Prevalence of Dysphagia in Dysphonic Patients with Non-Neoplastic Vocal Fold Lesions

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Yara Hany Hadhoud ◽  
Hassan Hosny Ghandour ◽  
Yomna Hassan Elfiky
Keyword(s):  
Vocal Fold ◽  
Screening Tools ◽  
Swallowing Therapy ◽  
Specialized Hospital ◽  
High Prevalence ◽  
Alarm Symptom ◽  
Swallowing Difficulties ◽  
Red Flag ◽  
Clinical Measures ◽  
Voice Problem

Abstract Background Dysphagia is the swallowing difficulties and trouble to move liquids, solids, medications and may be saliva from the mouth down to the stomach and is considered a serious red flag or alarm symptom. Aim of the Work to examine the prevalence of dysphagia on basis of subjective and objective measures in patients with the presenting symptom of dysphonia and diagnosed with non-neoplastic vocal fold lesions to consider the potential benefit of swallowing therapy hand in hand with the chosen management line of voice problem in the treatment of these patients if proved to have high prevalence of dysphagia. Subjects and Methods This study was applied on 50 patients with age ranging from 15-50 years diagnosed as being dysphonic secondary to non-neoplastic vocal fold lesions on objective and clinical measures, attending at the Phoniatric outpatient clinic at El-Demerdash hospital and Ain Shams University Specialized hospital. Results After the application of the A-EAT-10 questionnaire on 50 dysphonic patients who were selected to participate in this study, 12 cases (about 24%) were considered dysphagic with score above 3 and underwent VFSS. Within these 12 patients, Zero percent were found complaining of dysphagia according to VFSS. So there is No Correlation between frequencies of dysphagia by A-EAT-10 and by VFSS. Conclusion The present study showed that non-neoplastic vocal fold lesions are not an etiological factor for dysphagia despite the intricacy in the neuromuscular supply of pharynx and larynx. Diagnosis of Dysphagia can’t be confirmed depending only on subjective screening tools like A-EAT-10.

scholarly journals Screening for dysphagia in dysphonic patients with non-neoplastic vocal fold lesions by Arabic EAT-10: cross-sectional study

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Hassan Hosny Ghandour ◽  
Yara Hany Hadhoud ◽  
Yomna Hassan ElFiky
Keyword(s):  
Vocal Fold ◽  
Assessment Tool ◽  
Pathological Condition ◽  
Cross Sectional Study ◽  
Screening Tools ◽  
Sectional Study ◽  
Cross Sectional ◽  
Swallowing Difficulties ◽  
Clinical Measures ◽  
The Voice

Abstract Background Dysphagia is described as any disruption in the normal swallowing starting from the preparatory transport of a bolus from the oral cavity through both pharynx and esophagus down to the stomach. The purpose of this study is to detect the different symptoms of Dysphagia in dysphonic patients with non-neoplastic vocal fold lesions to consider the potential benefit of swallowing therapy hand in hand with the voice intervention strategies. Methods The Arabic Eating Assessment Tool-10 (A-EAT-10) was applied on 50 patients with age ranging from 15 to 50 years diagnosed as being dysphonic secondary to non-neoplastic vocal fold lesions on objective and clinical measures. Patients with a score above three will be considered to have dysphagia. Results Application of Arabic EAT-10 on dysphonic patients with minimal associated pathological lesions revealed swallowing difficulties that are not due to their vocal pathological condition. In the current study, 12 patients from the studied sample (24% of the patients) complained of phonasthenic symptoms and these symptoms may be misinterpreted by the patients as dysphagia. Symptoms of comorbid phonasthenia may be misinterpreted by the patients as dysphagia. Conclusions Although non-neoplastic vocal fold lesions are not the etiological factor for dysphagia, these group of patients still complains on subjective screening tools like A-EAT-10. The dysphagic symptoms in this group of patients may be related to the comorbid phonasthenia, and treatment of phonasthenia by voice therapy could alleviate these symptoms.

