Effects of Food Type on Pharyngeal Residue, Penetration, and Aspiration: A Prospective Study of 50 Dysphagic Adults.
James A Curtis, Anaïs Rameau, Christine M Clark and 3 others
PMID 40254019WHAT IT FOUND
In dysphagic adults undergoing FEES, saltine crackers left more residue in the oropharynx than other foods.
Shortbread cookies with pudding left more residue in the hypopharynx and required fewer chews, though they were involved in most of the rare penetration events.
Key findings
01Saltine crackers resulted in significantly higher oropharyngeal residue ratings compared to graham crackers, shortbread cookies, and shortbread cookies with pudding.
02Shortbread cookies, with or without pudding, were more likely to result in hypopharyngeal residue than saltine crackers, and shortbread cookies with pudding had higher residue ratings than graham crackers when residue was present.
03Shortbread cookies with pudding required significantly fewer chews than saltine crackers, plain shortbread cookies, or graham crackers.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The study population primarily consisted of individuals with mild swallowing impairments, limiting generalizability to severe dysphagia. The sample size was small (50 patients) and the study was not statistically powered for subgroup analyses. Foods were matched by volume but not by mass, meaning the shortbread cookie with pudding was much heavier (7.4 g) than the saltine cracker (1.8 g), which could influence residue and chewing demands. Airway invasion events were too rare to allow for statistical comparison of penetration-aspiration risk between foods. Instructions to swallow in one bite may have reduced the naturalness of the eating task.
Declared interests
The authors declare no conflicts of interest, and the study was not supported by any sponsor or funder.
The easy way to misread this
Do not conclude that shortbread cookies with pudding are unsafe or that saltine crackers are the superior diagnostic tool. The penetration events were too rare for statistical analysis, and the foods were not matched by mass. The findings highlight that food choice changes what you see on FEES, not necessarily which food is clinically 'best' for every patient.