Swallowing Outcomes Research Articles

Avoidance of primary site adjuvant radiotherapy following transoral robotic surgery: a cohort study.

Post-operative radiotherapy (PORT) volumes and dose to target structures likely influence swallowing function and quality of life following transoral robotic surgery (TORS). The aim of this study is to analyse disease control and swallowing outcomes in patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) to determine the impact of omitting the primary site from the PORT treatment volume. Prospectively collected data from patients that underwent TORS between March 2013 and April 2021 were reviewed. Patients were categorized into three groups: (1) no PORT, (2) PORT to the neck alone or (3) PORT to the primary site and neck. Survival curves were generated according to the Kaplan-Meier method and swallowing was assessed using the Functional Oral Intake Scale, Public Status Scale Head and Neck, MD Anderson Dysphagia Inventory and feeding tube/gastrostomy dependence. A total of 121 patients underwent TORS, of which 103 met inclusion criteria with a median follow up of 2.6 years. No patients developed local recurrence. The 3-year regional control rates were 90%, 100% and 100% for groups 1, 2 and 3, respectively. Disease-specific survival was 97% over the study period. Patients that received PORT to both the primary site and the neck (group 3) had worse swallowing outcomes at 12 months. Following TORS for OPSCC, avoiding PORT to the primary site, in appropriately selected patients, appears to be oncologically safe and is associated with superior swallowing outcomes.

Desfechos de deglutição e alimentação associados à intubação orotraqueal e à traqueostomia em pediatria

ABSTRACT Purpose To verify the swallowing and feeding outcomes of pediatric patients undergoing prolonged OTI, considering those who progressed to tracheostomy afterward. Methods Retrospective cohort study, carried out by analyzing the medical records of patients admitted to the Pediatric ICU and followed up until hospital discharge, between 03/2017 and 12/2018. Results Of the 51 patients included, 64.7% were male and the median age 6.7 months. Patients undergoing OTI for a median of 7 days had mild dysphagia and when submitted for more than 14 days had moderate/severe dysphagia and PFD with characteristics of food refusal, with contraindication to oral feeding at hospital discharge. 74.5% of the patients underwent OTI only and 25.5% progressed to tracheostomy afterward. Tracheostomized patients had a higher occurrence of hospital discharge with moderate/ severe oropharyngeal dysphagia, pediatric feeding disorder (PFD) with characteristics of food refusal and alternative method of feeding compared to patients without tracheostomy (p=0.001). Non-tracheostomized patients had a final diagnosis with milder degrees of dysphagia when compared to the initial diagnosis (p<0.001). Conclusion The time of OTI and the presence of tracheostomy are factors associated with the speech-language pathology diagnosis of moderate/severe oropharyngeal dysphagia, presence of signs of PFD with characteristics of food refusal and the need for an alternative method of feeding that persists until hospital discharge, being frequent findings among the swallowing/feeding outcomes in pediatrics.

Swallowing function in the chronic stage following stroke is associated with white matter integrity of the callosal tract between the interhemispheric S1 swallowing representation areas

Sensorimotor representations of swallowing in pre- and postcentral gyri of both cerebral hemispheres are interconnected by callosal tracts. We were interested in (1) the callosal location of fibers interconnecting the precentral gyri (with the primary motor cortex; M1) and the postcentral gyri (with the primary somatosensory cortex; S1) relevant for swallowing, and (2) the importance of their integrity given the challenges of swallowing compliance after recovery of dysphagia following stroke. We investigated 17 patients who had almost recovered from dysphagia in the chronic stage following stroke and age-matched and gender-matched healthy controls. We assessed their swallowing compliance, investigating swallowing of a predefined bolus in one swallowing movement in response to a ‘go’ signal when in a lying position. A somatotopic representation of swallowing was mapped for the pre- and postcentral gyrus, and callosal tract location between these regions was compared to results for healthy participants. We applied multi-directional diffusion-weighted imaging of the brain in patients and matched controls to calculate fractional anisotropy (FA) as a tract integrity marker for M1/S1 callosal fibers. Firstly, interconnecting callosal tract maps were well spatially separated for M1 and S1, but were overlapped for somatotopic differentiation within M1 and S1 in healthy participants’ data (HCP: head/face representation; in house dataset: fMRI-swallowing representation in healthy volunteers). Secondly, the FA for both callosal tracts, connecting M1 and S1 swallowing representations, were decreased for patients when compared to healthy volunteers. Thirdly, integrity of callosal fibers interconnecting S1 swallowing representation sites was associated with effective swallowing compliance. We conclude that somatosensory interaction between hemispheres is important for effective swallowing in the case of a demanding task undertaken by stroke survivors with good swallowing outcome from dysphagia.

