Color and Consistency Matter: How Puree Type and Dye Impact FEES

Recent research highlights that both the type and color of pureed foods and liquids can significantly impact swallowing outcomes during Flexible Endoscopic Evaluation of Swallowing (FEES). Let's dive into it!

In a study assessing puree types of food coloring, Curtis et al. (2025) found that pudding was associated with higher oropharyngeal residue than applesauce. Additionally, coloring applesauce blue increased both oropharyngeal and hypopharyngeal residue ratings compared to natural, while green dye on applesauce or pudding increased hypopharyngeal residue compared to their natural forms. These results suggest that even seemingly minor modifications in bolus characteristics can influence assessment outcomes, emphasizing the need for standardized presentations during instrumental swallow evaluations.

Earlier studies support these findings. Curtis et al. (2019) found that pharyngeal residue was detected more often for liquids that were blue, opaque, or had a coating effect than those that were white, did not have a coating effect, or were translucent. Penetration and aspiration were detected more frequently for liquids had a coating effect but not for trials that were blue or opaque. Similarly, Marvin et al. (2016) found that deeper airway invasion was measured for green-dyed liquids compared to liquids naturally white.

Research demonstrates the importance of standardization during FEES. Clinicians should be aware that bolus characteristics and dye can influence ratings, with the potential to impact clinical decision-making. Interested in learning more? Check out the references cited in this post.