{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:09:56Z","timestamp":1784304596157,"version":"3.55.0"},"reference-count":43,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Folia Phoniatr Logop"],"abstract":"<jats:p>Introduction: Thin liquids are an important part of many swallowing assessment protocols, yet little is known about self-selected sip sizes in outpatient adults nor their relationship with functional swallowing outcomes. Therefore, this quality improvement study aimed to: (1) assess the influence of testing-specific factors on the size of self-selected sips in outpatient adults; (2) examine the relationships between self-selected sip sizes, patient characteristics, and degree of swallowing impairment; and (3) evaluate the relationship between the self-selected sip sizes, swallowing safety, and swallowing efficiency. Methods: Consecutive outpatient adults being evaluated for known or suspected swallowing impairments completed randomized self-selected sips of thin liquids varying by cup size, fill level, liquid color, liquid type, bolus delivery method, swallowing instruction, and endoscope presence. Self-selected sip sizes were measured for each trial. Multilevel statistical models were used to assess the relationships between self-selected sip size, testing conditions, patient characteristics, and pharyngeal residue, penetration, and aspiration as seen during flexible endoscopic evaluation of swallowing (FEES) and modified barium swallow studies (MBS). Results: Seventy-four outpatient adults were recruited, yielding an analysis of 595 self-selected sip sizes. The median self-selected sip size was 24.0 mL during the most natural drinking condition. Colored liquids, smaller amount of liquid filling a cup, and straw use significantly decreased sip size, whereas transnasal endoscopy and barium significantly increased sip size (p &lt; 0.05). Sex and height were the only patient characteristics significantly associated with sip size (p &lt; 0.05). The size of self-selected sips of thin liquid was not associated with measures of pharyngeal residue, penetration, and aspiration (p &gt; 0.05). Conclusion: Outpatient adults typically select thin liquid sips of \u223c24 mL under natural conditions, similar to what is reported in healthy community dwelling adults and far exceeding sip sizes frequently used during routine clinical assessments. Testing-induced alterations significantly alter natural sip size, suggesting that \u201cnatural\u201d self-selected sips during clinical assessments, FEES, and MBS rarely reflect real-world drinking. Because sip size is not predictable from patient characteristics and is altered when being testing, clinicians should consider testing a range of fixed volumes to comprehensively assess swallowing function across patients.<\/jats:p>","DOI":"10.1159\/000552746","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T16:01:56Z","timestamp":1779984116000},"page":"1-15","source":"Crossref","is-referenced-by-count":0,"title":["Thin Liquid Sip Sizes in Outpatient Adults with Normal and Disordered Swallowing: Modifying Factors and Relationships with Swallowing Safety and Efficiency"],"prefix":"10.1159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5677-6364","authenticated-orcid":false,"given":"James A.","family":"Curtis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyla E.","family":"Jimenez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel M.","family":"Aberin-Angulo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8323-7068","authenticated-orcid":false,"given":"Valentina","family":"Mocchetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30283"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.34079"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1044\/2021_ajslp-20-00348"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-008-9185-9"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1044\/2021_jslhr-21-00014"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2008.06.011"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1044\/2017_jslhr-s-16-0117"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21727"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-018-09966-5"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1177\/0003489417742161"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1177\/000348940911800204"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1177\/000348940911800306"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1177\/000348941112000502"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-015-0990-y"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-021-10397-y"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-021-10373-6"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1111\/joor.12573"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/738971"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1961.02080010429023"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-008-9183-y"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1007\/BF00417900"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-002-0105-0"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s004550010017"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1044\/2023_jslhr-23-00132"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjorl.2021.03.002"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-023-10650-6"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1044\/2025_jslhr-25-00345"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1044\/2019_jslhr-s-18-0448"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1177\/000348940811701210"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1159\/000538935"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-019-10050-9"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1044\/1058-0360(2007\/018)"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-020-10131-0"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1177\/0003489415570935"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-021-10293-5"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1044\/2021_ajslp-21-00116"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.47739\/2379-948X\/1168"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1007\/bf00417897"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1995.tb02031.x"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1044\/2018_ajslp-18-0119"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1044\/1058-0360(2005\/005)"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1159\/000548977"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21116"}],"container-title":["Folia 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