Maxfacts

Getting food texture right for individual needs can make all the difference between enjoying food and being unable/unwilling to eat. There is no simple one-size-fits-all answer to this challenge, individual needs vary widely and it is important to investigate what works – and what doesn’t. This may have to be repeated over time because needs tend to change over time.

It is worthwhile to find out about these individual needs, to learn what is safe and enjoyable to eat, not just because of the need to feed the body but also for hugely important reasons of improving quality of life. The speech and language therapist (SALT) is the specialist who will normally help to assess the best food textures to try, and will also monitor changes over time.

It would be very wrong to believe that the choice is just between survival on power drinks or relying on a feeding tube, or that the only way to thicken liquids would be to add instantaneous thickening agents (which are mainly a matter of convenience in many care settings but do not necessarily produce an enjoyable texture & taste). We hope that a look at our recipes, cooking videos and other information about oral food intake, including a collection of practical tips will convince you that there are endless possibilities.

Some general trends for suitable textures and consistencies

The complicated and multi-step process of swallowing and the important role of saliva in this process suggest some general trends (with wide individual variation) for suitable food textures and consistencies when parts of the swallowing process are hampered:

• Difficulty controlling bolus: smooth textures, homogenous consistency, thickened liquids recommended.

This may happen after surgery in the floor of the mouth limits free movement of the tip of the tongue either in the short term because of discomfort (as when a ranula is removed), or if an excision has been performed and the reconstruction does not allow full mobility.

• Difficulty controlling / moving base of tongue / floor of mouth: smooth textures, homogenous consistency, lubricated foods, slippery foods recommended.

Treatments affecting the base of the tongue range from laser excisions (where the immobility may improve) or post-radiotherapy fibrosis (where there tends to be little improvement) to complete replacement with a flap after total glossectomy (removal of the tongue, which requires a completely new method of swallowing to be learnt).

• Reduced / malfunctioning swallowing reflex: temperature stimulus – alternate mouthfuls of hot and cold foods, possibly taste / flavour stimulus might also work (exploiting smell – cinnamon and vanilla tried and tested).

Surgery to the lateral pharynx (throat), or treatment or disease which encroaches the pterygoid plexus of nerves (group of nerves which control the largely involuntary pharyngeal component of swallowing) may disrupt this reflex.

• Treatments disturbing taste: can range from laser excisions where the taste buds are damaged, or quite simple surgery which may cause damage to the lingual nerve which carries taste fibres (removing a third molar tooth can do this), to high dose chemoradiotherapy which will effectively destroy all taste buds in the exposed fields.

• Poorly sealed airway or nasal cavity: requires thickening of liquids.

Hemimaxillectomy (removal of a large part of the upper jaw) with an obturator that doesn’t fit perfectly, or removal of a submandibular (salivary) gland which causes an inadvertent weakness of the marginal mandibular branch of the facial nerve (which moves the lower lip) means the lips have difficulty sealing to allow the increase in intraoral pressure necessary to swallow.

• Weak muscles in pharynx (upper part of throat) and/or upper oesophagus (gullet): soft and slippery foods (gliding easily and rapidly) recommended.

Radiotherapy to the posterior oropharynx and neck following cancer treatment is a likely cause.

• Problems with uvula and soft palate: thickened liquids, otherwise slippery homogenous foods (gliding easily) recommended.

Commonly in pre-treated cleft palate, sometimes seen after uvulopalatopharyngoplasty for treatment of snoring and sleep apnoea. After resection of soft palate for tumours.

Some other general trends

Some physiological properties can be exploited to optimise the texture and consistency of food to ease swallowing:

• if tolerated: acidic foods stimulate saliva production;
• salty foods tend to make saliva less viscous;
• sweet foods and dairy products make saliva more viscous;
• if relevant: solid foods activate the reflex for chewing;
• cold or frozen foods are more intensely noticed in the oral cavity and the pharynx.

Our detailed page about the adaption of food textures and consistencies revisits the topic in more detail, looking at it from the different food textures we can prepare in flexible ways. Combined with our collections of practical tips around eating and cooking and recipes in our searchable database, this should make for enjoyable and tasty meals for almost everybody!