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration-related structures in patients with head and neck cancer undergoing definitive and postoperative intensity-modulated radiotherapy.

The relationship between swallowing outcomes and radiotherapy dose to dysphagia and aspiration-related structures (DARS) may be different following definitive versus postoperative radiotherapy (PORT) for mucosal head and neck cancer (HNC) and has not been well-studied. Patient- and clinician-reported swallowing measures were prospectively collected at six time points from baseline to 24 months postradiotherapy HNC. Radiotherapy plans were retrospectively analyzed to assess dose delivered to DARS. The association between swallowing outcomes and participant demographics, tumor characteristics, and radiotherapy dose in definitive and postoperative treatment cohorts was assessed. Ninety-three participants who received radiotherapy for HNC were included in the analysis (n=49 definitive radiotherapy for laryngeal/pharyngeal primary tumors and n=44 postoperative PORT for predominantly oral cavity/salivary gland tumors). Participants undergoing PORT had lower doses to DARS than those undergoing definitive RT. High dose to the pharyngeal constrictors and base of tongue for definitive RT and the esophageal inlet, supraglottic larynx and cervical esophagus for the PORT group were associated with worse swallowing function. Radiation dose to DARS is associated with post-treatment swallowing outcomes. These dose/outcome relationships may vary between the definitive and postoperative settings.

Swallowing After Primary TORS and Unilateral or Bilateral Radiation for Low- to Intermediate-Risk Tonsil Cancer.

The primary course of treatment for patients with low- to intermediate-risk tonsil cancer has evolved with a shift toward primary transoral robotic surgery (TORS) or radiation therapy (RT). While favorable outcomes have been reported after deintensification via unilateral TORS or RT (uniRT), comparisons of functional outcomes between these treatments are lacking. We compared clinical outcomes (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST] and feeding tube [FT]) and patient-reported swallowing outcomes (MD Anderson Dysphagia Inventory [MDADI]) based on primary treatment strategy: TORS, uniRT, or bilateral RT (biRT). Secondary analysis of prospective cohort. Single institution. The study sample comprised 135 patients with HPV/p16+ T1-T3, N0-2b (American Joint Committee on Cancer, seventh edition), N0-1 (eighth edition) squamous cell carcinoma of the tonsil were sampled from a prospective registry. Modified barium swallow studies graded per DIGEST, FT placement and duration, and MDADI were collected. Baseline DIGEST grade significantly differed among treatment groups, with higher dysphagia prevalence in the TORS group (34%) vs the biRT group (12%, P = .04). No significant group differences were found in DIGEST grade or dysphagia prevalence at subacute and longitudinal time points (P = .41). Mean MDADI scores were similar among groups at baseline (TORS, 92; uniRT, 93; biRT, 93; P = .90), subacute (TORS, 83; uniRT, 88; biRT, 82; P = .38) and late time points (TORS, 86; uniRT, 86; biRT, 87; P = .99). FT placement and duration significantly differed among primary treatment groups (FT [median days]: TORS, 89% [3]; uniRT, 8% [82]; biRT, 37% [104]; P < .001). While TORS and uniRT offer optimal functional outcomes related to dysphagia, results suggest that no measurable clinician-graded or patient-reported differences in swallow outcomes exist among these primary treatment strategies and biRT. Aside from baseline differences that drive treatment selection, differences in FT rate and duration by primary treatment strategy likely reflect diverse toxicities beyond dysphagia.

