Rethinking the Dysphagia Diet: How Sensory Input Can Improve Swallow Function

Traditionally, speech-language pathologists and other healthcare providers have utilized dysphagia diets to compensate for impairments in swallow function. We reduce the texture of the food to compensate for difficulty with oral management and mastication, and we thicken liquids to compensate for delays in swallow response and airway closure.

Unfortunately, these dietary modifications are often unpalatable, affecting our patients' appetites and reducing their caloric and nutritional intake.

Perhaps it's time to rethink the idea of dysphagia diets.

Sensory input impacts motor output

We know that as the food and liquid pass from the oral cavity to the pharynx, all of the sensory information contained within that bolus is transmitted to the brainstem. That sensory input impacts the motor output of the swallow response.

The size, shape, viscosity, and temperature of the bolus have the potential to change the swallow response in any number of ways, including:¹

• Onset of swallow response

• Duration and onset of laryngeal valve closure

• Duration of opening of the upper esophageal sphincter

• Pharyngeal transit times

Perhaps, then, a true "dysphagia diet" is not one that compensates for impairments but one that stimulates improvements in swallow function.

Impacts of sensory stimulation

1. Cold

Those among you who have been doing therapy for as long as I have may remember doing thermal stimulation with our clients! Cold was one of the first sensory interventions studied.

In the 1980s, Dr. Jeri Logemann suggested the use of thermal stimulation in the form of a cold laryngeal mirror to the faucal arches as a therapeutic strategy to improve swallow response.² Research results were equivocal, and the focus turned to cold foods and liquids instead. As it turned out, cold does have the potential to improve swallow response, airway protection, and pharyngeal constriction.³

2. Taste

So, if cold can impact swallow function, what about other types of sensory input? Does flavor manipulation, for example, have an impact on swallow response?

Maybe.

Sour, in particular, does seem to have an impact on the timing of swallow response. The problem is that to have a measurable effect on swallow function, the bolus has to be very sour—enough to be unpalatable. Dr. Cathy Pelletier and Dr. Harry Lawless looked at boluses that were a sweet and sour mix and found that while they were much more palatable to the test subjects, they did not have the same kind of impact on swallow response.⁴

3. Carbonation

And what about fizz? Does carbonation have any effect on swallowing?

A number of studies, including a pediatric study,⁵ demonstrated an impact on various aspects of swallow function in response to carbonated boluses.^6,7 In one interesting study, researchers found that carbonated boluses had an impact on swallow function not only during those swallows, but also during the non-carbonated boluses that followed.⁸ Some clinicians have found that combining sensory inputs—like carbonation with strong flavors—may enhance the swallow response more than using either approach alone.

From compensation to stimulation: Rethinking the role of diet

So, what does this mean for our patients with swallowing impairments?

1. It's clear that sensory input has the potential to positively impact the swallow response; cold and carbonation appear to be particularly effective.

2. It's possible that intermittent stimulation may be an effective tool. If your client didn't have to drink the sour boluses for every swallow, this could mitigate the impact of unpleasant stimuli like sour.

3. Mixed input may be an effective tool—what happens if we combine cold with carbonated? Or sour with cold? There seems to be a cumulative effect with sensory input, and we may need to experiment a bit to find the right combination of stimulants.

Perhaps it's time to think about dysphagia diets as more than just compensatory, and instead explore how they can be used to support rehabilitation and promote functional improvement in feeding and swallowing skills.

Build your clinical skills with high-quality continuing education

Staying up to date on the latest evidence around dysphagia management, especially in areas like sensory stimulation, is essential for delivering effective, patient-centered care. Medbridge's speech-language pathology continuing education offers a wide range of accredited continuing education and patient engagement tools tailored to clinical practice.

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All continuing education content is accredited by ASHA and accepted in all 50 states. Whether you're focused on managing dysphagia, pediatric feeding, or another specialty area, Medbridge provides practical, expert-led learning that helps you grow professionally—and better serve your patients.

References

1. Newman, R., Vilardell, N., Clavé, P., & Speyer, R. (2016). Effect of Bolus Viscosity on the Safety and Efficacy of Swallowing and the Kinematics of the Swallow Response in Patients with Oropharyngeal Dysphagia: White Paper by the European Society for Swallowing Disorders (ESSD). Dysphagia, 31(2), 232–249. https://pmc.ncbi.nlm.nih.gov/articles/PMC4929168/

2. Lazzara, Gisela & Lazarus, Cathy & Logemann, Jeri. (1986). Impact of thermal stimulation on the triggering of the swallowing reflex. Dysphagia. https://www.researchgate.net/publication/225612370_Impact_of_thermal_stimulation_on_the_triggering_of_the_swallowing_reflex

3. Sciortino, K., Liss, J. M., Case, J. L., Gerritsen, K. G., & Katz, R. C. (2003). Effects of mechanical, cold, gustatory, and combined stimulation to the human anterior faucial pillars. Dysphagia, 18(1), 16–26. https://pubmed.ncbi.nlm.nih.gov/12497192/

4. Pelletier, C. A., & Lawless, H. T. (2003). Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia, 18(4), 231–241. https://pubmed.ncbi.nlm.nih.gov/14571326/

5. Lundine, J. P., Bates, D. G., & Yin, H. (2015). Analysis of carbonated thin liquids in pediatric neurogenic dysphagia. Pediatric radiology, 45(9), 1323–1332. https://pmc.ncbi.nlm.nih.gov/articles/PMC4632594/

6. Shapira-Galitz, Y., Levy, A., Madgar, O., Shpunt, D., Zhang, Y., Wang, B., Wolf, M., & Drendel, M. (2021). Effects of carbonation of liquids on penetration-aspiration and residue management. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 278(12), 4871–4881. https://pmc.ncbi.nlm.nih.gov/articles/PMC8297430/

7. Michou, E., Mastan, A., Ahmed, S., Mistry, S., & Hamdy, S. (2012). Examining the role of carbonation and temperature on water swallowing performance: a swallowing reaction-time study. Chemical senses, 37(9), 799–807. https://pubmed.ncbi.nlm.nih.gov/22843761/

8. Miura, Y., Morita, Y., Koizumi, H., & Shingai, T. (2009). Effects of taste solutions, carbonation, and cold stimulus on the power frequency content of swallowing submental surface electromyography. Chemical senses, 34(4), 325–331. https://pubmed.ncbi.nlm.nih.gov/19221127/