RESUMEN
Quantitative measures of swallowing function were extracted from modified barium swallowing studies (MBS) to characterize swallowing pathophysiology in patients with unilateral vocal fold immobility (UVFI). All individuals with UVFI completing a MBS during the prior 5 years were included. Demographic information, penetration-aspiration score, timing of aspiration and quantitative measures from the MBS were extracted from electronic medical records and compared across 1, 3, and 20 cc liquid bolus swallows. UVFI patient measures were compared to normal age-matched controls to identify swallowing pathophysiology associated with aspiration. The incidence of aspiration by UVFI etiology groups (i.e., central nervous system, idiopathic, iatrogenic, skull base tumor, or peripheral tumor) was also compared. Of the 61 patients who met inclusion criteria, aspiration was observed in 23%. Maximum pharyngeal constriction was abnormal in 79% of aspirators compared to 34% of non-aspirators (p = .003). Delay in airway closure was the most common swallowing abnormality identified in the study population (62%) but was not associated with aspiration. Among the 14 individuals who aspirated, the iatrogenic and skull base tumor etiology groups comprised the majority (i.e., 36% each). However, the incidence of aspiration for the iatrogenic group was 19% compared to 50% of the skull base tumor group. Aspiration in patients with UVFI was associated with abnormally reduced pharyngeal constriction. Delayed airway closure was common in both aspirators and non-aspirators.
Asunto(s)
Trastornos de Deglución , Parálisis de los Pliegues Vocales , Deglución/fisiología , Humanos , Estudios Retrospectivos , Parálisis de los Pliegues Vocales/complicaciones , Pliegues VocalesRESUMEN
OBJECTIVES/HYPOTHESIS: The purpose of this study was to investigate the impact of dysphagia definition on the incidence and overall prevalence of dysphagia in patients with unilateral vocal fold paralysis (UVP) stratified by etiology. STUDY DESIGN: Retrospective medical chart review. METHODS: Data was collected from the records of individuals diagnosed with UVP from 2013 to 2018, including patient demographics, dysphagia questionnaire total scores, clinical evaluation dysphagia symptoms, and instrumental swallow assessment outcomes. The annual incidence and overall prevalence of dysphagia were calculated by etiology as counts and percentages across five operational definitions of dysphagia. RESULTS: A total of 415 individuals met inclusion criteria for the study. Annual prevalence estimates ranged from 19% to 55%, depending on the definition of dysphagia used. The highest prevalence of dysphagia occurred when defined by symptoms or signs identified by the clinician (55%). The lowest prevalence of dysphagia occurred using a definition of abnormal swallowing function documented during instrumental assessment (19%). Dysphagia questionnaire scores were more frequently abnormal in those with iatrogenic than idiopathic etiology of UVP (adjusted P = 0.014). Rate of instrumental assessment and documentation of aspiration was highest for central UVP etiology (33%). On average, pneumonia was rare (6%) irrespective of UVP etiology. CONCLUSION: Up to 55% of patients diagnosed with UVP complained of dysphagia, but only 21% had dysphagia symptoms severe enough to prompt instrumental assessment. Incidence and severity of dysphagia varied depending on UVP etiologic category as well as dysphagia definition. The etiology of UVP may impact dysphagia risk and severity in this population and warrants further investigation. LEVEL OF EVIDENCE: IV Laryngoscope, 130:2397-2404, 2020.
