The reliability and validity of cervical auscultation in the diagnosis of dysphagia : A systematic review

Objective: To systematically review the available evidence for the reliability and validity of cervical auscultation in diagnosing the several aspects of dysphagia in adults and children suffering from dysphagia. Data sources: Medline (PubMed), Embase and the Cochrane Library databases. Review methods: The systematic review was carried out applying the steps of the PRISMA-statement. The methodological quality of the included studies were evaluated using the Dutch 'Cochrane checklist for diagnostic accuracy studies'. Results: A total of 90 articles were identified through the search strategy, and after applying the inclusion and exclusion criteria, six articles were included in this review. In the six studies, 197 patients were assessed with cervical auscultation. Two of the six articles were considered to be of 'good' quality and three studies were of 'moderate' quality. One article was excluded because of a 'poor' methodological quality. Sensitivity ranges from 23%-94% and specificity ranges from 50%-74%. Inter-rater reliability was 'poor' or 'fair' in all studies. The intra-rater reliability shows a wide variance among speech language therapists. Conclusion: In this systematic review, conflicting evidence is found for the validity of cervical auscultation. The reliability of cervical auscultation is insufficient when used as a stand-alone tool in the diagnosis of dysphagia in adults. There is no available evidence for the validity and reliability of cervical auscultation in children. Cervical auscultation should not be used as a stand-alone instrument to diagnose dysphagia

Laser/Light Applications in Otolaryngology

Lasers have been ubiquitous in otolaryngology since Jako and Strong first introduced the CO2 laser in 1970. Since that time lasers have traditionally been used like a scalpel, able to cut and cauterize precisely. More recently, the role of lasers has been expanded in otolaryngology depending on the specific laser wavelength and dosimetry parameters. Not only can lasers be utilized to extirpate cancer, but also used to recover hearing, improve the airway, treat epistaxis, and even break up salivary stones for easy removal. The individual characteristics of the laser are important for the specific application. However, the otolaryngologist often works in areas that are either difficult to access using classic methods or require extreme precision, and the mechanism and method for delivering the laser energy is often equally important. In this chapter, we describe the many ways lasers are used in otolaryngology treat both benign conditions to life-threatening diseases. New and innovative applications are also discussed