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Do you find yourself choking when you are chugging your drinks?

Does fast drinking from a cup or straw make you cough, like liquid is going down the wrong pipe? Maybe it is. Maybe a Speech-language Pathologist (SLP) needs to evaluate your swallowing function.

Speech-Language Pathologists specializing in difficulty swallowing (dysphagia) have lots of tricks to make it easier to swallow. Frequently, SLPs recommend the strategy of taking small sips, based on the person’s swallow study.

However, is that realistic?

Lawless, et al., (2003) noted that average cup sips are 25ml or 20ml for healthy men and healthy women, respectively. Recently, Steele, et al., (2015) found that when given a full cup of water, people tend to take sip sizes of 16ml, on average.

We may note on a person’s swallow study, that a teaspoon-size sip (5ml) of a thin liquid is safe, but who drinks out of a spoon? How would that affect the person’s hydration and quality of life?

We also may report on a swallow study that a small sip by cup prevented liquids from going down the wrong way, but who will sit next to that person all day and everyday to remind him to take small sips? If a 25ml size sip is his automatic-natural way of drinking, then a 5ml sip is a big change.

Furthermore, the swallow study may show that liquids go down the wrong way when taken rapidly by a straw (sequential drinking). However, it tends to be challenging to get staff and family to remember to avoid straws.

What if the person prefers to drink out of a straws? What if the dependent patient in the hospital is easier to feed when using a straw?

A straw may make it easier to get the liquid in the mouth. Veiga et al., (2014) found that it was easier for healthy elderly adults to take sequential sips via a straw from an oral point of view. The liquid did not spill out of the mouth as much as with sequential cup drinking. This study was done with healthy elderly with a mean age of 72.8 years. None of the healthy elderly had airway compromise, meaning no liquid got into the top of the airway/laryngeal vestibule (penetration) or below the level of the vocal cords (aspiration), but only 100ml was taken.

Do people aspirate more via straw than cup? Daniels, et al., (2004) studied healthy young and elderly individuals. They found inherent problems with sequential straw drinking that increase risks. Sequential straw drinking, no matter young or older, tends to allow the volume of liquid to drop too low in the throat before the swallow (i.e., bolus head was inferior to the valleculae in the hypopharynx before the onset of the swallow in 66% of adults). Additionally, older adults (ranging in age from 60-83 years old) had more airway compromise (penetration and aspiration) during sequential drinking of 300ml.

These studies were on healthy elderly. What if the elderly person is weak, lethargic, confused and sick? Is straw drinking safe and possible? This is why a swallowing evaluation may be needed by an SLP to rule-out dysphagia.

The amount of risk could be significantly higher in people with dysphagia (difficulty swallowing). Your Speech-Language Pathologist (SLP) can fully evaluate your swallowing function with a Modified Barium Swallow Study (aka, MBSS or Videoflouroscopic Swallow Study) or a Flexible/Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Depending on your specific structural and physiological swallowing difficulties, the SLP may recommend small sips to prevent penetration and aspiration of liquids into your airway.

Sometimes thickened liquids are recommended, especially if a person cannot modify his/her sip size and follow safe swallow strategies. However, thickened liquids may effect the person’s intake and quality of life.

Potentially, a device that modifies the sip size for the patient could keep the patient off thickened liquids and enjoying any regular thin liquid beverage safely (per testing by an SLP and your medical team’s advice).