Stroke is the second leading cause of death and the third leading cause of disability worldwide.2,3 An independent risk factor for increased mortality after stroke is oropharyngeal dysphagia (OD)1. OD is defined as a swallowing difficulty affecting the transport of foods and liquids from the mouth to the esophagus. OD is characterized by impaired swallowing mechanisms including safety, efficacy and physiology of swallowing and is associated with malnutrition, dehydration and respiratory infections.4
PSOD is a common complication following stroke, with an incidence up to 78% in acute stroke patients5. It was recently also found to be a risk factor for prolonged hospital stay and a decreased functional capacity.1
The European Society for Swallowing Disorders (ESSD) states that increasing the viscosity of liquids with thickening agents can enhance the safety of swallowing by reducing the risk of airway invasion6. Most studies on thickening agents only tested a few viscosity levels per study, and the optimal viscosity levels for patients suffering PSOD have not been determined yet.
The Triple S study evaluated the effect of Nutilis Clear in 120 patients with PSOD. The effect of the thickener was tested on safety, efficacy (e.g. presence of pharyngeal residue) and physiology of swallowing (e.g. time to laryngeal vestibule closure (LVC)). The LVC is a protective mechanism which ensures that the airways are not accessible by the food or liquid bolus during the swallowing process.
The study was conducted by evaluating 10 mL boluses of 150, 250, 450, 800, 1400, and 2000 mPa.s in comparison to unthickened (thin) liquid. Swallowing mechanisms were evaluated with videofluoroscopy (VFSS) and Penetration Aspiration Scale (PAS).
The Triple S study is the first study designed to evaluate the effect of 7 different viscosities in PSOD patients. Access the full study here.
Study results demonstrated:
• 92.1% of patients could swallow safely at 800 mPa·s
• The therapeutic needs of these patients can be covered with a viscosity range of 150 –800 mPa·s
• This is in contrast to modified starch thickeners, which have been shown to increase pharyngeal residue with increased bolus viscosity1,7,8
• The time to LVC by the epiglottis is crucial and is the first line of defense that prevents food and liquids from entering the airways9
• For the first time, it is shown that a xanthan gum-based thickener significantly reduced time to LVC at all tested viscosities (p<0.01)
These results confirm the effectiveness of Nutilis Clear and support the recommendation of use in the management of oropharyngeal dysphagia.