Single Stage Transoral Cordectomy and Medialization Thyroplasty in Early Glottic Squamous Cell Carcinoma: A Case Report

ABSTRACT&#x0D; Objective: To present the case of a 78-year-old man with Glottic SCCa stage I who underwent single stage transoral cordectomy type IV with medialization thyroplasty under general anesthesia.&#x0D; Methods:&#x0D; Design: Case Report&#x0D; Setting: Tertiary Government Training Hospital&#x0D; Patient: One&#x0D; Results: Postoperatively, patient was able to phonate and gave a VHI score of 12 and GRBAS score of 4. He was able to resume oral feeding without any signs of aspiration. Postoperative flexible laryngoscopy showed fully mobile vocal cords with good approximation in the midline.&#x0D; Conclusion: This report suggests that vocal cord medialization via thyroplasty may be performed after cordectomy in a single stage, providing acceptable postoperative voice as well as good swallowing outcome

Swallowing Function Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharyngeal Carcinoma: A 2-Year Follow-up.

To evaluate 2-year follow-up swallowing function in patients with human papillomavirus-related oropharyngeal squamous cell carcinoma (HPV+ OPSCC) who completed neoadjuvant chemotherapy and transoral robotic surgery (NAC+S). Retrospective analysis of patients with OPSCC treated with NAC+S between 2010 and 2021. A single academic institution. This is a cross-sectional study of patient-reported swallowing function, assessed with the MD Anderson Dysphagia Inventory (MDADI) at least 2 years after completion of treatment. The inclusion criteria are patients with HPV+ OPSCC who underwent NAC+S at least 2 years ago. Those requiring adjuvant radiation or chemoradiation or experiencing relapse were excluded from the study. Completed MDADIs were received from 37 patients at a median 3.8 years posttreatment (interquartile range, 2.0-8.6 years). Of those, 94.6% (n = 35) were male and 81.1% (n = 30) were White. The median age at OPSCC diagnosis was 59.0 years (interquartile range, 41-80 years). The most frequent primary subsite of OPSCC was the base of the tongue (n = 20, 54.1%), followed by the tonsils (n = 16, 43.2%). In addition, 75.7% (n = 28) had stage IVa disease (TNM seventh edition), and 29 (78.4%) had scores ≥80, classified as optimal function. When compared with patients who received bilateral neck dissection, patients who received unilateral neck dissection were associated with an age <65 years old (P = .036) and lower clinical TNM stage (P = .04), as well as higher composite, emotional, functional, and physical MDADI scores (P = .017, .046, .013, and .05, respectively). Patients with OPSCC who were treated with NAC+S achieved satisfactory long-term swallowing outcomes. Unilateral neck dissection was significantly associated with higher MDADI scores in this patient cohort.

Improved Swallow Outcomes with Early Intervention using Combined Swallow Therapy in Advanced Oropharyngeal Carcinoma.

AbstractObjectiveTo evaluate the impact of early intervention using combined swallow therapy, consisting of traditional swallow exercises and transcutaneous neuromuscular electrical stimulation, on patients with advanced oropharyngeal squamous cell carcinoma.MethodsA cohort study of 60 prospectively enrolled patients was performed. Thirty patients with advanced oropharyngeal squamous cell carcinoma starting combined swallow therapy two weeks after surgery that continued throughout chemoradiotherapy were compared with a matched cohort of 30 patients starting combined swallow therapy after cancer treatment completion. Gastrostomy tube status, modified barium swallow, and Functional Oral Intake Scale scores were assessed before and after therapy.ResultsBoth cohorts demonstrated a statistically significant improvement in Functional Oral Intake Scale scores. All patients in the early intervention cohort discontinued gastrostomy tube use, compared with one-third in the control cohort, with greater improvements in Functional Oral Intake Scale scores. The tongue base was the site of greatest improvement in the early intervention group.ConclusionEarly initiation of combined swallow therapy may optimise swallow outcomes in patients with advanced oropharyngeal squamous cell carcinoma.