Asunto(s)
Trastornos de Deglución/epidemiología , Trastornos de Deglución/fisiopatología , Parálisis de los Pliegues Vocales/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Encuestas y Cuestionarios , Utah/epidemiologíaRESUMEN
OBJECTIVE: Reflux disease is common in patients with oropharyngeal dysphagia, but the impact of reflux on oropharyngeal swallowing physiology is not known. This study uses objective measures of swallowing function from modified barium swallow studies to describe the pathophysiology of dysphagia in a group of patients whose only associated condition is reflux. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care voice and swallowing clinic. SUBJECTS AND METHODS: The Swallowing Database at the University of Utah was queried for patients with a diagnosis of reflux without additional conditions known to affect swallowing function. Pharyngeal transit time (TPT), distance of hyoid elevation (Hmax), maximum opening size of the upper esophageal sphincter (UESmax), area of pharynx at maximum constriction (PAmax), airway closure timing relative to the arrival of the bolus at the UES, and penetration/aspiration (Pen/Asp) score were assessed. RESULTS: Of the 122 patients who met inclusion criteria for the study, 42% had normal pharyngeal swallowing function, 57% had at least 1 abnormal swallowing measure, and 47.5% demonstrated a delay in airway closure relative to arrival of the bolus at the UES on at least 1 swallow. The incidence of prolonged TPT, diminished Hmax, poor UESmax, and enlarged PAmax were 2.5%, 8%, 4%, and 11.5%, respectively. Sixty percent with a delay in airway closure had a normal Pen/Asp score. CONCLUSION: A delay in airway closure relative to the arrival of the bolus at the UES is the most common abnormality of swallowing function found in patients with reflux-associated dysphagia but may not be identified using the Pen/Asp score.
Asunto(s)
Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Esfínter Esofágico Superior/fisiopatología , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/fisiopatología , Faringe/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Deglución/fisiología , Femenino , Humanos , Hueso Hioides/fisiopatología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVES: Chronic bacterial infection of the larynx is characterized by long-standing hoarseness and exudative laryngitis. Prolonged antibiotic therapy is required to clear the infection, and methicillin-resistant staphylococcus aureus (MRSA) may be the responsible pathogen. The objective of this study was to describe the presentation, comorbidities, treatment response, and underlying etiology- including the incidence of MRSA-in our patient population with chronic bacterial laryngitis. METHODS: A review of patients with a diagnosis of chronic bacterial laryngitis from 2012 to 2016 was performed. Diagnosis of chronic bacterial laryngitis was based on clinical history and findings on flexible laryngoscopy. In selected cases, the diagnosis of bacterial laryngitis was confirmed by operative biopsy. Information regarding clinical presentation and course was collected. RESULTS: Twenty-eight patients were included in the study. Twenty-three were treated empirically with Amoxicillin-clavulonic acid for a minimum of 21 days. Twelve of the 23 (52%) had recurrence or nonresolution of infection. Seven of the 12 nonresponders (58%) were found to have MRSA by laryngeal tissue culture. Five patients were treated initially with Sulfamethoxazole and trimethoprim, and all resolved the infection without the need for further treatment. There was a nonstatistically significant increase in smoking and reflux in the MRSA population compared to the non-MRSA group. CONCLUSION: MRSA infection was documented in 30% of patients overall with chronic bacterial laryngitis. Based on the results of the study, a treatment algorithm for management of this unusual patient population is suggested. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:921-925, 2018.
Asunto(s)
Antibacterianos/uso terapéutico , Laringitis/epidemiología , Laringe/microbiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/epidemiología , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Laringitis/tratamiento farmacológico , Laringitis/microbiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Utah/epidemiologíaRESUMEN
OBJECTIVES/HYPOTHESIS: Quantitative measures of swallowing function may improve the reliability and accuracy of modified barium swallow (MBS) study interpretation. Quantitative study analysis has not been widely instituted, however, secondary to concerns about the time required to make measures and a lack of research demonstrating impact on MBS interpretation. This study compares the accuracy of the penetration/aspiration (PEN/ASP) scale (an observational visual-perceptual assessment tool) to quantitative measures of airway closure timing relative to the arrival of the bolus at the upper esophageal sphincter in identifying a failure of airway protection during deglutition. STUDY DESIGN: Retrospective review of clinical swallowing data from a university-based outpatient clinic. METHODS: Swallowing data from 426 patients were reviewed. Patients with normal PEN/ASP scores were identified, and the results of quantitative airway closure timing measures for three liquid bolus sizes were evaluated. The incidence of significant airway closure delay with and without a normal PEN/ASP score was determined. Inter-rater reliability for the quantitative measures was calculated. RESULTS: In patients with a normal PEN/ASP score, 33% demonstrated a delay in airway closure on at least one swallow during the MBS study. There was no correlation between PEN/ASP score and airway closure delay. Inter-rater reliability for the quantitative measure of airway closure timing was nearly perfect (intraclass correlation coefficient = 0.973). CONCLUSIONS: The use of quantitative measures of swallowing function, in conjunction with traditional visual perceptual methods of MBS study interpretation, improves the identification of airway closure delay, and hence, potential aspiration risk, even when no penetration or aspiration is apparent on the MBS study. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2314-2318, 2017.
