Effect of bolus consistency on swallowing - does altering consistency help?

The influence of food bolus consistency on the pharyngeal wave during swall owing was investigated using a four-sensor manometry probe in 22 healthy vo lunteers. Pharyngeal pressures were recorded for 5 ml boluses of water, pud ding and buttered bread via a manometry probe placed transnasally. The dist al sensor was sited within the upper oesophageal sphincter (UOS); the three proximal sensors were then located 2, 4 and 6 cm above the UOS. The amplit ude and timing of the swallow waveforms for pudding and buttered bread were recorded and compared with those for water. Increased bolus viscosity led to increased amplitude of the bolus wave and clearing contraction within th e pharynx. In the UOS, increased bolus viscosity was associated with a larg er pressure nadir (sub-atmospheric pressure) on opening and intra bolus pre ssure during transit. Bolus consistency also influenced the coordination of the swallow response with delayed pharyngeal clearance. The putative relev ance of these findings to dietary modification fur patients with neurologic al and neuromuscular dysphagia is discussed.