15 Triggers for the pharmacological management of delirium in palliative care: a mixed methods study

2018 ◽  
Vol 8 (3) ◽  
pp. 365.2-365
Author(s):  
Catherine L Fairfield ◽  
Anne M Finucane ◽  
Juliet A Spiller
Keyword(s):  
Palliative Care ◽  
Severe Form ◽  
Screening Tools ◽  
Pharmacological Intervention ◽  
Inpatient Setting ◽  
List Type ◽  
Structured Interviews ◽  
Retrospective Case ◽  
Pharmacological Management ◽  
High Prevalence

IntroductionDelirium is a serious neurocognitive disorder with a high prevalence in palliative care and debate regarding its management is ongoing.AimsTo describe how delirium and its symptoms is documented in patient recordsTo determine the use of delirium screening tools and how these are viewed by staffTo identify triggers for pharmacological intervention in delirium management in a terminally ill population.MethodsA retrospective case-note review concerning all patients admitted to a hospice inpatient setting between 1–17th August 2017 and semi-structured interviews with 7 hospice doctors and nurses.Results21 patients were reviewed. 62% were screened for delirium using the 4AT on admission. 76% had documented symptoms of delirium and of these 81% died without delirium resolution. There were inconsistencies in the documentation of delirium and the term itself was used infrequently. Non-pharmacological measures were poorly documented. Midazolam was the most commonly used medication. Triggers for pharmacological intervention included failure of non-pharmacological measures distress agitation and risk of patient harm. Nursing staff recognised delirium in its severe form but were less likely to do so in milder cases.ConclusionsTriggers for pharmacological intervention are in-keeping with guidelines however the level of understanding of delirium’s presentation varied between participants. This along with the high prevalence of delirium frequent use of midazolam and limited awareness and documentation of non-pharmacological measures (e.g. structured family support) highlights the need for further training and research.

Ageing, multimorbidity, and daily functioning

2017 ◽  
pp. 111-116
Author(s):  
Barbara Gryglewska ◽  
Karolina Piotrowicz ◽  
Tomasz Grodzicki
Keyword(s):  
Risk Factor ◽  
Chronic Disease ◽  
Functional Performance ◽  
Negative Impact ◽  
High Prevalence ◽  
Short And Long Term ◽  
Long Term Prognosis ◽  
Clinical Measures

Multimorbidity is defined as any combination of a chronic disease with at least one other acute or chronic disease or biopsychosocial or somatic risk factor. Old age is a leading risk factor for multimorbidity. It has a negative impact on short- and long-term prognosis, patients’ cognitive and functional performance, self-care, independence, and quality of life. It substantially influences patients’ clinical management and increases healthcare-related costs. There is a great variety of clinical measures to assess multimorbidity; some are presented in this chapter. Despite its high prevalence in older adults, clinical guidelines for physicians managing patients with multimorbidity are underdeveloped and insufficient.

Red flag findings in children with headaches: Prevalence and association with emergency department neuroimaging

Cephalalgia ◽  
2018 ◽  
Vol 39 (2) ◽  
pp. 185-196 ◽  
Author(s):  
Daniel S Tsze ◽  
Julie B Ochs ◽  
Ariana E Gonzalez ◽  
Peter S Dayan
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Healthy Children ◽  
High Prevalence ◽  
Associated Symptoms ◽  
Neurological Exam ◽  
Red Flag