Swallowing and communication outcomes following primary transoral robotic surgery for advanced or recurrent oropharyngeal cancer: Case series

Purpose: Transoral robotic surgery (TORS) is most commonly undertaken as a minimally invasive approach for early staged oropharyngeal cancers (OPC), with good expectations for a functional recovery. A small number of patients, however, require TORS for recurrent or advanced OPC tumours. Their prospects for longer term recovery of communication and swallowing are both unreported and hypothesised to be poorer than the majority of TORS cases. This case-series describes the recovery of swallowing and communication function post-TORS for this unique group of patients. Method: Consecutive recruitment was carried out prospectively at a quaternity oncology referral centre. Participants were aged 18 years and older, with reconstruction involving a free-flap and tracheostomy. Patients were assessed using Fibreoptic Endoscopic Evaluation of Swallowing, and clinician and patient-reported outcomes 12-months post-TORS. Their pre-operative baseline and three-month post-TORS FOIS scores were collated retrospectively. Result: Six participants were recruited over an 18-month period of which three patients underwent TORS for recurrent, and three for advanced OPC. Those with recurrent-OPC did not return to their baseline diet and demonstrated post-swallow silent aspiration of pharyngeal residue. Three of the six were rehabilitated back to their baseline intelligibility (100%). Conclusion: TORS in the recurrent OPC setting appears congruent with high rates of silent aspiration and prolonged reliance on a feeding tube due to oropharyngeal dysphagia, as well as compromised intelligibility. This is the first study that evaluates this instrumentally and provides clinically relevant evidence to inform practice.

Outcomes and complications of surgical treatment of anterior osteophytes causing dysphagia: Single center experience

Study designRetrospective case series. ObjectiveTo better understand the functional swallow outcomes, cervical balance, and surgical complications, we examined patients with anterior osteophytes and dysphagia who were treated operatively. Summary of background dataAnterior osteophytes from diffuse idiopathic skeletal hyperostosis (DISH) or degenerative etiology of the cervical spine can cause dysphagia from mechanical compression of the esophagus. Osteophytectomy is generally accepted as a safe surgical treatment, but the risk of instability is unclear. The potential for associated complications must be considered. MethodsPatients who had anterior osteophytes and dysphagia from 2005 to 2020 were reviewed retrospectively. Demographics, radiographic parameters, functional swallow outcome, and complications were examined. ResultsThere were 15 patients identified treated surgically. Increased osteophyte height positively correlated with severity of dysphagia with Pearson coefficient of 0.53 (p = 0.042). Functional Outcome Swallowing Scale (FOSS) scores improved after surgical treatment from median of 2 to 0 (p = 0.002). C2–7 SVA did increase by 8 mm (p = 0.007) but was generally well tolerated. There was a 27% complication rate including a case of C5 lateral mass fracture with central cord syndrome after a fall 4 days following osteophytectomy. There was one patient who was preoperatively dependent on gastrostomy tube who required a tracheostomy and had continued reliance on the gastrostomy tube. ConclusionSurgical treatment of anterior osteophytes causing dysphagia with osteophytectomy can lead to overall improved FOSS scores for most patients. However, a high preoperative FOSS score may be a prognostic indicator of poor postoperative functional swallow outcome. It is important to consider the potential for instability when osteophytectomy is performed at 3 or more spinal segments.