Asunto(s)
Trastornos de Deglución/prevención & control , Deglución/fisiología , Esfínter Esofágico Superior/fisiopatología , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/fisiopatología , Esfínter Esofágico Superior/diagnóstico por imagen , Femenino , Fluoroscopía , Humanos , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , Grabación en VideoRESUMEN
Quantitative, reliable measures of swallowing physiology can be made from an modified barium swallowing study. These quantitative measures have not been previously employed to study large dysphagic patient populations. The present retrospective study of 139 consecutive patients with dysphagia seen in a university tertiary voice and swallowing clinic sought to use objective measures of swallowing physiology to (1) quantify the most prevalent deficits seen in the patient population, (2) identify commonly associated diagnoses and describe the most prevalent swallowing deficits, and (3) determine any correlation between objective deficits and Eating Assessment Tool (EAT-10) scores and body mass index. Poor pharyngeal constriction (34.5 %) and airway protection deficits (65.5 %) were the most common swallowing abnormalities. Reflux-related dysphagia (36 %), nonspecific pharyngeal dysphagia (24 %), Parkinson disease (16 %), esophageal abnormality (13 %), and brain insult (10 %) were the most common diagnoses. Poor pharyngeal constriction was significantly associated with an esophageal motility abnormality (p < 0.001) and central neurologic insult. In general, dysphagia symptoms as determined by the EAT-10 did not correlate with swallowing function abnormalities. This preliminary study indicates that reflux disease is common in patients with dysphagia and that associated esophageal abnormalities are common in dysphagic populations and may be associated with specific pharyngeal swallowing abnormalities. However, symptom scores from the EAT-10 did not correspond to swallowing pathophysiology.
Asunto(s)
Trastornos de Deglución/fisiopatología , Deglución/fisiología , Fluoroscopía/métodos , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Anciano , Cinerradiografía/métodos , Trastornos de Deglución/diagnóstico , Esófago/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Faringe/fisiopatología , Reproducibilidad de los Resultados , Aspiración Respiratoria/diagnóstico , Aspiración Respiratoria/fisiopatología , Estudios RetrospectivosRESUMEN
This epidemiological investigation examined the prevalence, risk factors, and quality-of-life effects of swallowing disorders in Sjögren's syndrome (SS). One hundred and one individuals with primary or secondary SS (94 females, 7 males; mean age 59.4, SD = 14.1) were interviewed regarding the presence, nature, and impact of swallowing disorders and symptoms. Associations among swallowing disorders and symptoms, select medical and social history factors, SS disease severity, and the M.D. Anderson Dysphagia Inventory (MDADI) and Short Form 36 Health Survey (SF-36) were examined. The prevalence of a current self-reported swallowing disorder was 64.4 %. SS disease severity was the strongest predictor of swallowing disorders, including significant associations with the following swallow symptoms: taking smaller bites, thick mucus in the throat, difficulty placing food in the mouth, and wheezing while eating (p < .05). Additional swallowing disorder risk factors included the presence of a self-reported voice disorder, esophageal reflux, current exposure to secondary tobacco smoke, frequent neck or throat tension, frequent throat clearing, chronic post-nasal drip, and stomach or duodenal ulcers. Swallowing disorders did not differ on the basis of primary or secondary SS. Swallowing disorders and specific swallowing symptoms were uniquely associated with reduced quality of life. Among those with swallowing disorders, 42 % sought treatment, with approximately half reporting improvement. Patient-perceived swallowing disorders are relatively common in SS and increase with disease severity. Specific swallowing symptoms uniquely and significantly reduce swallow and health-related quality of life, indicating the need for increased identification and management of dysphagia in this population.
