The discriminant ability of the eating assessment tool-10 questionnaire to detect residue and aspiration in patients with mixed etiology of dysphagia.

PURPOSE: To investigate the discriminant ability of the eating assessment tool-10 (EAT-10) to detect postswallow residue and aspiration for different consistencies. METHODS: Seventy-two consecutive patients with mixed etiology of dysphagia (42 males and 30 females, mean ± sd age of 60.42 ± 15.82) were included. After completing the EAT-10, Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed to assess the efficiency and safety of swallowing for the following consistencies: thin liquid, nectar thick, yogurt, and solid. While swallowing efficiency was evaluated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), the Penetration-Aspiration Scale (PAS) was used to evaluate swallowing safety. RESULTS: The EAT-10 questionnaire significantly identified the patients with residue from those without residue for the following consistencies and anatomic locations: thin liquid residue in the pyriform sinus (cutoff score ≥ 10, p = 0.009), nectar thick residue in the vallecula (cutoff score ≥ 15, p = 0.001), yogurt residue in the vallecula (cutoff score ≥ 15, p = 0.009), yogurt residue in the pyriform sinus (cutoff score ≥ 9, p = 0.015), and solid residue in the vallecula (cutoff score ≥ 13, p = 0.016). However, the same discriminant ability of EAT-10 was not found for detecting aspiration in any consistency. CONCLUSIONS: The EAT-10 questionnaire can be used as an assessment tool to judge swallowing efficiency in patients with mixed etiology of dysphagia, but the same is not evident for swallowing safety.

How Does Long Term Use of Surgical Face Mask Affect the Voice in Normophonic Subjects?

OBJECTIVES: To assess the effects of the longterm-use of surgical face mask (SFM) on acoustic and auditory-perceptual voice parameters in normophonic subjects without any known risk factor related to voice disorders. MATERIALS AND METHODS: Of 73 normophonic subjects who were previously included in a couple of studies before the COVID-19 outbreak, 25 people (18 female and 7 male) who were free of any known risk factor related to voice disorders during the outbreak were re-evaluated to assess the long-term effect of SFM on voice by using acoustic (mean F0, Jitter-local, Shimmer-local, Cepstral Peak Prominence (CPP), Noise to Harmonic Ratio (NHR), maximum phonation time (MPT)) and auditory-perceptual (Consensus Auditory-Perceptual Evaluation of Voice, CAPE-V) parameters and those data found in SFM period were compared with the previous (preSFM) data. MPT and acoustic data were analyzed by PRAAT software. RESULTS: It was seen that the mean F0 value presented a significant increase, while Jitter-local and Intensity values revealed a significant decrease in females after 2 years pass with SFM use (average 22.52 ± 0.18 months).In males, only a significant decrease in Jitter-local was detected. CONCLUSIONS: This study is the first longitudinal investigation on the effects of SFM use on acoustic and auditory-perceptual measures of voice. The data in this study, revealed that long-term use of SFM would not appear to be negatively affecting the acoustic parameters of the voice in normophonic subjects (particularly females) without any related risk factors such as tobacco use, reflux, and etc.

Acoustic and Auditory-Perceptual Analysis of Voice in the Female Smokers Who Do Not Have Self-Reported Voice Complaint.

OBJECTIVES: Smoking affects the voice quality and the previous studies presented higher Voice Handicap Index (VHI) scores, and abnormal acoustic data in smokers. However, there is no study revealing any voice parameter indicating incipient damage in voice functionality. The studies documented that the adverse effects of smoking on phonatory function were higher in females than males and further the prevalence of smoking among females tends to increase. The purpose of this study was to investigate the effect of smoking on the acoustic and auditory-perceptual analysis of the speaking voice in female smokers who scored the VHI-10 scale as grade 0 (absent), and thus to look for a criterion for incipient vocal damage of smoking. METHODS: The study group composed of 22 female smokers and 22 female nonsmokers between the ages of 18 and 55 years. The acoustic parameters (mean F0, jitter local [%], jitter local abs, jitter rap, jitter ppq, shimmer local [%], shimmer local [dB], shimmer apq3, shimmer apq5, shimmer apq11, and mean HNR) and the GRBAS scale were analyzed in all subjects. RESULTS: No significant difference observed between the smoker and nonsmokers groups in acoustic voice analysis. It was seen that the smokers presented a small but significant increase in the Strain parameter of the GRBAS scale while there was no significant difference in the Grade, Roughness, Breathiness, and Asthenia parameters between the study groups. CONCLUSION: The results of this study indicate that increase in Strain could be considered as an early data in the smokers without voice complaints. However, our data declared that conventional acoustic perturbation analysis did not reveal incipient Strain in voice.