Background Clinicians appear to obtain emergent neuroimaging for children with headaches based on the presence of red flag findings. However, little data exists regarding the prevalence of these findings in emergency department populations, and whether the identification of red flag findings is associated with potentially unnecessary emergency department neuroimaging. Objectives We aimed to determine the prevalence of red flag findings and their association with neuroimaging in otherwise healthy children presenting with headaches to the emergency department. Our secondary aim was to determine the prevalence of emergent intracranial abnormalities in this population. Methods A prospective cohort study of otherwise healthy children 2–17 years of age presenting to an urban pediatric emergency department with non-traumatic headaches was undertaken. Emergency department physicians completed a standardized form to document headache descriptors and characteristics, associated symptoms, and physical and neurological exam findings. Children who did not receive emergency department neuroimaging received 4-month telephone follow-up. Outcomes included emergency department neuroimaging and the presence of emergent intracranial abnormalities. Results We enrolled 224 patients; 197 (87.9%) had at least one red flag finding on history. Several red flag findings were reported by more than a third of children, including: Headache waking from sleep (34.8%); headache present with or soon after waking (39.7%); or headaches increasing in frequency, duration and severity (40%, 33.1%, and 46.3%). Thirty-three percent of children received emergency department neuroimaging. The prevalence of emergent intracranial abnormalities was 1% (95% CI 0.1, 3.6). Abnormal neurological exam, extreme pain intensity of presenting headache, vomiting, and positional symptoms were independently associated with emergency department neuroimaging. Conclusions Red flag findings are common in children presenting with headaches to the emergency department. The presence of red flag findings is associated with emergency department neuroimaging, although the risk of emergent intracranial abnormalities is low. Many children with headaches may be receiving unnecessary neuroimaging due to the high prevalence of non-specific red flag findings.

scholarly journals Combination of Forestier’s disease and laryngeal cancer: a rare clinical case

2020 ◽  
Vol 10 (2) ◽  
pp. 79-84
Author(s):  
А. М. Zaytsev ◽  
А. P. Polyakov ◽  
М. V. Ratushny ◽  
Т. М. Kobyletskaya ◽  
S. А. Kisariev ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Laryngeal Cancer ◽  
Vocal Fold ◽  
Clinical Case ◽  
Anterior Commissure ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Movement Restriction ◽  
Forestier’S Disease ◽  
Swallowing Difficulties ◽  
Forestier's Disease

The objective of the scientific report is to describe a rare clinical case of a combination of Forestier’s disease (diffuse idiopathic skeletal hyperostosis) and laryngeal cancer that have common symptoms. Case report. A 68-year-old male patient presented with hoarseness lasting for a year. Indirect laryngoscopy revealed a vocal fold tumor. Histological examination confirmed well-differentiated keratinizing squamous cell carcinoma of the larynx. A 6-cm tumor was located in the projection of the right vocal fold and had no signs of invasion into the supraglottis, subglottis, and anterior commissure. No other focal disorders were detected. The patient has undergone endolaryngeal laser resection of the larynx and tracheostomy. After probe removal, the patient had swallowing difficulties with esophageal content passing to the trachea mainly due to organic changes in the cervical spine at the СЗ–С4 level, where there was a massive local calcification of the anterior longitudinal ligament. We also noticed severe movement restriction in the cervical spine: the amplitude of movements did not exceed 10°. The formation of the C3–C4 segment was removed via ventrolateral approach. Conclusion. Dysphagia, dysphonia, and dyspnea may indicate both malignant tumor and large osteophyte causing compression of the trachea and esophagus. In this case, no symptom resolution after tumor removal led to the suspicion of a second disease, namely Forestier’s disease.

scholarly journals Perceptual Assessment and Acoustic Voice Analysis as Screening Tests for Vocal Fold Paresis After Thyroid or Parathyroid Surgery

2020 ◽  
Author(s):  
Maria Heikkinen ◽  
Elina Penttilä ◽  
Mari Qvarnström ◽  
Kimmo Mäkinen ◽  
Heikki Löppönen ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Roc Analysis ◽  
Screening Tools ◽  
Screening Tests ◽  
Parathyroid Surgery ◽  
Voice Analysis ◽  
Acoustic Voice Analysis ◽  
Vocal Fold Paresis ◽  
Voice Assessment ◽  
Perceptual Assessment

