title: The risk of aspiration of pureed food as determined by flexible endoscopic evaluation of swallowing with sensory testing.
abstract: OBJECTIVE
  This study evaluates the risk of aspiration of pureed foods in patients with dysphagia with increasing sensory deficits of the hypopharynx with intact versus impaired pharyngeal muscular tone (pharyngeal squeeze).
  
  
  METHODS
  Two hundred four dysphagic patients underwent flexible endoscopic evaluation of swallowing with sensory testing and were prospectively divided into 3 groups, with normal, moderate, and severe sensory deficits. Each group was divided into those with normal and those with impaired pharyngeal squeeze. Subjects were given pureed food boluses and were evaluated for aspiration.
  
  
  RESULTS
  There was a significant difference in the incidence of aspiration of pureed foods for normal and moderate sensory loss when comparing normal and impaired pharyngeal squeeze (P < 0.001, Fisher exact test). There was no significant difference in the severe sensory loss group. In both the normal and impaired pharyngeal squeeze groups, there was no significant difference in aspiration as the sensory deficit increases.
  
  
  CONCLUSIONS
  Patients with impaired pharyngeal squeeze at different levels of sensory deficits are at significantly greater risk for aspiration of pureed foods compared with those with normal squeeze. However, as sensory deficits increased, the patients did not show a significant increase in aspiration. The aspiration of pureed foods may depend more on muscle tone of the hypopharynx than on sensation. Dysphagic patients who are given a pureed diet to prevent aspiration may still be at risk for aspiration. This may be easily predicted by the use of flexible endoscopic evaluation of swallowing with sensory testing in conjunction with evaluation of pharyngeal muscle tone.
authors.affiliation: Division of Otolaryngology, North Shore University Hospital, Manhasset, New York 11030, USA. nozdiver@aol.com
authors.forename: Philip W
authors.initials: PW
authors.lastname: Perlman
authors.forename: Manderly A
authors.initials: MA
authors.lastname: Cohen
authors.forename: Michael
authors.initials: M
authors.lastname: Setzen
authors.forename: Peter C
authors.initials: PC
authors.lastname: Belafsky
authors.forename: Joel
authors.initials: J
authors.lastname: Guss
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Mattucci
authors.forename: Michael
authors.initials: M
authors.lastname: Ditkoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000503:physiopathology*; D004435:Eating; D004724:Endoscopy; D005260:Female; D005511:Food Handling; D006801:Humans; D007013:Hypopharynx / Q000503:physiopathology; D001239:Inhalation; D008297:Male; D008875:Middle Aged; D010609:Pharyngeal Muscles / Q000503:physiopathology; D010614:Pharynx / Q000503:physiopathology*; D011446:Prospective Studies