Asunto(s)
Trastornos de Deglución/epidemiología , Calidad de Vida , Síndrome de Sjögren/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
OBJECTIVE: Dysphagia and associated aspiration pneumonia are commonly reported sequelae of Parkinson's disease (PD). Previous studies of swallowing in patients with PD have described prolonged pharyngeal transit time, delayed onset of pharyngeal transit, cricopharyngeal (CP) achalasia, reduced pharyngeal constriction, and slowed hyolaryngeal elevation. These studies were completed using inconsistent evaluation methodology, reliance on qualitative analysis, and a lack of a large control group, resulting in concerns regarding diagnostic precision. The purpose of this study was to investigate swallowing function in patients with PD using a norm-referenced, quantitative approach. METHODS: This retrospective study includes 34 patients with a diagnosis of PD referred to a multidisciplinary voice and swallowing clinic. Modified barium swallow studies were performed using quantitative measures of pharyngeal transit time, hyoid displacement, CP sphincter opening, area of the pharynx at maximal constriction, and timing of laryngeal vestibule closure relative to bolus arrival at the CP sphincter. RESULTS: Reduced pharyngeal constriction was found in 30.4%, and a delay in airway closure relative to arrival of the bolus at the CP sphincter was the most common abnormality, present in 62% of patients. Previously reported findings of prolonged pharyngeal transit, poor hyoid elevation, and CP achalasia were not identified as prominent features.
Asunto(s)
Trastornos de Deglución/diagnóstico , Deglución/fisiología , Enfermedad de Parkinson/complicaciones , Faringe/fisiopatología , Anciano , Anciano de 80 o más Años , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Femenino , Fluoroscopía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/fisiopatología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Tiempo , Grabación en VideoRESUMEN
OBJECTIVES: This study examined the effects of a laryngeal desiccation challenge and nebulized isotonic saline on voice production in young, healthy male singers and nonsingers. STUDY DESIGN: This is a prospective, double-blind, within-subjects experimental design. METHODS: Participants included 10 male university-trained singers and 10 age-matched nonsingers (mean age, 21.8 years; range, 18-26 years) who underwent a 30-minute oral breathing laryngeal desiccation challenge using medical grade dry air (<1% relative humidity) on two occasions in consecutive weeks. After the challenge, participants received either 3 mL or 9 mL of nebulized isotonic saline (0.9% Na+Cl-); order of administration was counterbalanced. Phonation threshold pressure (PTP), the cepstral spectral index of dysphonia (CSID) for sustained vowels and connected speech, and self-perceived vocal effort, mouth dryness, and throat dryness were measured at each recording (baseline, after challenge, and at 5, 35, and 65 minutes after treatment). RESULTS: Self-perceived effort and dryness measures increased (worsened) after desiccation challenge and decreased (improved) after nebulized treatment (P < 0.05). No consistent changes were observed for PTP or CSID over time. Overall, singers demonstrated significantly lower vocal effort and CSID as compared with nonsingers. CONCLUSIONS: Young, vocally healthy men may not experience physiologic changes in voice production associated with laryngeal desiccation and nebulized saline treatments; however, self-reported increases in vocal effort which are associated with dryness symptoms might improve with nebulized treatments. Future hydration research should consider age and sex variables.
Asunto(s)
Acústica , Deshidratación/fisiopatología , Laringe/efectos de los fármacos , Fonación/efectos de los fármacos , Autoimagen , Canto , Cloruro de Sodio/administración & dosificación , Acústica del Lenguaje , Percepción del Habla , Calidad de la Voz/efectos de los fármacos , Administración por Inhalación , Adolescente , Adulto , Estudios Cruzados , Método Doble Ciego , Humanos , Soluciones Isotónicas , Laringe/fisiopatología , Masculino , Nebulizadores y Vaporizadores , Presión , Estudios Prospectivos , Medición de la Producción del Habla , Adulto JovenRESUMEN
OBJECTIVES: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease which may adversely affect phonatory function. This study aimed to establish the prevalence, risks, and quality of life effects of voice disorders in RA. STUDY DESIGN: This is a cross-sectional, descriptive epidemiology study. METHODS: One hundred individuals with RA underwent a telephone interview to determine the frequency, severity, risks associated with, and quality of life burden of voice disorders. The results were analyzed using summary statistics, frequencies, chi-square tests, regression analysis, and risk ratios (P < 0.05). RESULTS: Thirty-five percent of participants with RA reported a current voice disorder which was chronic and long-standing in most cases. The prevalence of a current voice disorder did not significantly differ across age, sex, medication use, voice use patterns, medical history, or RA severity. These chronic voice disorders produced significant adverse effects on both voice-related quality of life and short form 36 health-related quality of life scales. Specific voice symptoms such as "voice-related discomfort" and "chronic throat dryness" contributed disproportionately to the quality of life burden. Of those participants with a voice disorder, only 37% had ever sought professional help to improve their voice. CONCLUSIONS: These results indicate that voice disorders are common in RA and produce significant adverse effects on quality of life. Further research is necessary to better understand the origin of these disorders and their potential response to treatment.