Abstract Background The aim of this study was to evaluate the reliability of clinician-based perceptual assessment of voice and computerized acoustic voice analysis as screening tests for vocal fold paresis or paralysis (VFP) after thyroid and parathyroid surgery. Methods This was a prospective study of 181 patients undergoing thyroid or parathyroid procedure with pre and postoperative laryngoscopic vocal fold inspection, perceptual voice assessment using grade, roughness, breathiness, asthenia, and strain (GRBAS) scale and acoustic voice analysis using the multi-dimensional voice program (MDVP). Patients were divided into 2 groups for comparison; those with new postoperative VFP and those without. Potential screening tools were evaluated using the receiving operating characteristic (ROC) analysis. Results Fourteen (6.6%) patients had a new postoperative VFP. Postoperative GRBAS scores were significantly (P < 0.05) higher in patients with VFP compared to those without. However, there were no statistically significant differences in MDVP values between the groups. Postoperative GRBAS grade score (cut off > 0) had the best sensitivity, 93%, for predicting VFP, but the specificity was only 50%. Postoperative jitter (cut off > 1.60) in MDVP had a good specificity, 90%, but only 50% sensitivity. Combining all the GRBAS and MDVP variables with P < 0.05 in the ROC analysis yielded a test with 100% sensitivity and 55% specificity. Conclusions Physician-based perceptual voice assessment has a high sensitivity for detecting postoperative VFP, but the specificity is poor. The risk of VFP is low in patients with completely normal voice at discharge. However, routine laryngoscopy after thyroid and parathyroid surgery is still the most reliable exam for VFP screening.

A meta-analysis of the accuracy of the Addenbrooke's Cognitive Examination (ACE) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) in the detection of dementia

2013 ◽  
Vol 26 (4) ◽  
pp. 555-563 ◽  
Author(s):  
Andrew J. Larner ◽  
Alex J. Mitchell
Keyword(s):  
Primary Care ◽  
Diagnostic Accuracy ◽  
Mini Mental State Examination ◽  
Meta Analysis ◽  
Screening Tools ◽  
High Prevalence ◽  
Memory Clinics ◽  
State Examination ◽  
Addenbrooke’S Cognitive Examination ◽  
Prevalence Of Dementia

ABSTRACTBackground:The Addenbrooke's Cognitive Examination (ACE) and its Revised version (ACE-R) are relatively new screening tools for cognitive impairment that may improve upon the well-known Mini-Mental State Examination (MMSE) and other brief batteries. We systematically reviewed diagnostic accuracy studies of ACE and ACE-R.Methods:Published studies comparing ACE, ACE-R and MMSE were comprehensively sought and critically appraised. A meta-analysis of suitable studies was conducted.Results:Of 61 possible publications identified, meta-analysis of qualifying studies encompassed 5 for ACE (1,090 participants) and 5 for ACE-R (1156 participants); of these, 9 made direct comparisons with the MMSE. Sensitivity and specificity of the ACE were 96.9% (95% CI = 92.7% to 99.4%) and 77.4% (95% CI = 58.3% to 91.8%); and for the ACE-R were 95.7% (95% CI = 92.2% to 98.2%) and 87.5% (95% CI = 63.8% to 99.4%). In a modest prevalence setting, such as primary care or general hospital settings where the prevalence of dementia may be approximately 25%, overall accuracy of the ACE (0.823) was inferior to ACE-R (0.895) and MMSE (0.882). In high prevalence settings such as memory clinics where the prevalence of dementia may be 50% or higher, overall accuracy again favored ACE-R (0.916) over ACE (0.872) and MMSE (0.895).Conclusions:The ACE-R has somewhat superior diagnostic accuracy to the MMSE while the ACE appears to have inferior accuracy. The ACE-R is recommended in both modest and high prevalence settings. Accuracy of newer versions of the ACE remain to be determined.

