Curtis James A, Rameau Anaïs, Mocchetti Valentina
Aerodigestive Innovations Research Lab (AIR), Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College of Cornell University, New York, New York, USA.
The Laryngology Innovation Lab, Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College of Cornell University, New York, New York, USA.
Folia Phoniatr Logop. 2025;77(3):246-255. doi: 10.1159/000542227. Epub 2024 Nov 19.
Flexible endoscopic evaluations of swallowing (FEES) involve the administration of a variety of foods and liquids to assess outcomes related to pharyngeal residue, penetration, and aspiration. While the type and color of thin liquids used during FEES have been found to significantly affect FEES ratings, it is unknown if similar effects are observed with pureed foods. Therefore, the aims of this study were to assess the effects of puree type (applesauce vs. pudding) and color (natural, blue, green) on ratings of pharyngeal residue, penetration, and aspiration during FEES.
Pharyngeal residue, penetration, and aspiration were assessed in 37 consecutive outpatient adults undergoing FEES. Patients were presented with two types of puree: 5 mL applesauce and 5 mL pudding. Each puree type was presented once with either blue or green food coloring added to it by a clinician. Each puree type was also presented once with no clinician-added food coloring ("natural"). The order of presentation was randomized between patients and all data were blindly analyzed by pairs of independent raters using the Visual Analysis of Swallowing Efficiency and Safety (VASES). Multilevel statistical models were used to examine the effects of puree type and color on oropharyngeal residue, hypopharyngeal residue, and Penetration-Aspiration Scale scores (PAS).
Pudding trials were associated with higher oropharyngeal residue ratings compared to applesauce trials. Blue-colored applesauce was associated with higher oropharyngeal and hypopharyngeal residue ratings when compared to natural applesauce. Lastly, green-colored applesauce and green-colored pudding were both associated with higher hypopharyngeal residue ratings compared to natural applesauce and natural pudding, respectively.
This study identified statistically significant effects of puree type and color and ratings of pharyngeal residue ratings, but not penetration or aspiration, as seen during FEES. These data suggest that clinicians and researchers should consider standardizing the type and color of pureed food used during FEES.
吞咽功能的软性内镜评估（FEES）包括给予各种食物和液体，以评估与咽部残留、食物误咽及误吸相关的结果。虽然已发现FEES期间使用的稀液体的类型和颜色会显著影响FEES评分，但对于泥状食物是否有类似影响尚不清楚。因此，本研究的目的是评估泥状食物类型（苹果酱与布丁）和颜色（自然色、蓝色、绿色）对FEES期间咽部残留、食物误咽及误吸评分的影响。
对37例接受FEES的门诊成年患者进行咽部残留、食物误咽及误吸评估。向患者提供两种类型的泥状食物：5毫升苹果酱和5毫升布丁。每种泥状食物类型均由临床医生添加蓝色或绿色食用色素后呈现一次。每种泥状食物类型也会在不添加临床医生添加的食用色素（“自然色”）的情况下呈现一次。呈现顺序在患者之间随机安排，所有数据由独立评估者对使用吞咽效率和安全性视觉分析（VASES）进行盲法分析。使用多级统计模型来检验泥状食物类型和颜色对口咽残留、下咽残留和食物误咽-误吸量表评分（PAS）的影响。
与苹果酱试验相比，布丁试验的口咽残留评分更高。与自然色苹果酱相比，蓝色苹果酱的口咽和下咽残留评分更高。最后，与自然色苹果酱和自然色布丁相比，绿色苹果酱和绿色布丁分别与更高的下咽残留评分相关。
本研究确定了泥状食物类型和颜色以及咽部残留评分在统计学上有显著影响，但在FEES期间未发现对食物误咽或误吸有影响。这些数据表明，临床医生和研究人员应考虑对FEES期间使用的泥状食物的类型和颜色进行标准化。
