Swallowing Disorders – What Role Do Consistency and Texture Play?

Consistencies are important in swallowing disorders. Textures are also responsible for the pleasure of eating.

When you ask speech therapists in the field of dysphagia about swallowing disorders, you hear a lot about consistencies. Having IDDSI – an international nomenclature for these consistencies – is appreciated. They rely on customized levels of liquids.

And yes, it’s very important in neurology. Liquids can be a problem when it comes to swallowing, especially in this field. It’s also certain that speech therapists in neurology have a very strong therapeutic presence.

However, the fixation on consistencies is unfortunate, and I say this as a speech therapist with roots in neurology!

A guest contribution by a speech therapist Alexander Fillbrandt.

Löffelweiche Mozarttorte von Marvella

September 10, 2023

Fixation on consistencies in swallowing and chewing disorders

There are two reasons for this. When you are new to treating people with swallowing disorders and taking your first steps in neurology (but even if you have been working there for a long time), you tend to lose sight of the fact that there are also other types of swallowing disorders. The term alone is too narrowly defined. Swallowing and chewing disorders can be found in other medical fields as well. (At this point, it seems a bit funny that chewing disorders somehow also involve consistencies.)

Swallowing and chewing disorders are similar in their effects but also differ, especially with regard to consistencies. In neurology, for example, drinks are often made thicker, whereas in oncology or geriatrics, foods often need to be made more liquid.

Furthermore - and this is the second reason - adjustments to consistency often unfortunately lead to the destruction of textures.


Textures in foods and beverages?

Oh yes! Textures are what we all feel when chewing and tasting. Fibers, crumbs, bits, surfaces... all of these stimulate the tongue and palate. Most of them add to the enjoyment of eating and drinking. However, they also serve a physiological purpose: they assist our swallowing centers in making decisions.

To understand this better, let's take a closer look at swallowing.

As soon as we have food in our mouth, our body begins to analyze it. We call this tasting. It's not just about identifying the taste to decide whether the swallowing process should continue; it also involves determining the temperature. Our teeth are excellent at detecting any bones or hairs in the food. Additionally, we assess the size and texture of the bite. All of this happens consciously, so it's more of an active process.

As the swallowing process continues, the esophagus needs to open - or more accurately, it's opened. But how wide and for how long should this opening be? Exactly - it's determined by the quantity and consistency of the bolus, which is the chewed food mass in the mouth. This part of the process is no longer under conscious control. It just happens, much like breathing and heartbeat occur without us actively controlling them.

To simplify, one could say: Consistency determines how quickly the swallow can occur, while texture determines the duration of the part we can no longer control. In even more abstract terms, textures help make a swallow more successful, while consistencies make it safer.


Success, safety, and enjoyment in swallowing

By the way, success and safety are the two important tasks of swallowing when viewed purely from a medical perspective. But then eating and drinking wouldn't be enjoyable. We wouldn't have to go to the café.

Fortunately, textures and flavors ensure that eating succeeds, that swallowing works; but to a significant extent, they also make it enjoyable.

Marvella's cakes for chewing and swallowing disorders offer a great middle ground from a speech therapist's perspective. On one hand, they have a consistent consistency, but they still offer different textures. Especially the apricot cake: a familiar taste, consistent consistency, and exciting textures - a perfect combination.


We thank the author for the contribution!

You might also be interested in this: