Voice-quality abnormalities as a sign of dysphagia: validation against acoustic and videofluoroscopic data.
In this study we explored the validity of clinician judgments of voice abnormalities as indicators of penetration-aspiration or other swallowing abnormalities. Voice samples were collected using a high-quality microphone from 40 adults during videofluoroscopy (VFSS), at baseline and following each of four thin liquid swallows. Blinded speech-language pathologists (SLPs) rated the audio recordings for voice quality using the GRBAS scale and the VFSS recordings for abnormal swallow onset, penetration-aspiration, airway closure, and pharyngeal residues. Acoustic measures of % jitter, % shimmer, and signal-to-noise ratio were calculated using two /a/ vowel segments spliced from each voice recording. Preswallow to postswallow measures of voice-quality change were derived and the data were compared to determine the correspondence between perceived voice abnormalities, acoustic voice parameters, and radiographically confirmed swallowing abnormalities. The sensitivity of perceived postswallow changes in voice quality to dysphagia and penetration-aspiration was poor, ranging from 8 to 29%. Specificity was stronger for both penetration-aspiration (75-94%) and dysphagia (59-86%). Acoustic measures of voice quality had moderate sensitivity and specificity for both dysphagia and penetration-aspiration. Overall, perceptual judgments of postswallow wet voice showed the strongest potential for detecting penetration-aspiration (relative risk = 3.24). We conclude that a clear postswallow voice quality provides reasonable evidence that penetration-aspiration and dysphagia are absent. However, observations of abnormal postswallow voice quality can be misleading and are not a valid indication that penetration-aspiration or dysphagia exists.
Waito
Ashley
A
Toronto Rehabilitation Institute, Toronto, ON, M5G 2A2, Canada.
Bailey
Gemma L
GL
Molfenter
Sonja M
SM
Zoratto
Dana C
DC
Steele
Catriona M
CM
D000465:Algorithms; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008403:Mass Screening; D011237:Predictive Value of Tests; D012306:Risk; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013637:Tape Recording / Q000295:instrumentation / Q000379:methods*; D014741:Video Recording / Q000295:instrumentation / Q000379:methods*; D014833:Voice Quality / Q000502:physiology*
Dysphagia. 2003 Winter;18(1):53-7
12497197
Arch Phys Med Rehabil. 1998 Jan;79(1):14-9
9440410
AJR Am J Roentgenol. 2002 Feb;178(2):393-8
11804901
Gastroenterology. 1997 Nov;113(5):1457-64
9352847
Stroke. 2009 Feb;40(2):555-61
19074483
Dysphagia. 2000 Spring;15(2):84-8
10758190
J Speech Lang Hear Res. 2007 Jun;50(3):585-94
17538102
J Commun Disord. 2001 Jan-Apr;34(1-2):55-72
11322570
Dysphagia. 1988;3(1):46-8
3248393
Arch Otolaryngol Head Neck Surg. 2005 Sep;131(9):762-70
16172351
Am J Phys Med Rehabil. 2004 Oct;83(10):753-7
15385783
Eur Arch Otorhinolaryngol. 2004 Sep;261(8):429-34
14615893
Dysphagia. 1993;8(3):170-9
8359036
Dysphagia. 2008 Dec;23(4):392-405
18855050
Dysphagia. 1999 Winter;14(1):44-51
9828274
Dysphagia. 1998 Summer;13(3):142-7
9633153
Dysphagia. 1996 Spring;11(2):93-8
8721066
Dysphagia. 2008 Sep;23(3):244-50
18058175
J Speech Lang Hear Res. 2010 Jun;53(3):620-32
20029051