Asunto(s)
Artritis Reumatoide/epidemiología , Calidad de Vida , Trastornos de la Voz/epidemiología , Calidad de la Voz , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/fisiopatología , Artritis Reumatoide/psicología , Distribución de Chi-Cuadrado , Costo de Enfermedad , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Utah/epidemiología , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/psicología , Adulto JovenRESUMEN
OBJECTIVES: This study examined quality of life burden of voice disorders in Sjögren's syndrome (SS). METHODS: Patients with SS (n = 101) completed interviews involving patient-reported histories of voice disorders, specific voice symptoms, SS disease severity, the Voice-Related Quality of Life (V-RQOL), and the general health-related quality of life Short Form 36 (SF-36) questionnaires. Relationships among voice symptoms, disease severity, and quality-of-life measures were examined and compared with patient-reported voice disorders. RESULTS: Significant correlations were observed among voice symptoms, disease severity, V-RQOL, SF-36, and patient-reported voice disorders (P < .05). Patients with SS who reported a voice disorder experienced a greater burden on general quality of life as compared with those without voice disorders. Specific voice symptoms significantly correlated with reduced SF-36 scores included frequent throat-clearing, throat soreness, difficulty projecting, and vocal discomfort. Despite the added burden of a voice disorder on quality of life in SS, voice-related treatment seeking was low (15.8%). However, the majority of patients who received voice treatment reported voice improvement. CONCLUSIONS: Individuals with SS frequently experience voice disorders and specific voice-related symptoms that are associated with reduced quality of life. These findings have important implications for voice referral practices and voice disorder symptom management in this population.
Asunto(s)
Costo de Enfermedad , Calidad de Vida , Síndrome de Sjögren/complicaciones , Trastornos de la Voz , Entrenamiento de la Voz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/fisiopatología , Estadística como Asunto , Encuestas y Cuestionarios , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/psicología , Trastornos de la Voz/terapia , Calidad de la VozRESUMEN
OBJECTIVE: This study examined the effects of a topical vocal fold hydration treatment on voice production over time. STUDY DESIGN: Prospective, longitudinal, within-subjects A (baseline), B (treatment), A (withdrawal/reversal), B (treatment) experimental design. METHODS: Eight individuals with primary Sjögren's syndrome (SS), an autoimmune disease causing laryngeal dryness, completed an 8-week A-B-A-B experiment. Participants performed twice-daily audio recordings of connected speech and sustained vowels and then rated vocal effort, mouth dryness, and throat dryness. Two-week treatment phases introduced twice-daily 9-mL doses of nebulized isotonic saline (0.9% Na(+)Cl(-)). Voice handicap and patient-based measures of SS disease severity were collected before and after each 2-week phase. Connected speech and sustained vowels were analyzed using the Cepstral Spectral Index of Dysphonia (CSID). Acoustic and patient-based ratings during each baseline and treatment phase were analyzed and compared. RESULTS: Baseline CSID and patient-based ratings were in the mild-to-moderate range. CSID measures of voice severity improved by approximately 20% with nebulized saline treatment and worsened during treatment withdrawal. Posttreatment CSID values fell within the normal-to-mild range. Similar patterns were observed in patient-based ratings of vocal effort and dryness. CSID values and patient-based ratings correlated significantly (P < .05). CONCLUSION: Nebulized isotonic saline improves voice production based on acoustic and patient-based ratings of voice severity. Future work should optimize topical vocal fold hydration treatment formulations, dose, and delivery methodologies for various patient populations. This study lays the groundwork for future topical vocal fold hydration treatment development to manage and possibly prevent dehydration-related voice disorders. LEVEL OF EVIDENCE: 2b.