Effect of Transcutaneous Electrical Stimulation in Chronic Poststroke Patients with Oropharyngeal Dysphagia: 1-Year Results of a Randomized Controlled Trial

Background. Chronic poststroke oropharyngeal dysphagia (CPSOD) is associated with impaired oropharyngeal sensory/motor function. We aimed to assess effect of sensory (SES) and motor (NMES) transcutaneous electrical stimulation (TES) on safety of swallow and clinical outcomes in patients with CPSOD in a one-year follow-up randomized controlled trial. Methods. Ninety patients (74.1 ± 11.5 y, modified Rankin score 2.6 ± 1.7) with CPSOD and impaired safety of swallow were randomized to (a) compensatory treatment (CT), (b) CT + SES, and (c) CT + NMES. Patients were treated with up to two cycles (6 months apart) of 15 × 1 hour TES sessions over two weeks and followed up with 4-5 clinical and videofluoroscopic assessments during one year. Key results. Baseline penetration–aspiration scale (PAS) was 4.61 ± 1.75, delayed time to laryngeal vestibule closure (LVC) 396.4 ± 108.7 ms, and impaired efficacy signs 94.25%. Swallowing parameters significantly improved between baseline and 1-year follow-up in SES and NMES groups for prevalence of patients with a safe swallow (P < .001), mean PAS (P < .001), time to LVC (P < .01), and need for thickening agents (P < .001). Patients in the CT presented a less intense improvement of signs of impaired safety of swallow without significant changes in time to LVC. No differences between groups were observed for 1-year mortality (6.1%), respiratory infections (9.6%), nutritional and functional status, QoL, and hospital readmission rates (27.6%). No significant adverse events related to TES were observed. Conclusions and inferences. Transcutaneous electrical stimulation is a safe and effective therapy for older patients with CPSOD. After 1-year follow-up, TES greatly improved the safety of swallow and reduced the need for fluid thickening in these patients.

Airway and Swallowing Outcomes Following Laryngotracheoplasty With Posterior Grafting in Children.

Evaluate swallowing and airway outcomes following laryngotracheoplasty with posterior grafting (LTP PCCG). Retrospective review of pediatric patients undergoing LTP PCCG from 2016 to 2019 at a tertiary care pediatric hospital. We included demographics, indications, approach, and revision status. We evaluated preoperative and postoperative instrumental and functional swallow evaluations, and we also gathered information on airway outcomes. Thirty-one patients were included in the study. Median (interquartile range [IQR]) age was 4.0 (2.0, 7.0) years old. Primary indication for surgery was bilateral vocal cord immobility (BVCI) in 11 (35.5%) and posterior glottic stenosis (PGS) in 20 (64.5%). Mean (standard deviation) length of follow-up was 11.0 (8.3) months. Twelve patients had gastrostomy tubes (GT) before surgery, and no patients required placement of GT after surgery. Of the remaining 19 patients, 6 required nasogastric feeding for >4 weeks (average length 1.8 months, longest 3.5 months). At last follow-up, 25 (80.6%) patients were primarily orally fed. Eighteen patients had tracheotomies prior to surgery. No patients without a tracheostomy required placement of tracheostomy before or after surgery and only 1 patient had a tracheostomy at last follow-up. Average time to decannulation was 3.7 months, with surgery-specific success of 87.1% and overall success of 96.8%. Four (12.9%) patients required a major intervention to achieve decannulation. LTP PCCG is an effective surgical technique to address PGS and BVCI with high decannulation rates. It may cause temporary swallowing dysfunction, but in this series a majority of children were orally fed at last follow-up. 4 Laryngoscope, 131:2798-2804, 2021.

