given the diversity of identified studies. RESULTS Synthesis of findings was challenging given the exploratory phase of most research activity with diverse populations described and extensive differences in research methodologies. There is currently weak, but potentially positive evidence to support using carbonation as a compensatory technique in dysphagia rehabilitation. CONCLUSION Despite future potential, existing evidence fails to provide clear direction for the clinical implementation of carbonation. Validation of carbonation use with the dysphagic population requires further research with consistent, controlled methodologies, and larger cohorts of participants to inform potential for dysphagia rehabilitation. Implications for Rehabilitation The use of carbonated liquids has been proposed as a possible sensory enhancement technique which may facilitate changes to swallow physiology. However to date, there is limited information to direct clinical implementation. This paper provides a narrative synthesis of existing knowledge and highlights possible limitations of findings reported. Research to date has used disparate research methodologies in varied populations making synthesis of current findings challenging.
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Affiliation(s)
- Leisa G Turkington
- a Speech Pathology Department , Royal Brisbane & Women's Hospital, Queensland Health , Herston , Queensland , Australia.,b School of Health & Rehabilitation Sciences , The University of Queensland , St Lucia , Queensland , Australia
| | - Elizabeth C Ward
- b School of Health & Rehabilitation Sciences , The University of Queensland , St Lucia , Queensland , Australia.,c Centre for Functioning and Health Research , Queensland Health , Buranda, Brisbane , Queensland , Australia
| | - Anna M Farrell
- a Speech Pathology Department , Royal Brisbane & Women's Hospital, Queensland Health , Herston , Queensland , Australia
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Hoffman HJ, Rawal S, Li CM, Duffy VB. New chemosensory component in the U.S. National Health and Nutrition Examination Survey (NHANES): first-year results for measured olfactory dysfunction. Rev Endocr Metab Disord 2016; 17:221-40. [PMID: 27287364 PMCID: PMC5033684 DOI: 10.1007/s11154-016-9364-1] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The U.S. NHANES included chemosensory assessments in the 2011-2014 protocol. We provide an overview of this protocol and 2012 olfactory exam findings. Of the 1818 NHANES participants aged ≥40 years, 1281 (70.5 %) completed the exam; non-participation mostly was due to time constraints. Health technicians administered an 8-item, forced-choice, odor identification task scored as normosmic (6-8 odors identified correctly) versus olfactory dysfunction, including hyposmic (4-5 correct) and anosmic/severe hyposmic (0-3 correct). Interviewers recorded self-reported smell alterations (during past year, since age 25, phantosmia), histories of sinonasal problems, xerostomia, dental extractions, head or facial trauma, and chemosensory-related treatment and changes in quality of life. Olfactory dysfunction was found in 12.4 % (13.3 million adults; 55 % males/45 % females) including 3.2 % anosmic/severe hyposmic (3.4 million; 74 % males/26 % females). Selected age-specific prevalences were 4.2 % (40-49 years), 12.7 % (60-69 years), and 39.4 % (80+ years). Among adults ≥70 years, misidentification rates for warning odors were 20.3 % for smoke and 31.3 % for natural gas. The highest sensitivity (correctly identifying dysfunction) and specificity (correctly identifying normosmia) of self-reported olfactory alteration was among anosmics/severe hyposmics (54.4 % and 78.1 %, respectively). In age- and sex-adjusted logistic regression analysis, risk factors of olfactory dysfunction were racial/ethnic minority, income-to-poverty ratio ≤ 1.1, education <high school, and heavy drinking. Moderate-to-vigorous physical activity reduced risk of impairment. Olfactory dysfunction is prevalent, particularly among older adults. Inexpensive, brief odor identification tests coupled with questions (smell problems past year, since age 25, phantosmia) could screen for marked dysfunction. Healthcare providers should be prepared to offer education on non-olfactory avoidance of hazardous events.
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Affiliation(s)
- Howard J Hoffman
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and other Communication Disorders (NIDCD) at the National Institutes of Health (NIH), Bethesda, MD, USA
| | - Shristi Rawal
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Rockville, MD, USA
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA
| | - Chuan-Ming Li
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and other Communication Disorders (NIDCD) at the National Institutes of Health (NIH), Bethesda, MD, USA
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA.