Asunto(s)
Síndrome de Sjögren/fisiopatología , Cloruro de Sodio/administración & dosificación , Pliegues Vocales/efectos de los fármacos , Voz/efectos de los fármacos , Adulto , Anciano , Deshidratación/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Síndrome de Sjögren/terapiaRESUMEN
OBJECTIVES/HYPOTHESIS: Sjögren's Syndrome (SS) is an autoimmune disease that causes sicca (dryness) symptoms by affecting secretions most notably of the lacrimal and salivary glands. Voice disorders have been documented in patients with SS, but the true prevalence and relationships among possible contributing factors remain unknown. This preliminary epidemiological investigation examined prevalence and risk factors for voice disorders in SS. STUDY DESIGN: Self-report epidemiological questionnaire. METHODS: One hundred and one (101) patients with SS (94 females, 7 males; M age = 59.4 years; standard deviation [SD] = 14.1 years) completed an extensive interview using a previously validated questionnaire involving the patient's medical, family, occupational, psychosocial, social/lifestyle, voice use, and general health histories. Summary statistics, chi-squares, risk ratios, and multiple logistic regression were used to determine the frequency and severity of voice disorders in individuals with SS, as well as associations with demographic, lifestyle, health, disease severity, and voice use factors. RESULTS: The prevalence of a current voice disorder in individuals with SS was 59.4%. In general, voice disorders began gradually; were chronic; and correlated with SS disease severity independent of age, sex, duration of the disease, comorbid autoimmune conditions, and use of SS-related medication. Specific voice symptoms including chronic throat dryness and soreness were significantly associated with SS disease severity. CONCLUSIONS: Voice disorders are relatively common in SS and are more frequent as disease severity worsens. These findings have important implications for evaluation and treatment of patients with SS. LEVEL OF EVIDENCE: 4.
Asunto(s)
Síndrome de Sjögren/complicaciones , Trastornos de la Voz/epidemiología , Trastornos de la Voz/etiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: The purpose of this study was to determine if persistent changes in the duration of bolus movement through the pharynx and bolus movement coordination with pharyngeal swallowing gestures occur after treatment of oropharyngeal carcinoma with chemoradiation therapy. METHODS: The timing of bolus movement and coordination with swallowing gestures was evaluated in 30 patients using a modified barium swallowing study at least 1 year after completion of treatment. Patients were recruited irrespective of any swallowing complaints. The mean of each measure from the study subjects was compared to those from a group of age-matched controls. RESULTS: Bolus transit duration in the study population was unchanged compared with normal controls. Unlike normal controls, the patients were found to allow the bolus to arrive in the vallecula before the initiation of swallowing gestures that resulted in a swallow. Earlier opening of the upper esophageal sphincter was found for a 1-cc bolus (p = .004). For the 20 cc bolus size, the onset of hyoid and aryepiglottic fold elevation was delayed (p = .029 and .037, respectively). Gesture timing did not change to accommodate larger bolus sizes, as it normally does, resulting in a delay in airway protection for the 20-cc bolus. CONCLUSION: Patients are able to move a liquid bolus through the pharynx in a timely manner. However, patients are unable to modify swallowing gestures to safely protect the airway.
Asunto(s)
Carcinoma/terapia , Quimioradioterapia/efectos adversos , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Deglución , Neoplasias Orofaríngeas/terapia , Anciano , Sulfato de Bario/farmacología , Estudios de Casos y Controles , Medios de Contraste/farmacología , Fluoroscopía , Humanos , Masculino , Manometría , Persona de Mediana Edad , Medición de Riesgo , Factores de Tiempo , Grabación en VideoRESUMEN
OBJECTIVES/HYPOTHESIS: To compare objective measures of swallowing function with patient reports of swallowing-related quality of life 1 year after treatment of oropharyngeal cancer with chemoradiation therapy. STUDY DESIGN: Patients seen for follow-up at least 1 year after treatment of oropharyngeal carcinoma with chemoradiation therapy were sequentially approached and asked to participate in the study. METHODS: Maximum pharyngeal constriction, hyoid elevation, upper esophageal sphincter opening size, and bolus pharyngeal transit time were measured from modified barium swallowing studies in a group of 31 patients at least 1 year after chemoradiation therapy for the treatment of oropharyngeal carcinoma. Measures were made for a liquid 1-mL, 3-mL, and 20-mL bolus. Objective measure results were compared to scores from the MD Anderson Dysphagia Inventory and The University of Washington Swallowing Quality of Life Questionnaire results from the same patients. RESULTS: No strong correlation was identified between any of the objective measures of swallowing physiology and quality-of-life scores. CONCLUSIONS: Patient perception of the impact of swallowing function on quality of life does not correlate well with actual physiologic functioning.
