ACOUSTIC ANALYSIS OF SWALLOWING SOUNDS: A NEW TECHNIQUE FOR ASSESSING DYSPHAGIA

Objective: To perform acoustic analysis of swallowing sounds, using a microphone and a notebook computer system, in healthy subjects and patients with dysphagia affected by neurological diseases, testing the positive/negative predictive value of a pathological pattern of swallowing sounds for penetration/aspiration. Design: Diagnostic test study, prospective, not blinded, with the penetration/aspiration evaluated by fibreoptic endo scopy of swallowing as criterion standard. Subjects: Data from a previously recorded database of normal swallowing sounds for 60 healthy subjects according to gender, age, and bolus consistency was compared with those of 15 patients with dysphagia from a university hospital referral centre who were affected by various neurological diseases. Methods: Mean duration of the swallowing sounds and postswallowing apnoea were recorded. Penetration/aspiration was verified by fibreoptic endoscopy of swallowing in all patients with dysphagia. Results: The mean duration of swallowing sounds for a liquid bolus of 10 ml water was significantly different between patients with dysphagia and healthy patients. We also described patterns of swallowing sounds and tested the negative/positive predictive values of post-swallowing apnoea for penetration/aspiration verified by fibreoptic endoscopy of swallowing (sensitivity 0.67 (95% confidence interval 0.24–0.94); specificity 1.00 (95% confidence interval 0.56–1.00)). Conclusion: The proposed technique for recording and measuring swallowing sounds could be incorporated into the bedside evaluation, but it should not replace the use of more diagnostic and valuable measures

Do Patients With Gastroesophageal Reflux Disease (Gerd) Exhibit Vocal Fold Deficits Manifested In Physical Or Acoustical Abnormalities?

GERD is an esophageal disease that has both esophageal and extra-esophageal symptoms. Due to the acidic nature of GERD, there appears to be a disruption in the function of the tissues surrounding the area of the vocal folds. This study investigated the influence of GERD as it relates to voice and swallowing. Data were previously collected on twelve individuals, six with a medical diagnosis of GERD and six with no medical diagnosis of GERD, and analyzed. This included descriptive analysis of data points from a Visi-Pitch, Videostroboscopy, and Fiberoptic Endoscopic Evaluation of the Swallow (FFES). The objective measurements from the Visi-Pitch and descriptive information from the Videostroboscopy and FEES were then combined and compared based on the presence of a medical diagnosis of GERD, by the PI of the study and the co-investigator. Results showed changes in tissue ranging from trace to severe in both the GERD and no-GERD groups. Findings suggest a correlation between abnormal acoustical measures and changes in tissue. Trends were also found based on age, length of diagnosis, and level of severity of tissue changes in both groups. The results of this study could be significant in the clinical treatment of individuals with GERD and highlight the importance of objective data points, and an interdisciplinary team

Clinical dysphagia risk predictors after prolonged orotracheal intubation

OBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. RESULTS: Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. CONCLUSIONS: Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population

A statistical analysis of cervical auscultation signals from adults with unsafe airway protection

Background: Aspiration, where food or liquid is allowed to enter the larynx during a swallow, is recognized as the most clinically salient feature of oropharyngeal dysphagia. This event can lead to short-term harm via airway obstruction or more long-term effects such as pneumonia. In order to non-invasively identify this event using high resolution cervical auscultation there is a need to characterize cervical auscultation signals from subjects with dysphagia who aspirate. Methods: In this study, we collected swallowing sound and vibration data from 76 adults (50 men, 26 women, mean age 62) who underwent a routine videofluoroscopy swallowing examination. The analysis was limited to swallows of liquid with either thin (<5 cps) or viscous (≈300 cps) consistency and was divided into those with deep laryngeal penetration or aspiration (unsafe airway protection), and those with either shallow or no laryngeal penetration (safe airway protection), using a standardized scale. After calculating a selection of time, frequency, and time-frequency features for each swallow, the safe and unsafe categories were compared using Wilcoxon rank-sum statistical tests. Results: Our analysis found that few of our chosen features varied in magnitude between safe and unsafe swallows with thin swallows demonstrating no statistical variation. We also supported our past findings with regard to the effects of sex and the presence or absence of stroke on cervical ausculation signals, but noticed certain discrepancies with regards to bolus viscosity. Conclusions: Overall, our results support the necessity of using multiple statistical features concurrently to identify laryngeal penetration of swallowed boluses in future work with high resolution cervical auscultation

Effects of liquid stimuli on dual-axis swallowing accelerometry signals in a healthy population

