Frailty Syndrome, Cognition, and Dysphonia in the Elderly.

PURPOSE: The purpose of the current study is to determine the relation of frailty syndrome to acoustic measures of voice quality and voice-related handicap. METHODS: Seventy-three adults (52 community-dwelling participants and 21 assisted living residents) age 60 and older completed frailty screening, acoustic assessment, cognitive screening, and the Voice Handicap Index-10 (VHI-10). Factor analysis was used to consolidate acoustic measures. Statistical analysis included multiple regression, analysis of variance, and Tukey post-hoc tests with alfa of 0.05. RESULTS: Montreal Cognitive Assessment (MoCA) and exhaustion explained 28% of the variance in VHI-10. MoCA and sex explained 27% of the variance in factor 1 (spectral ratio), age and MoCA explained 13% of the variance in factor 2 (cepstral peak prominence for speech), and slowness explained 10% of the variance in factor 3 (cepstral peak prominence for sustained /a/). There were statistically significant differences in two measures across frailty groups: VHI-10 and MoCA. Acoustic factor scores did not differ significantly among frailty groups (P > 0.05). CONCLUSIONS: Voice-related handicap and cognitive status differed among robust and frail older adults, yet vocal function measures did not. The components of frailty most related to VHI-10 were exhaustion and weight loss rather than slowness, weakness, or inactivity. Based on these findings, routine screening of physical frailty and cognition are recommended as part of a complete voice evaluation for older adults.

Vocal Fold Vibration in Older Adults With and Without Age-Related Dysphonia.

Purpose: The purpose of this study was to identify the extent to which 7 measures of glottal area timing and regularity differ between older adults with and without age-related dysphonia (ARD). Method: Laryngeal high-speed videoendoscopy was completed at 4,000 frames per second for 42 adults aged 70 years and older (ARD: 9 female, 5 male; control group: 15 female, 13 male). Relative glottal gap, open quotient, speed index, maximum area declination rate, harmonics-to-noise ratio, harmonic richness factor, and standard deviation of fundamental frequency were measured from a 0.5-s segment of the glottal area waveform. Eta squared (η2) was computed to estimate group effect. Results: Small effect sizes (η2 = .18-.35) were present for relative glottal gap, open quotient, maximum area declination rate, harmonic richness factor, and standard deviation of fundamental frequency. Speed index and glottal harmonics-to-noise ratio did not explain group membership (η2 = .001 and .05, respectively). Conclusion: These findings provide evidence that vocal fold vibration in ARD is different than in normal aging, whereas the overlap in values for every measure is consistent with the concept that normal aging and ARD exist as a continuum of health and disease.

Multidisciplinary evaluation and management of dysphagia: the role for otolaryngologists.

INTRODUCTION: The Dysphagia Clinic of the McGill University Health Centre (MUHC) is composed of a multidisciplinary team including an otolaryngologist, a speech therapist, an occupational therapist, and a nutritionist. The clinic was created to provide a comprehensive assessment of patients with dysphagia. All patients are evaluated with flexible endoscopic evaluation of swallowing (FEES) and other necessary investigations. Following this evaluation, appropriate treatment, dietary modifications, and swallowing techniques are taught to the patient. OBJECTIVE: To study the characteristics of the population evaluated at the McGill University Health Centre Dysphagia Clinic to better understand the role and impact of a multidisciplinary team. METHOD: A retrospective chart review of 183 patients presenting to the Dysphagia Clinic since its creation in December 2004 was conducted. Information regarding demographics, etiology, comorbidities, additional referrals or investigations, treatment, and outcome was collected. RESULTS: The majority of patients (61%) were referred by otolaryngologists. The FEES was normal for all consistencies in 28% of patients, and pooling was the most frequently encountered abnormality. The most common etiologies were neurologic (27%), laryngopharyngeal reflux (22%), and malignancy (21%). The four treatment modalities consisted of dietary modifications (37%), teaching of therapeutic swallowing manoeuvres (33%), medical treatment (26%), and surgical treatment (11%). CONCLUSION: A multidisciplinary dysphagia clinic is an invaluable resource for patients suffering from cervical dysphagia. As the etiologies and initial presentation of patients vary greatly, otolaryngologists' expertise in endoscopy gives them a critical role in the evaluation of this condition.

Case Series: raising awareness about Kikuchi-Fujimoto disease among otolaryngologists: is it linked to systemic lupus erythematosus?

OBJECTIVES: Kikuchi-Fujimoto disease (KFD) is a rare, benign, self-limiting condition occasionally associated with systemic lupus erythematosus (SLE). Although rising in incidence, nonspecific symptoms make diagnosis difficult. We present a small case series and review the literature to increase awareness of this condition among otolaryngologists. METHODS: Nine cases of KFD were diagnosed between 2003 and 2006 at the McGill University Health Care institution by either excisional or fine-needle biopsy. Clinical and histologic features were reviewed in the context of a comprehensive analysis of the KFD literature. RESULTS: Seven of nine cases are female, with a mean age of 27.2 years (range 18-35 years). Only one patient had systemic SLE predating KFD. Our results are comparable to those in the current literature regarding the association with SLE. CONCLUSIONS: We present the first Canadian small case series and extensive review of the literature to highlight the clinical and pathologic features of this disease and its association with SLE.