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The Effects of High-Coating White Water, Low-Coating White Water, and Milk on the Identification of Swallowing Safety and Efficiency in Healthy Adults as Assessed via Flexible Endoscopic Evaluation of Swallowing: A Pilot Study.

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Title: The Effects of High-Coating White Water, Low-Coating White Water, and Milk on the Identification of Swallowing Safety and Efficiency in Healthy Adults as Assessed via Flexible Endoscopic Evaluation of Swallowing: A Pilot Study.
Authors: Cline, Kristen G.1,2 kgcline.slp@gmail.com, Butler, Susan G.2, Lundgren, Kristine2, Love, Kim R.3
Source: American Journal of Speech-Language Pathology. Jan2026, Vol. 35 Issue 1, p306-316. 11p.
Subject Terms: *Data analysis, *Comparative studies, *Inter-observer reliability, *Adults, Pharynx physiology, Pilot projects, Research evaluation, Milk, Endoscopic surgery, Respiratory aspiration, Descriptive statistics, Chi-squared test, Odds ratio, Biomedical materials, Water, Statistics, Deglutition, Confidence intervals, Data analysis software, Deglutition disorders, Endoscopy
Abstract: Purpose: The best liquid bolus protocol to use that accurately identifies penetration, aspiration, and residue on flexible endoscopic evaluation of swallowing (FEES) remains unclear. Recently, the use of high-coating white food dye–colored water has been recommended; however, evidence to support its use is limited. In this study, penetration/aspiration and residue as a function of high-coating white water, low-coating white water, and milk were systematically evaluated. Method: The effects of liquid type (i.e., high-coating white water, low-coating white water, and milk) and volume (i.e., 15, 20, and 90 ml) on penetration–aspiration scale (PAS) scores (i.e., 1–2 vs. 3–8) and residue (i.e., present vs. not present) were assessed in 20 healthy adults ages 22–53 years during FEES . Results: PAS scores, vallecular residue, and pyriform sinus residue differed significantly by liquid type (p < .001, p = .002, and p < .001, respectively). PAS scores also differed significantly by bolus volume (p = .045). In general, highcoating white water yielded a significantly greater probability of penetration events than low-coating white water and milk; however, raw PAS data revealed aspiration events (PAS 6–8) were only identified in the low-coating white water and milk conditions. Vallecular residue and pyriform sinus residue were observed in 100% of the high-coating white water swallows with markedly less residue in the low-coating white water and milk conditions. Conclusion: High-coating white water resulted in increased observed penetration events (likely due to its coating effect) compared to low-coating white water and milk while still underidentifying aspiration seen more frequently with milk test boluses in healthy adults. [ABSTRACT FROM AUTHOR]
Copyright of American Journal of Speech-Language Pathology is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
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  Data: The Effects of High-Coating White Water, Low-Coating White Water, and Milk on the Identification of Swallowing Safety and Efficiency in Healthy Adults as Assessed via Flexible Endoscopic Evaluation of Swallowing: A Pilot Study.
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– Name: Abstract
  Label: Abstract
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  Data: Purpose: The best liquid bolus protocol to use that accurately identifies penetration, aspiration, and residue on flexible endoscopic evaluation of swallowing (FEES) remains unclear. Recently, the use of high-coating white food dye–colored water has been recommended; however, evidence to support its use is limited. In this study, penetration/aspiration and residue as a function of high-coating white water, low-coating white water, and milk were systematically evaluated. Method: The effects of liquid type (i.e., high-coating white water, low-coating white water, and milk) and volume (i.e., 15, 20, and 90 ml) on penetration–aspiration scale (PAS) scores (i.e., 1–2 vs. 3–8) and residue (i.e., present vs. not present) were assessed in 20 healthy adults ages 22–53 years during FEES . Results: PAS scores, vallecular residue, and pyriform sinus residue differed significantly by liquid type (p &lt; .001, p = .002, and p &lt; .001, respectively). PAS scores also differed significantly by bolus volume (p = .045). In general, highcoating white water yielded a significantly greater probability of penetration events than low-coating white water and milk; however, raw PAS data revealed aspiration events (PAS 6–8) were only identified in the low-coating white water and milk conditions. Vallecular residue and pyriform sinus residue were observed in 100% of the high-coating white water swallows with markedly less residue in the low-coating white water and milk conditions. Conclusion: High-coating white water resulted in increased observed penetration events (likely due to its coating effect) compared to low-coating white water and milk while still underidentifying aspiration seen more frequently with milk test boluses in healthy adults. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of American Journal of Speech-Language Pathology is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ehh&AN=190920666
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1044/2025_AJSLP-25-00183
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 306
    Subjects:
      – SubjectFull: Data analysis
        Type: general
      – SubjectFull: Comparative studies
        Type: general
      – SubjectFull: Inter-observer reliability
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Pharynx physiology
        Type: general
      – SubjectFull: Pilot projects
        Type: general
      – SubjectFull: Research evaluation
        Type: general
      – SubjectFull: Milk
        Type: general
      – SubjectFull: Endoscopic surgery
        Type: general
      – SubjectFull: Respiratory aspiration
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Chi-squared test
        Type: general
      – SubjectFull: Odds ratio
        Type: general
      – SubjectFull: Biomedical materials
        Type: general
      – SubjectFull: Water
        Type: general
      – SubjectFull: Statistics
        Type: general
      – SubjectFull: Deglutition
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Data analysis software
        Type: general
      – SubjectFull: Deglutition disorders
        Type: general
      – SubjectFull: Endoscopy
        Type: general
    Titles:
      – TitleFull: The Effects of High-Coating White Water, Low-Coating White Water, and Milk on the Identification of Swallowing Safety and Efficiency in Healthy Adults as Assessed via Flexible Endoscopic Evaluation of Swallowing: A Pilot Study.
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              Text: Jan2026
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              Y: 2026
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