Thin Liquid Sip Sizes in Outpatient Adults with Normal and Disordered Swallowing: Modifying Factors and Relationships with Swallowing Safety and Efficiency.
James A Curtis, Leyla E Jimenez, Isabel M Aberin-Angulo and 2 others
Self-selected thin-liquid sip size did not predict swallowing safety or efficiency in 74 outpatient adults.
Testing conditions like straws, colored liquids, and partial cup fills systematically shifted sip size away from the 24 mL patients choose under natural conditions.
Key findings
1Self-selected sip size was not significantly associated with oropharyngeal residue, hypopharyngeal residue, laryngeal vestibule residue, vocal fold residue, Penetration-Aspiration Scale score, or Bolus Clearance Ratio (all p > 0.05).
2Straw delivery produced the largest reduction in sip size (16.7 mL small straw, 19.6 mL large straw, versus 25.1 mL cup). Food coloring reduced sips (19.7 mL green, 20.8 mL white, versus 24.2 mL clear). A smaller fill volume also reduced sips (22.8 mL versus 25.3 mL). Barium and endoscope presence each increased sip size modestly.
3Age, BMI, EAT-10 scores, and DIGEST Safety, Efficiency, and Total severity grades showed no significant association with self-selected sip size. Men selected larger sips than women (25.0 mL versus 19.7 mL), and taller height was associated with larger sips, but a post hoc model showed these two effects were not independent of each other.
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What it does not show
Single tertiary care center with specific cup types, straws, and food-coloring preparations; results may not generalize to other settings or equipment. Most participants had normal to moderate swallowing impairment; only 10.8% had severe dysphagia and none had profound dysphagia, so findings may not apply to more severely impaired patients. Aspiration events were very infrequent (only four subglottic events), making it impossible to formally test the relationship between sip size and aspiration. All sips were taken in a clinical environment where patients knew they were being evaluated, so home drinking behavior may differ. The study was not designed or powered to compare diagnostic subgroups (neurologic, head and neck cancer, respiratory, esophageal, spinal). The number of testing and patient-level variables relative to the sample of 74 may limit the precision of some estimates.
Declared interests
The authors declare no conflicts of interest. The study was not supported by any sponsor or funder.
The easy way to misread this
Do not assume that a self-selected sip taken during FEES or MBS reflects what the patient actually drinks at home. Straws, colored liquids, and partial cup fills all reduced sip size, while barium and the endoscope increased it. The 'natural' sip in the clinic is shaped by the testing setup, not by the patient's everyday behavior. Also do not read the null safety finding as proof that larger sips are safe for all patients: this cohort had mostly normal to moderate impairment and very few aspiration events, so the result may not hold for more severely impaired individuals.
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