When treating dysphagia, sensory strategies like carbonation are increasingly being explored as tools to stimulate and support a safer swallow. However, somewhere along the way, a misconception took root—that carbonated beverages are a substitute for nectar-thick liquids.

Let’s break down what carbonation actually does in dysphagia management—and what it doesn’t.

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Carbonated Beverages: A Sensory Strategy, Not a Thickener

Recent research has placed greater focus on the sensory component of swallowing, revealing that sensory input plays a vital role in swallowing efficiency and safety. Carbonated beverages are one form of sensory enhancement being used in dysphagia rehabilitation.

Key Point: Carbonated drinks are not thickened liquids. They don’t behave like nectar-thick liquids, and shouldn’t be used interchangeably.

How Carbonation Works in the Swallow

Carbonation triggers a sensory process called chemesthesis – the tingly, fizzy feeling from carbonated drinks. This sensation stimulates the Trigeminal nerve (Cranial Nerve V), a nerve deeply involved in the oral and pharyngeal phases of swallowing.

Because this nerve has bare nerve endings, it is highly sensitive to input. This enhanced afferent stimulation (sensory input) may lead to increased motor output during the swallow, which can support swallow safety in some individuals.

What the Research Says

Studies have explored how carbonation affects swallowing physiology:

• Saravou & Walshe (2012): No significant change in transit times, but reduced penetration and aspiration during 5–10 ml sips.

• Newman et al. (2001): Carbonated thin liquids decreased spillover, delayed response, and penetration compared to non-carbonated thin liquids.

• Krival & Bates (2012): Sour and heat-activating drinks affected swallowing more than water.

• Miura et al. (2009): Sour and carbonated drinks promoted stronger submental muscle activity.

• Turkington et al. (2017–2019): Carbonation may benefit some with neurogenic dysphagia, but responses vary.

Note: Research typically used carbonated beverages like club soda, ginger brew, or citrus soda — not Coke, Pepsi, or Sprite.

It’s Not One-Size-Fits-All

Like any strategy, carbonation doesn’t work for everyone. It may help some and worsen swallow safety in others. Use instrumental assessment (e.g., VFSS or FEES) to guide recommendations.

Avoid assuming carbonation can replace thickened liquids. Assess effectiveness individually.

Key Takeaways

• Carbonation increases sensory input, not thickness.

• Some patients may benefit from the sensory stimulation carbonation provides.

• Use evidence-based practice and individual assessment before recommending.

• Choose clinical beverages, not commercial sodas.

• Always remember that while there is not strong evidence to support changes in the swallow with carbonated beverages, observation of the swallow with use of MBSS or FEES can help determine if carbonation is an effective sensory stimulation per patient. 

  Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

  Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation?   Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care?  You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes.   You can get your copy here.  

References:  

Krival K, Bates C. Effects of Club Soda and Ginger Brew on Linguapalatal Pressures in Healthy Swallowing. Dysphagia (2012). 27: 228-239.

Newman, et al. Carbonated Thin Liquid Significantly Decreases the Incidence of Spillover, Delayed Pharyngeal Response and Laryngeal Penetration Compared to Non-Carbonated Thin Liquids. Dysphagia 2001: 16: 146-150.

Saravou K, Walshe M. Effects of Carbonated Liquids on Oropharyngeal Swallowing Measures in People with Neurogenic Dysphagia. Dysphagia(2012) 27: 240-250.

Miura, Yutaka, et al. “Effects of taste solutions, carbonation, and cold stimulus on the power frequency content of swallowing submental surface electromyography.” Chemical senses 34.4 (2009): 325-331.

Morishita, M., Mori, S., Yamagami, S., & Mizutani, M. (2014). Effect of carbonated beverages on pharyngeal swallowing in young individuals and elderly inpatients. Dysphagia, 29(2), 213-222.

Rofes, L., Cola, P. C., & Clavé, P. (2014). The effects of sensory stimulation on neurogenic oropharyngeal dysphagia. Journal of Gastroenterology and Hepatology Research, 3(5).

Regan, J. (2020). Impact of sensory stimulation on pharyngo-esophageal swallowing biomechanics in adults with dysphagia: a high-resolution manometry study. Dysphagia, 35(5), 825-833.

Turkington, L., Ward, E. C., Farrell, A., Porter, L., & Wall, L. R. (2019). Impact of carbonation on neurogenic dysphagia and an exploration of the clinical predictors of a response to carbonation. International journal of language & communication disorders, 54(3), 499-513.

Turkington, L. G., Ward, E. C., & Farrell, A. M. (2017). Carbonation as a sensory enhancement strategy: a narrative synthesis of existing evidence. Disability and rehabilitation, 39(19), 1958-1967.

Lundine, J. P., Bates, D. G., & Yin, H. (2015). Analysis of carbonated thin liquids in pediatric neurogenic dysphagia. Pediatric radiology, 45(9), 1323-1332.

Saiki, A., Yoshimi, K., Nakagawa, K., Nagasawa, Y., Yoshizawa, A., Yanagida, R., … & Tohara, H. (2022). Effects of thickened carbonated cola in older patients with dysphagia. Scientific Reports, 12(1), 22151.

Price, K., Isbister, G., Long, S., Mirams, J., & Smithard, D. (2023). Are bubbles the future of dysphagia rehabilitation: a systematic review analysing evidence on the use of carbonated liquids in dysphagia rehabilitation. Geriatrics, 8(1), 6.Nagano, A., Maeda, K., Shimizu, A., Murotani, K., & Mori, N. (2022). Effects of carbonation on swallowing: systematic review and meta‐analysis. The Laryngoscope, 132(10), 1924-1933.

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