Asunto(s)
Carcinoma de Células Escamosas/terapia , Trastornos de Deglución/diagnóstico , Deglución/fisiología , Neoplasias Orofaríngeas/terapia , Calidad de Vida , Autoevaluación (Psicología) , Anciano , Carcinoma de Células Escamosas/patología , Quimioradioterapia/efectos adversos , Quimioradioterapia/métodos , Estudios de Cohortes , Trastornos de Deglución/etiología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neoplasias Orofaríngeas/patología , Estudios Prospectivos , Medición de Riesgo , Perfil de Impacto de Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE OF REVIEW: This review presents recent advances in high-speed digital imaging (HSDI) of the larynx including data acquisition, data analysis, and clinical applicability. RECENT FINDINGS: Software designed to summarize the large amounts of data captured with HSDI makes it possible to quantitatively analyze recordings from patients, improving the accuracy of the methodology. The new software has been used in studies of normal individuals, increasing our knowledge of normal vocal fold vibratory behavior. HSDI has also been used in patient populations and shows promise in distinguishing various laryngeal conditions that are difficult to distinguish with other imaging modalities. Studies of postoperative patients with HSDI demonstrate the return of some vibratory characteristics but not others, potentially leading the way to improvements in surgical technique. SUMMARY: Recent advances in HSDI technology have increased the clinical usefulness of the imaging technology and recent studies demonstrate the clinical applicability of HSDI. However, challenges to widespread clinical use of HSDI remain.
Asunto(s)
Laringe/fisiología , Fenómenos Biomecánicos , Humanos , Procesamiento de Imagen Asistido por Computador , Enfermedades de la Laringe/diagnóstico , Enfermedades de la Laringe/fisiopatología , Programas Informáticos , Estroboscopía , Vibración , Pliegues Vocales/fisiopatología , Trastornos de la Voz/diagnósticoRESUMEN
OBJECTIVES/HYPOTHESIS: Up to one-third of patients presenting with adductor spasmodic dysphonia will have an associated vocal tremor. These patients may not respond fully to treatment using thyroarytenoid (TA) muscle botulinum toxin (Botox) injection. Treatment failures are attributed to the involvement of multiple muscle groups in the tremor. This study evaluates the results of combined interarytenoid (IA) and TA muscle Botox injection in a group of 27 patients with adductor spasmodic dysphonia and vocal tremor and in four patients with severe vocal tremor alone. STUDY DESIGN: Patient-satisfaction data were reviewed retrospectively. Pre- and postinjection acoustic data were collected prospectively. METHODS: Acoustic measures of fundamental frequency and cycle-by-cycle variability in frequency (jitter) and intensity (shimmer) were obtained from 15 patients' sustained vowel productions. Measures were collected after TA muscle injection, alone, and after combined TA and IA (TA+IA) muscle injections. In addition, two experienced voice clinicians blindly assessed tremor severity from recordings made for each patient in the two conditions. Patients were also queried regarding their satisfaction with the results of the injections and whether they desired to continue receiving TA+IA treatment. RESULTS: Significant improvement in all acoustic measures except for % jitter was observed after the TA+IA muscle injections. Listeners identified voice samples after TA+IA muscle injections as demonstrating less tremor in 73% of the paired comparisons. Sixty-seven percent of the patients with spasmodic dysphonia and vocal tremor wished to continue to receive IA muscle injections. Only one patient with severe vocal tremor wished to continue with injections. CONCLUSIONS: The addition of an IA muscle Botox injection to the treatment of patients with a combination adductor spasmodic dysphonia and vocal tremor may improve voice outcomes.