Reflux, dysphonia, and dysphagia symptoms in patients with diabetes and their association with diabetic complications.

BACKGROUND: Diabetes mellitus (DM) could influence various organs, especially the eyes, kidneys, nerves, heart, and blood vessels, and finally results in many irreversible disease-related complications. In this paper, the association between reflux, swallowing, and voice symptoms in patients with DM and the possible effect of diabetic complications on these symptoms were investigated. METHODS: A total of 179 patients with diabetes were included to the study. Three self-reported questionnaires; Reflux Symptom Index (RSI), Eating Assessment Tool-10 (EAT-10), and Voice Handicap Index-10 (VHI-10) were administrated to the patients and, their association with DM-related neuropathy and nephropathy were examined. RESULTS: The scores of each questionnaire were significantly correlated with each other (p < 0.001). There was not any statistically significant association between the score of T-RSI and the diabetic complications (p = 0.077), while a statistically significant association was found between the T-EAT-10 score and neuropathy (p < 0.001). Neither neuropathy nor nephropathy alone had an association with the T-VHI-10 score. However, the presence of nephropathy and neuropathy together was found to be associated with the T-VHI-10 score (p = 0.027). DISCUSSION: It is possible to conclude that gastrointestinal symptoms such as reflux, dysphonia, and dysphagia are associated with each other and they may possibly be related to the microvascular complications of DM. The clinicians should be aware of the possible reflux, voice, and swallowing complaints and also inquire about the presence of neuropathy and nephropathy in the diabetic population.

Vocal outcomes after COVID-19 infection: acoustic voice analyses, durational measurements, self-reported findings, and auditory-perceptual evaluations.

PURPOSE: The ongoing literature suggests that COVID-19 may have a potential impact on voice characteristics during the infection period. In the current study, we explored how the disease deteriorates different vocal parameters in patients who recovered from COVID-19. METHODS: A total of 80 participants, 40 patients with a prior history of COVID-19 (20 male, 20 female) with a mean age of 39.9 ± 8.8 (range, 21-53) and 40 gender and age-matched healthy individuals (mean age, 37.3 ± 8.8; range, 21-54) were included to this study. The data of acoustic voice analyses, durational measurements, patient-reported outcomes, and auditory-perceptual evaluations were compared between the study group and the control group. Correlation analyses were conducted to examine the association between the clinical characteristics of the recovering patients and measured outcomes. RESULTS: Maximum phonation time (MPT) and the scores of both Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL) questionnaires significantly differed between the groups, which was more evident in female participants. The overall severity score of dysphonia was found to be higher in the study group than the control group (p = 0.023), but gender-based comparisons reached significance only in males (p = 0.032). VHI-10 and V-RQOL revealed significant correlations with the symptom scores of the disease. CONCLUSIONS: Patients with a prior history of COVID-19 had significantly lower MPT, increased VHI-10 scores, decreased voice-related quality of life based on the V-RQOL questionnaire, and higher overall severity scores in the auditory-perceptual evaluation. Self-reported voice complaints disclosed close relationships with the symptom scores of COVID-19 disease.

The Effect of An Indirect Voice Therapy Approach on the Voice of Children With Vocal Fold Nodules: A Prospective Cohort Study.

PURPOSE: To investigate the effect of a combination indirect voice therapy approach on the management of vocal nodules in the pediatric population. METHODS: A prospective cohort study with thirty children (24 males and 6 females; mean age 8.8 ± 2.2) with a diagnosis of vocal fold nodule (VFN) was conducted. All participants were included in an 8-week voice therapy program consisting of vocal hygiene education and parental rule-setting. Videolaryngoscopic examination, auditory-perceptual evaluation, and acoustic voice analysis were performed immediately before and after the intervention. RESULTS: The comparison of videolaryngoscopic findings before and after the therapy revealed that the size of the nodules decreased significantly (P < 0.001). Findings from the laryngeal examination showed that the vast majority of children 73.3% (n = 22) had no VFN anymore after the intervention. The auditory-perceptual evaluation showed that overall severity of dysphonia decreased significantly [from 50 (40-70) to 38 (30-45), P < 0.001]. Jitter local (P = 0.031) and Jitter local abs (P = 0.043) parameters statistically differed after the therapy. There were not any statistically significant differences for mean F0, shimmer local (%), shimmer local (dB), and mean HNR. CONCLUSIONS: The voice therapy method in this study has a clear benefit on the voice of children with VFN and can be used in clinical practice. Specifically, clinicians should consider the parents as a core component of voice therapies and pay attention to vocal hygiene education for optimal management of VFN related childhood dysphonia.