Medial Arytenoidectomy versus Transverse Cordotomy as a Treatment for Bilateral Vocal Fold Paralysis

2005 ◽  
Vol 114 (12) ◽  
pp. 922-926 ◽  
Author(s):  
Brooke Bosley ◽  
Clark A. Rosen ◽  
C. Blake Simpson ◽  
Brian T. McMullin ◽  
Jackie L. Gartner-Schmidt
Keyword(s):  
Sound Pressure Level ◽  
Vocal Fold ◽  
Sound Pressure ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Pressure Level ◽  
Voice Handicap Index ◽  
Index Score ◽  
Bilateral Vocal Fold Paralysis ◽  
Swallowing Difficulties

Objectives: Transverse cordotomy (TC) and medial arytenoidectomy (MA) are procedures performed to enlarge the glottic airway in patients with bilateral vocal fold paralysis (BVFP). Both are less destructive than total arytenoidectomy and have distinct theoretical advantages for voice preservation, but they have never been compared. Methods: The records of patients with BVFP treated with TC or MA were reviewed; information regarding the outcome measures of tracheotomy decannulation, dysphagia, Voice Handicap Index score, voice intensity, clinical course, and preoperative and postoperative voice quality was obtained. Results: Seventeen patients were available for evaluation (11 with TC, 6 with MA). All 6 patients with a preoperative tracheotomy were decannulated. Four patients in the MA group and 2 in the TC group had an increase in their postoperative Voice Handicap Index score. Two of the patients in the MA group had a decrease in phonatory sound pressure level of 3 dB, and 1 in the TC group had a decrease of 2 dB sound pressure level. Patient self-report of airway status following TC or MA showed that 62.5% (10 of 16) were significantly better and 25% (4 of 16) were somewhat better. Blinded audio perceptual analysis comparing preoperative and postoperative voice quality showed no difference between the MA and TC groups. A swallowing quality-of-life instrument confirmed a lack of swallowing difficulties postoperatively. Conclusions: Both TC and MA are good treatment options for BVFP, with a low incidence of complications in postoperative voice or of swallowing difficulties and a consistent improvement of laryngeal airway restriction symptoms.

Methods and tools used by healthcare professionals to identify barriers to return-to-work for workers with upper extremity conditions in Australia

Hand Therapy ◽  
2016 ◽  
Vol 22 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Susan E Peters ◽  
Venerina Johnston
Keyword(s):  
Return To Work ◽  
Upper Extremity ◽  
Healthcare Professionals ◽  
Assessment Tools ◽  
Screening Tools ◽  
Future Research ◽  
Factor Screening ◽  
Extremity Injuries ◽  
Clinical Measures ◽  
Tools And Methods

Introduction Healthcare professionals, including hand therapists, are frequently called upon to identify barriers to return-to-work for workers with upper extremity injuries. However, the methods and tools used to assess barriers to return-to-work remain unknown. Results from these assessments can be used to direct appropriate interventions for those who may be at risk of a prolonged work absence. Methods The purpose of this study was to identify the tools and methods used by healthcare professionals to assess barriers to return-to-work for workers with upper extremity conditions. A total of 596 Australian healthcare professionals responded to an open-ended question regarding the tools/methods they use to identify barriers to return-to-work. All responses were coded and analysed descriptively. Differences between professional disciplines were recorded. Results Healthcare professionals nominated 59 types of tools and methods that they use to identify barriers to return-to-work for workers with upper extremity conditions in their clinical practice. The most favoured method was clinical interviewing. Other commonly used tools were clinical measures, e.g., strength, and a return-to-work risk-factor screening tool validated on musculoskeletal diagnoses, the Orebro Musculoskeletal Screening Questionnaire. Discussion Healthcare professionals use a variety of methods and tools to identify barriers to return-to-work for workers with upper extremity conditions. Generally, they favoured subjective methods. Future research is needed to develop or validate assessment tools designed to identify barriers to return-to-work for workers with upper extremity conditions. In the absence of upper extremity specific screening tools, hand therapists should consider the biopsychosocial framework when evaluating barriers to return-to-work.

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