Voice Quality as a Predictor of Dysphagia

The clinical swallowing evaluation (CSE) is a non-instrumental exam that informs speech-language pathologists about a patient’s cognition, readiness for instrumental evaluation, and swallowing symptoms. Because of the common neuroanatomy and physiology of the larynx during voicing and swallowing tasks, coughing or throat clearing after food and drink may indicate swallowing impairment. Also because of the shared mechanisms of the larynx, some clinicians also attribute voice changes after swallowing to dysphagia although many studies to date demonstrate conflicting results on the effectiveness of post-prandial voice assessment. The aim of this study was to assess if dysphonia and/or voice change after swallowing is indicative of a swallowing disorder. Thirty-nine adults between the ages of 49-97 years were audio recorded completing a sustained vowel and sentence prior to a videofluoroscopic swallowing study (VFSS) and again after swallowing each bolus. Swallowing function was categorized with a revised Penetration-Aspiration Scale, and pharyngeal residue was measured with the Normalized Residue Ratio Scale (NRRS). Two hundred and fifty voice samples were measured acoustically and perceptually. Acoustic measures of interest included mean fundamental frequency, relative average perturbation, and noise-to-harmonic ratio. Following listener training, perceptual analysis of the voice samples was completed by three speech-language pathologists using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Results indicated that baseline dysphonia was associated with greater instances of penetration and/or aspiration. Speech-language pathologists perceptually identified a change in the voice when there was a change in the acoustic signal; however, perceptually-identified voice change after swallowing was not related to dysphagia. Based on these results, dysphonia during a CSE should alert speech-language pathologists of a possible comorbid dysphagia; however, voice change after swallowing appears unrelated to airway invasion

Respiratory Muscle Strength Training to Improve Vocal Function of Patients with Presbyphonia

Background: Presbyphonia is an age-related voice disorder characterized by vocal fold atrophy, and its effects on voice are potentially compounded by declines in respiratory function. We assessed: 1) the relationships between respiratory and voice function; 2) the effect of adding respiratory exercises to voice therapy; and 3) the impact of baseline respiratory function on the response to therapy in patients with presbyphonia. Methods: Twenty-one participants underwent respiratory and voice assessments, from which relationships were drawn. Ten of these participants were blocked-randomized to receive either voice exercises only, or voice exercises combined with inspiratory muscle strength training or expiratory muscle strength training, for a duration of four weeks. Results: FVC, FEV1, and MEP had an impact on phonation physiology through their effect on aerodynamic resistance and vocal fold pliability. Percent predicted values of FVC and FEV1 were strong predictors of perceived voice handicap. IMST induced the largest improvements in perceived handicap, and a lower baseline respiratory function was associated with a greater improvement, regardless of the intervention received. Conclusion: Respiratory function impacts voice and the response to behavioral voice therapy. Adding IMST to voice exercises improves self-reported outcomes even in patients with a normal respiratory function

Objective assessment of dysarthric disorders in patients with multiple sclerosis depending on sex, age, and type of text read

PurposeTo assess dysarthric disorders in multiple sclerosis (MS) patients in comparison with healthy individuals and MS patients without dysarthria depending on the patient’s sex, age, and the type of text read using an objective tool.MethodsThe study was carried out in a group of 72 persons, including 24 with MS presenting dysarthria (study group) and 24 healthy individuals (healthy control group), and 24 with MS without dysarthria (MS control group). Performance (reading) time was evaluated by means of an objective tool created for the purpose of the analysis.ResultsThe study showed significant statistical differences in the analyzed performance time of: poetry reading, prose reading, and completing a diction exercise, among persons with MS from the study group presenting dysarthria and both control groups (p < 0.05). It took more time to read the poem, and prose and to perform a diction exercise in the study group with dysarthria than in both control groups (with no significant differences between the two) Similarly, the comparison between the groups in terms of sex and age showed disturbances in the above-mentioned parameter in the study group. What was not demonstrated were significant differences in the evaluated speech parameters depending on both sex and age separately in the group of MS patients with dysarthria, and both control groups (p < 0.05).ConclusionThe objective tool created for the purpose of speech analysis is useful in detecting discrepancies in performance (reading) time among MS patients with dysarthria, and healthy individuals, as well as patients with MS without dysarthria and can be used in clinical practice for diagnostic purposes, however, further research is essential to complete its validation