Asunto(s)
Toxinas Botulínicas Tipo A/administración & dosificación , Disfonía/tratamiento farmacológico , Músculos Laríngeos/efectos de los fármacos , Fármacos Neuromusculares/administración & dosificación , Calidad de la Voz , Toxinas Botulínicas Tipo A/efectos adversos , Disfonía/fisiopatología , Humanos , Inyecciones Intramusculares , Músculos Laríngeos/fisiopatología , Fármacos Neuromusculares/efectos adversos , Satisfacción del Paciente , Estudios Prospectivos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Procesamiento de Señales Asistido por Computador , Espectrografía del Sonido , Acústica del Lenguaje , Medición de la Producción del Habla , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe normal vocal fold vibratory characteristics recorded with high-speed digital imaging (HSV) of the larynx. DESIGN: Prospective study of healthy subjects who volunteered to undergo laryngeal HSV and videostroboscopy. Image analysis was randomly assigned to 3 blinded raters. SETTING: Community-based clinic with a specialty in laryngology. PARTICIPANTS: Fifty healthy subjects aged 21 to 65 years who were nonsmokers and who had no voice problems, laryngopharyngeal reflux, or reactive airway disease. MAIN OUTCOME MEASURES: The following characteristics of vibration were described: glottal configuration, phase closure, vibratory symmetry, mucosal wave propagation, amplitude of vibration, and periodicity of vibration. Interrater and intrarater reliabilities were calculated for both imaging modalities. RESULTS: The range of findings for each measure is described. The comparison of videostroboscopy ratings with ratings from HSV studies did not reveal any significant difference between the 2 modalities for any of the measures except for the assessment of periodicity. Aperiodic vibratory characteristics were noted on 30% of the videostroboscopy studies (n = 15) and in only 4% of the HSV studies (n = 2) (P <. 001). Although interrater and intrarater agreement were considered to be generally acceptable, a significant rater effect was identified. CONCLUSION: This preliminary study describes a range of normal values for vocal fold vibratory characteristics as recorded with laryngeal HSV, providing a basis for comparison of studies in patients with voice problems.
Asunto(s)
Aumento de la Imagen/métodos , Laringoscopía/métodos , Laringe/anatomía & histología , Estroboscopía/métodos , Grabación en Video , Adulto , Anciano , Femenino , Humanos , Laringe/fisiología , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Valores de Referencia , Reproducibilidad de los Resultados , Pliegues Vocales/anatomía & histología , Pliegues Vocales/fisiología , Adulto JovenRESUMEN
OBJECTIVE: The development of a cricopharyngeal dysfunction is associated with a hypertonic cricopharyngeus (CP) muscle. Therefore, CP myotomy has been advocated by some authors to be an essential part of repair of this condition. However, little objective data exists to show that there is improvement in the upper esophageal sphincter (UES) after CP myotomy. This study assesses the impact of CP myotomy on UES opening. STUDY DESIGN: Prospective. METHODS: Twenty patients treated at a university tertiary care center for cricopharyngeal dysfunction between 1998 and 2003 were identified. All patients underwent CP myotomy with or without Zenker's diverticulectomy. These patients had videofluoroscopic swallow studies before and after repair. The values of UES opening for 3 mL boluses from pre- and postrepair studies were compared with each other as well as with normal controls. Sixty percent (12/20) of the patients had a Zenker's diverticulum. Of these 12 patients, 5 had undergone previous attempts at surgical correction. Cricopharyngeal myotomy by way of an external approach, with or without Zenker's diverticulectomy, was performed in all patients by the senior author. RESULTS: Before Zenker's diverticulectomy and CP myotomy, the mean UES opening (n = 20) for a 3 mL bolus was 0.30 cm +/- 0.17, which was 57% of the mean of 60 normal controls (0.52 cm +/- 0.15) (P < .001). After repair, the mean UES opening for the same bolus size improved to 0.51 cm +/- 0.16 (P < .0001). The UES opening size in patients who have undergone repair is comparable with that of the normal controls (P > .05). CONCLUSIONS: UES opening size in patients with cricopharyngeal dysfunction is 57% of the size in normal controls. CP myotomy helps to normalize the UES opening in cricopharyngeal dysfunction repair.