<p>Abstract</p> <p>Background</p> <p>Dual-axis swallowing accelerometry has recently been proposed as a tool for non-invasive analysis of swallowing function. Although swallowing is known to be physiologically modifiable by the type of food or liquid (i.e., stimuli), the effects of stimuli on dual-axis accelerometry signals have never been thoroughly investigated. Thus, the objective of this study was to investigate stimulus effects on dual-axis accelerometry signal characteristics. Signals were acquired from 17 healthy participants while swallowing 4 different stimuli: water, nectar-thick and honey-thick apple juices, and a thin-liquid barium suspension. Two swallowing tasks were examined: discrete and sequential. A variety of features were extracted in the time and time-frequency domains after swallow segmentation and pre-processing. A separate Friedman test was conducted for each feature and for each swallowing task.</p> <p>Results</p> <p>Significant main stimulus effects were found on 6 out of 30 features for the discrete task and on 5 out of 30 features for the sequential task. Analysis of the features with significant stimulus effects suggested that the changes in the signals revealed slower and more pronounced swallowing patterns with increasing bolus viscosity.</p> <p>Conclusions</p> <p>We conclude that stimulus type does affect specific characteristics of dual-axis swallowing accelerometry signals, suggesting that associated clinical screening protocols may need to be stimulus specific.</p

Advances in Management of Voice and Swallowing Disorders

Special Issue “Advances in Management of Voice and Swallowing Disorders” is dedicated to innovations in screening and assessment and the effectiveness of interventions in both dysphonia and dysphagia. In contemporary practice, novel techniques have been introduced in diagnostics and rehabilitative interventions (e.g., machine learning, electrical stimulation). Similarly, advancements in methodological approaches to validate measures have been introduced (e.g., item response theory using Rasch analysis), prompting the need to develop new, robust measures for use in clinics and intervention studies. Against this backdrop, this Special Issue focuses on studies aiming to improve early diagnostics of laryngological disorders and its management. This issue also welcomes the submission of studies on diagnostic accuracy and psychometrics performance of existing and newly developed measures. This includes but is not limited to studies investigating screening tools with sound diagnostic accuracy and robust psychometric properties. Furthermore, interventions with high levels of evidence in relation to clinical outcome using robust methodology (e.g., sophisticated meta-analytic approaches) are of great interest. This issue provides an overview of the latest advances in voice and swallowing disorders

Acoustic analysis of swallowing sounds: A new technique for assessing dysphagia

Objective: To perform acoustic analysis of swallowing sounds, using a microphone and a notebook computer system, in healthy subjects and patients with dysphagia affected by neurological diseases, testing the positive/negative predictive value of a pathological pattern of swallowing sounds for penetration/aspiration. Design: Diagnostic test study, prospective, not blinded, with the penetration/aspiration evaluated by fibreoptic endo scopy of swallowing as criterion standard. Subjects: Data from a previously recorded database of normal swallowing sounds for 60 healthy subjects according to gender, age, and bolus consistency was compared with those of 15 patients with dysphagia from a university hospital referral centre who were affected by various neurological diseases. Methods: Mean duration of the swallowing sounds and postswallowing apnoea were recorded. Penetration/aspiration was verified by fibreoptic endoscopy of swallowing in all patients with dysphagia. Results: The mean duration of swallowing sounds for a liquid bolus of 10 ml water was significantly different between patients with dysphagia and healthy patients. We also described patterns of swallowing sounds and tested the negative/positive predictive values of post-swallowing apnoea for penetration/aspiration verified by fibreoptic endoscopy of swallowing (sensitivity 0.67 (95% confidence interval 0.24–0.94); specificity 1.00 (95% confidence interval 0.56–1.00)). Conclusion: The proposed technique for recording and measuring swallowing sounds could be incorporated into the bedside evaluation, but it should not replace the use of more diagnostic and valuable measures

Presbyphagia and dysphagia in old age

Although presbyphagia is a clinically relevant problem among elderly population, possibly leading to dysphagia in old age, it remains a still underestimated health condi-tion. The present review analyzes swallow-ing related anatomical and functional changes during aging, both in healthy peo-ple and in those affected by dysphagia. First of all, dysphagia in old people must not be confused with presbyphagia. To distinguish these two different conditions, a correct def-inition of both should be considered. Subsequently, a comprehensive evaluation including instrumental analysis should be carried out. The aim of this narrative review is to analyze the current knowledge of this clinical condition and to provide the state of art to clinicians. A systematic PubMed research on dysphagia in the elderly was conducted and most relevant and most recent references were manually screened and selected. The aim of a correct diagnosis is to enable the choice of a correct interven-tion in order to prevent and treat complica-tions of dysphagia, such as ab ingestis pneumonia and malnutrition. Moreover, the assessment, diagnosis and therapy of dys-phagia/presbyphagia should include the intervention of different specialists