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Elshukri O, Michou E, Mentz H, Hamdy S. Brain and behavioral effects of swallowing carbonated water on the human pharyngeal motor system. J Appl Physiol (1985) 2015; 120:408-15. [PMID: 26607248 DOI: 10.1152/japplphysiol.00653.2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/20/2015] [Indexed: 11/22/2022] Open
Abstract
Chemical stimulation of the swallowing network with carbonation and citric acid has been investigated, showing potential benefits on swallowing of dysphagic patients. Despite this, the underlying mechanisms for these effects are not fully understood. Here we investigated the effects of 5 ml liquid bolus swallows of carbonated, citric acid, and still water on a swallowing reaction-time tasks paradigm in 16 healthy adults (8 male, mean age 33 ± 3.7 yr, protocol 1). We then investigated the net effects of "sensory bolus interventions" (40 repeated swallows every 15 s) of the three different liquid boluses on corticobulbar excitability, as examined with single-pulse transcranial magnetic stimulation (TMS) in 16 participants (8 female, mean age 33 ± 3.7 yr, protocol 2). The findings showed that a larger number of correctly timed swallows (within a predetermined time window) was accomplished mainly with carbonated liquids (z = -2.04, P = 0.04 vs. still water, protocol 1). Both carbonated and citric acid liquid interventions with 40 swallows increased corticobulbar excitability of the stronger pharyngeal projection, suggesting a similar modulatory pathway for the effects on swallowing. However, carbonation showed superiority (P = 0.04, F = 4.75, 2-way ANOVA), with the changes lasting up to 60 min following the intervention. These results hold significance for future further and in-depth physiological investigations of the differences between different stimuli on swallowing neural network.
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Affiliation(s)
- Omsaad Elshukri
- Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, United Kingdom; and
| | - Emilia Michou
- Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, United Kingdom; and
| | - Hannah Mentz
- Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, United Kingdom; and Department Pädagogik und Rehabilitation, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Shaheen Hamdy
- Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, United Kingdom; and
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Steele CM. The Blind Scientists and the Elephant of Swallowing: A Review of Instrumental Perspectives on Swallowing Physiology. J Texture Stud 2014. [DOI: 10.1111/jtxs.12101] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory; Toronto Rehabilitation Institute; University Health Network; 550 University Avenue Toronto Ontario M5G 2A2
- Department of Speech-Language Pathology; University of Toronto; Toronto Canada
- Graduate Department of Rehabilitation Sciences; University of Toronto; Toronto Canada
- Institute of Biomaterials and Biomedical Engineering; University of Toronto; Toronto Canada
- Bloorview Research Institute; Toronto Canada. International Dysphagia Diet Standardisation Initiative Foundation Committee; Brisbane Australia
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Nagy A, Steele CM, Pelletier CA. Barium versus nonbarium stimuli: differences in taste intensity, chemesthesis, and swallowing behavior in healthy adult women. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2014; 57:758-767. [PMID: 24167232 DOI: 10.1044/2013_jslhr-s-13-0136] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The authors examined the impact of barium on the perceived taste intensity of 7 different liquid tastant stimuli and the modulatory effect that these differences in perceived taste intensity have on swallowing behaviors. METHOD Participants were 80 healthy women, stratified by age group (<40; >60) and genetic taste status (supertasters; nontasters). Perceived taste intensity and chemesthetic properties (fizziness; burning-stinging) were rated for 7 tastant solutions (each prepared with and without barium) using the general Labeled Magnitude Scale. Tongue-palate pressures and submental surface electromyography (sEMG) were simultaneously measured during swallowing of these same randomized liquids. Path analysis differentiated the effects of stimulus, genetic taste status, age, barium condition, taste intensity, and an effortful saliva swallow strength covariate on swallowing. RESULTS Barium stimuli were rated as having reduced taste intensity compared with nonbarium stimuli. Barium also dampened fizziness but did not influence burning-stinging sensation. The amplitudes of tongue-palate pressure or submental sEMG did not differ when swallowing barium versus nonbarium stimuli. CONCLUSIONS Despite impacting taste intensity, the addition of barium to liquid stimuli does not appear to alter behavioral parameters of swallowing. Barium solutions can be considered to elicit behaviors that are similar to those used with nonbarium liquids outside the assessment situation.
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Differences in swallowing between high and low concentration taste stimuli. BIOMED RESEARCH INTERNATIONAL 2014; 2014:813084. [PMID: 24877135 PMCID: PMC4022122 DOI: 10.1155/2014/813084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/22/2014] [Accepted: 04/10/2014] [Indexed: 11/18/2022]
Abstract
Taste is a property that is thought to potentially modulate swallowing behavior. Whether such effects depend on taste, intensity remains unclear. This study explored differences in the amplitudes of tongue-palate pressures in swallowing as a function of taste stimulus concentration. Tongue-palate pressures were collected in 80 healthy women, in two age groups (under 40, over 60), stratified by genetic taste status (nontasters, supertasters). Liquids with different taste qualities (sweet, sour, salty, and bitter) were presented in high and low concentrations. General labeled magnitude scale ratings captured perceived taste intensity and liking/disliking of the test liquids. Path analysis explored whether factors of taste, concentration, age group, and/or genetic taste status impacted: (1) perceived intensity; (2) palatability; and (3) swallowing pressures. Higher ratings of perceived intensity were found in supertasters and with higher concentrations, which were more liked/disliked than lower concentrations. Sweet stimuli were more palatable than sour, salty, or bitter stimuli. Higher concentrations elicited stronger tongue-palate pressures independently and in association with intensity ratings. The perceived intensity of a taste stimulus varies as a function of stimulus concentration, taste quality, participant age, and genetic taste status and influences swallowing pressure amplitudes. High-concentration salty and sour stimuli elicit the greatest tongue-palate pressures.
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