Disease related changes in vocal parameters of patients with type 2 diabetes mellitus.

BACKGROUND: As the duration of diabetes progresses, various disease related complications might occur in patients. The main goal of this paper is to compare acoustic and aerodynamic measures of patients with type 2 diabetes mellitus (T2DM) with a control group of healthy subjects. METHODS: A total of 91 subjects, 51 individuals with type 2 diabetes mellitus (DM group) and 40 healthy volunteers (HV group) were participated in the study. Maximum phonation time (MPT) was captured for assessing phonatory mechanics. Acoustic voice parameters, including mean fundamental frequency (mean fo), jitter local (Jlocal), jitter absolute (Jabs), shimmer local (Slocal), shimmer decibel (SdB), and harmonics to noise ratio (HNR) were detected using the Praat software program. RESULTS: Only for Jabs, statically significant difference was found between the groups. There were no statically significant differences between any voice parameters of HV versus those with the duration of diabetes ≥10 years and the HbA1c level ≥7%. However, statically significant differences for MPT and Slocal were found between patients with neuropathy versus HV. In addition, a comparison between patients with voice complaint versus HV showed significant differences for Slocal and SdB. CONCLUSIONS: The findings of the present study do not provide strong evidence about the possible effect of DM on the human voice. However, diabetic neuropathy is considered to be a factor affecting the voice parameters in the target population. The physicians should pay attention to the acoustic and aerodynamic voice parameters in patients with diabetes, particularly in those with neuropathy or voice complaints.

Fiberoptic Endoscopic Evaluation of Swallowing in Patients with Type 2 Diabetes Who Have Self-Reported Swallowing Difficulties.

INTRODUCTION: People with diabetes frequently have gastrointestinal problems and related deglutition disorders. OBJECTIVE: The aims of the present study are to determine the symptomatic swallowing complaints and to evaluate the functionality of oropharyngeal swallowing in patients with type 2 diabetes mellitus (T2DM) by using the Turkish Eating Assessment Tool-10 (T-EAT-10) and fiberoptic endoscopic evaluation of swallowing (FEES). METHODS: In this descriptive cross-sectional study, the T-EAT-10 questionnaire was completed by 121 patients with diabetes, and FEES was planned for each individual whose baseline score of the T-EAT-10 was ≥3. Before swallowing trials via samples of nectar-thick consistency, laryngeal sensation and severity of secretion in the hypopharynx were observed. While the swallowing safety was determined using the Penetration-Aspiration Scale (PAS), the Yale Pharyngeal Residue Severity Rating Scale was used to assess the swallowing efficiency. RESULTS: Of the total participants, 22.3% (n = 27) were found to have abnormal swallowing function (T-EAT-10 ≥3), 27.3% (n = 33) had concomitant neuropathy and 28.1% (n = 34) mentioned a reflux complaint. The results of the multivariate linear regression analysis exposed that the T-EAT-10 score was significantly associated with neuropathy (r = 3.763, p < 0.001) and reflux complaint (r = 2.254, p = 0.031). Of the total FEES-tested subjects (n = 20), 95% (n = 19) had a safe swallowing function (PAS = 1). However, diminished laryngeal sensation, increased secretion and presence of residue revealed that patients with T2DM who have self-reported swallowing difficulties have reduced swallowing efficiency. CONCLUSIONS: This study has demonstrated that almost 1 out of 4 T2DM patients reported to have swallowing-related problems, and the score of the T-EAT-10 was found to be independently associated with both neuropathy and reflux complaint. FEES results pointed out that swallowing efficiency was relatively reduced in the target population. However, further research is still necessary before obtaining a definitive answer to oropharyngeal swallowing problems in patients with T2DM.