Functional Outcomes Following Delayed Laryngeal Reinnervation Of Patients with Vagal Paralysis After Paraganglioma and Schwannoma Surgery

We present a prospective case series that aimed to report the functional (voice and swallowing) outcomes of delayed laryngeal reinnervation following vagal interruption by resection of vagal paraganglioma and schwannoma. A dedicated, anonymized database was established in 2012 with a minimum eighteen-month follow up set for this report. Internationally validated self- and observer-reported measures were recorded preoperatively and at six, 12 and, 18 months together with demographics, diagnoses, and operative details. A total of eight patients with a median age of 46 (37-54) underwent excision of vagal paraganglioma (five) and schwannoma (three) with few mild complications. Three underwent selective and five non selective reinnervation. Seven out of eight patients underwent synchronous injection medialization. The voice handicap index (VHI-30) improved from a baseline median 83 (range 52-102) to 7.5 (5-58) at 18 months; maximum phonation time improved from median 8 (range 5-15) to 10.5 (8.5-11); voice grade ("G" in grade, roughness, breathiness, asthenia, and strain [GRBAS] scoring) improved from median three (severe impairment, range 0-3) to one (mild impairment, 0-2); Eating Assessment Tool (EAT-10) score improved from median 12 (range 3.5-27) preoperatively to one (0-16); and reflux symptom index (RSI) improved from median 25 (range 17-36) to 7 (0-36). One patient exhibited no discernible reinnervation, while the remainder exhibited good cord bulk and tone, though without purposive abduction. Delayed laryngeal reinnervation for high vagal paralysis is a safe technique associated with good voice and swallowing outcomes by 12-18 months. Potential confounders in this small series and the absence of a control arm both limit conclusions, but this study suggests that further prospective, controlled studies, and/or case registration are merited.

Functional results of swallowing and aspiration after oral cancer treatment and microvascular free flap reconstruction: A retrospective observational assessment

This study aimed to assess the functional swallowing outcomes in cohort of oral cancer patients treated with tumor resection and reconstruction by means of microvascular free flaps.Duration from onset to the last examination was classified into three periods: less than 12 months, from 13 to 24 months, and more than 24 months. Type of feeding, dysphagia, and laryngeal aspiration were the dependent variables, and the study was mainly focused on the data from the multivariate analysis.Fifty-one patients were included in the study. Twenty-one patients had dysphagia, 11 showed stasis in vallecula and pyriform sinuses, 9 experienced laryngeal penetration, and 8 aspirations. Surgery combined with radiochemotherapy was associated with a higher prevalence of dysphagia (p = 0.03). Frequency of dysphagia was higher in the first year after treatment and less frequent after 24 months (p = 0.003). Dysphagia was associated with laryngeal penetration (p = 0.001), and this with aspiration (p < 0.0005).In conclusion, as it seems that the method of reconstruction has a major influence on swallowing, when there are relevant alternatives in the way the reconstruction is done, always the approach should be chosen that reduces dysphagia to a minimum.

263 Airway, Voice and Swallow Outcomes Following Endotracheal Intubation and Mechanical Ventilation For COVID-19 Pneumonitis: Preliminary Results of a Prospective Cohort Study

IntroductionThe COVID-19 pandemic has placed exceptional demands on Intensive Care Units (ICU) across the world – particularly requiring patients to be intubated and mechanically ventilated. Laryngeal injury following intubation is a common occurrence, therefore this study aims to analyse airway, voice, and swallow (AVS) outcomes of patients intubated for COVID-19 pneumonitis and compares it to intubated non-COVID-19 respiratory patients and other ICU admissions.MethodWe collected data from inpatient records, and follow-up clinics on intubated adult patients discharged from a tertiary care hospital ICU between 01/03/20 and 30/04/20. Patients were assessed with the AVS Scale, Voice Handicap Index-10 (VHI-10), and Eating Assessment Tool-10 (EAT-10).Results86 patients were admitted with COVID-19 pneumonitis, 17 patients were admitted with non-COVID-19 respiratory failure, and 26 patients were admitted with a non-respiratory diagnosis.The COVID-19 cohort demonstrated higher rates of AVS difficulties (airway 59% vs 44% and 31%, voice 40% vs 19% and 19%, swallow 21% vs 6% and 12%). VHI-10 and EAT-10 scores showed no significant differences between groups.ConclusionsPatients intubated for COVID-19 pneumonitis reported higher rates of AVS difficulties against non-COVID-19 reasons for intubation. Robust prospective screening protocols are essential to improving patient outcomes by highlighting and therefore managing laryngological sequelae that occur following intubation.

