title: Effects of liquid type, delivery method, and bolus volume on penetration-aspiration scores in healthy older adults during flexible endoscopic evaluation of swallowing.
abstract: OBJECTIVE
  The type of liquid (eg, water or milk) that should be used during flexible endoscopic evaluation of swallowing (FEES) has received little investigation. Aspiration may vary as a function of the thin liquid type used during FEES.
  
  
  METHODS
  We measured the effects of liquid type (water, skim milk, 2% milk, and whole milk; all dyed with green food coloring), delivery method (cup and straw), and bolus volume (5, 10, 15, and 20 mL) on Penetration-Aspiration Scale (PAS) scores in 14 healthy older adults (mean, 75 years; range, 69 to 85 years). Each participant generated 32 swallows.
  
  
  RESULTS
  The PAS scores differed significantly by liquid type (p = 0.003) and by bolus volume (p = 0.017), but not by delivery method (p = 0.442). The PAS scores were significantly greater for 2% milk and whole milk than for skim milk and water (p < 0.05), and for 20 mL versus smaller volumes. Penetration and aspiration were observed on 113 (25%) and 15 (3%) of 448 swallows, respectively.
  
  
  CONCLUSIONS
  These findings suggest that both milk and water should be used during FEES for an accurate assessment of aspiration status.
authors.affiliation: Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Butler
authors.forename: Andrew
authors.initials: A
authors.lastname: Stuart
authors.forename: L Douglas
authors.initials: LD
authors.lastname: Case
authors.forename: Catherine
authors.initials: C
authors.lastname: Rees
authors.forename: Mara
authors.initials: M
authors.lastname: Vitolins
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kritchevsky
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition / Q000502:physiology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008365:Manometry; D012016:Reference Values; D053120:Respiratory Aspiration / Q000175:diagnosis* / Q000453:epidemiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014783:Viscosity