Leder, S.B., et al. 2013. Promoting safe swallowing when puree is swallowed without aspiration but thin liquid is aspirated: Nectar is enough. Dysphagia, 28, 58-62.

How many patients have said, “You know, if I am gonna drink that thick stuff, I want it to be the thickest possible. Yeah, like that honey-thick stuff.” I am willing to wager that most cognitively intact patients, and those who are not, are going to be more agreeable to the less viscous liquid.

The above study investigated whether both honey and nectar consistencies were swallowed safely (without aspiration) in the same patient that swallowed puree safely but aspirated thin liquids. Essentially, if both thickened viscosities could be swallowed safely then perhaps it may question the use of using honey liquids during objective swallowing assessments and in diet recommendations.

A group of 84 consecutive patients were referred to Speech-Language Pathology for formal dysphagia evaluations and were evaluated by FEES. Participant etiologies ranged from CVA to Dementia. All participants who swallowed pureed food without aspiration but demonstrated aspiration with thin liquids consumed both nectar and honey consistencies with 100% success at the time of evaluation and judged clinically safe 24 hours later upon SLP follow-up. The data indicate that in a subset of patients that there does not appear to be a reason to test with nor recommend honey liquids when patients demonstrate a safe swallow with puree but aspirate with thin liquids.

Discussion: Eliminating honey liquids from an evaluation protocol can save time and money as well as promote compliance with patients by using the least restrictive thickened option

Personal take-away message: I love the practicality of this article and how it can translate to the real clinical world. This article addresses two key points in our ever-changing health care system: Time and Money. Like mentioned earlier, I don’t think there would be too many patients that would object to the elimination of honey thick liquids from a test protocol and diet recommendation. Furthermore, I don’t think supervisors, managers and administrators would mind if they were approached with an idea on how to save time and improve productivity, all while maintaining patient safety. Sample size, small bolus volumes during FEES and challenges with follow-up beyond 24 hours, were a few of the limitations the author noted.


So what do you think? Does it get you excited to think that there is support to say “NECTAR IS ENOUGH”?

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