Swallowing and communication outcomes following primary transoral robotic surgery.

Heterogeneity within studies examining transoral robotic surgery (TORS) for oropharyngeal cancer (OPC) has made it challenging to make clear conclusions on functional outcomes. Infrequent use of instrumental swallow examinations compounds uncertainty surrounding the proposed functional advantage to TORS. A prospective cohort of 49 patients underwent speech and swallowing assessment 12 months following treatment for OPC. Patients were assessed using fibreoptic endoscopic evaluation of swallowing (FEES), clinician- and patient-reported outcomes. Participants were matched according to tumor site, T category, and age. Speech and swallowing outcomes were compared for those receiving TORS versus chemoradiation. When adjuvant radiotherapy to the primary site could be avoided, TORS demonstrated an advantage for feeding tube duration, secretion severity, penetration/aspiration, M. D. Anderson Dysphagia Inventory (MDADI), and airway protection. This explorative study suggests that a treatment philosophy of selecting patients for TORS where adjuvant therapy can be omitted or confined to the neck warrants further evaluation.

Examining Relationships Between GRBAS Ratings and Acoustic, Aerodynamic and Patient-Reported Voice Measures in Adults With Voice Disorders

To determine if auditory-perceptual voice ratings performed using the GRBAS scale correlate with acoustic and aerodynamic measures of voice. A secondary aim was to examine the relationship between GRBAS ratings and patient-reported quality of life scales. GRBAS ratings, acoustic, aerodynamic and patient-reported quality of life ratings were collected from the University of Wisconsin Madison Voice and Swallow Outcomes Database for 508 adults with voice disorders. Acoustic measures included noise to harmonic ratio, jitter%, shimmer%, highest fundamental frequency (F0) of vocal range, lowest F0 of vocal range, maximum phonation time and dysphonia severity index. Aerodynamic measures included phonation threshold pressure, subglottal pressure, mean transglottal airflow and laryngeal airway resistance. Patient-reported quality of life measures included the Vocal Handicap Index (VHI) and Glottal Function Index (GFI). GRBAS ratings were significantly correlated with several acoustic and aerodynamic measures, VHI and GFI. The strongest significant correlations for acoustic measures were observed between GRBAS ratings of overall voice quality and perturbation measures (jitter% r = 0.58, shimmer% r = 0.45, noise to harmonic ratio r = 0.36, Dysphonia Severity Index r=-0.56). The strongest significant correlation for aerodynamic voice measures was observed between GRBAS ratings of breathiness and transglottal airflow (r = 0.23), subglottal pressure (r = 0.49), and phonation threshold pressure (r = 0.26). GRBAS ratings were also significantly correlated with both VHI and the GFI scales. R values were higher for the VHI, but remained largely in low range for both scales. Although GRBAS ratings were significantly correlated with multiple objective voice and patient related quality of life ratings, r values were low. These findings support the need for multiple voice measures when performing voice evaluations as no single voice measure was highly correlated with voice quality as measured by the GRBAS scale.

Objective and Subjective Clinical Swallowing Outcomes via Telehealth: Reliability in Outpatient Clinical Practice.

Purpose The COVID-19 pandemic has drastically increased the use of telehealth. Prior studies of telehealth clinical swallowing evaluations provide positive evidence for telemanagement of swallowing. However, the reliability of these measures in clinical practice, as opposed to well-controlled research conditions, remains unknown. This study aimed to investigate the reliability of outcome measures derived from clinical swallowing tele-evaluations in real-world clinical practice (e.g., variability in devices and Internet connectivity, lack of in-person clinician assistance, or remote patient/caregiver training). Method Seven raters asynchronously judged clinical swallowing tele-evaluations of 12 movement disorders patients. Outcomes included the Timed Water Swallow Test (TWST), Test of Masticating and Swallowing Solids (TOMASS), and common observations of oral intake. Statistical analyses were performed to examine inter- and intrarater reliability, as well as qualitative analyses exploring patient and clinician-specific factors impacting reliability. Results Forty-four trials were included for reliability analyses. All rater dyads demonstrated "good" to "excellent" interrater reliability for measures of the TWST (intraclass correlation coefficients [ICCs] ≥ .93) and observations of oral intake (≥ 77% agreement). The majority of TOMASS outcomes demonstrated "good" to "excellent" interrater reliability (ICCs ≥ .84), with the exception of the number of bites (ICCs = .43-.99) and swallows (ICCs = .21-.85). Immediate and delayed intrarater reliability were "excellent" for most raters across all tasks, ranging between ICCs of .63 and 1.00. Exploratory factors potentially impacting reliability included infrequent instances of suboptimal video quality, reduced camera stability, camera distance, and obstruction of the patient's mouth during tasks. Conclusions Subjective observations of oral intake and objective measures taken from the TWST and the TOMASS can be reliably measured via telehealth in clinical practice. Our results provide support for the feasibility and reliability of telehealth for outpatient clinical swallowing evaluations during COVID-19 and beyond. Supplemental Material https://doi.org/10.23641/asha.13661378.

The Relationship Between Auditory-Perceptual Rating Scales and Objective Voice Measures in Children With Voice Disorders.

Purpose The purpose of this study was to determine concurrent validity of the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) auditory-perceptual scales in children with voice disorders. A secondary purpose was to determine correlation between the GRBAS, CAPE-V, and objective voice measures. Method GRBAS and CAPE-V ratings and acoustic and aerodynamic measures were collected from the University of Wisconsin-Madison Voice and Swallow Outcomes Database. Correlations between CAPE-V and GRBAS ratings were calculated for overall severity of dysphonia, roughness, breathiness, and strain. Correlations between auditory-perceptual voice ratings and objective voice measures were also examined. Results One hundred thirty GRBAS and CAPE-V auditory-perceptual ratings were significantly correlated for overall severity, roughness, breathiness, and strain. r 2 values were highest for overall severity of dysphonia (r 2 = .75) and lowest for strain (r 2 = .54). CAPE-V and GRBAS ratings were largely associated with similar acoustic and aerodynamic measures. The highest correlations were observed for auditory-perceptual ratings of breathiness and jitter% (CAPE-V r 2 = .44, GRBAS r 2 = .44), shimmer% (CAPE-V r 2 = .45, GRBAS r 2 = .45), noise-to-harmonic ratio (CAPE-V r 2 = .42, GRBAS r 2 = .40), fundamental frequency (CAPE-V r 2 = .47, GRBAS r 2 = .44), and maximum phonation time (CAPE-V r 2 = .56, GRBAS r 2 = .51). Akaike information criterion values indicated that CAPE-V ratings were more strongly correlated with objective voice measures than GRBAS ratings. Conclusions CAPE-V and GRBAS scales have concurrent validity in children with voice disorders. CAPE-V ratings are more strongly correlated with acoustic and aerodynamic voice measures.

Pediatric Open Airway Reconstruction

Subglottic stenosis (SGS) and tracheal stenosis (TS) can be congenital or acquired. Ongoing improvements in neonatal care have led to an increased number of infants with prolonged intubation and tracheostomy. Both of these interventions have led to an increase in SGS and TS and management of these lesions can be challenging. A wide array of endoscopic and open techniques exist to manage these issues. This article aims to review previous and current literature on open airway reconstruction to guide care for these children. Experience and expertise in airway surgery have shifted recent research towards non-airway outcome measures such as swallowing and voice, though the primary treatment objective remains decannulation. Various open surgical options as slide tracheoplasty, laryngotracheal reconstruction, and partial cricotracheal resection and anastomosis are available for correcting laryngotracheal stenosis. The choice of the surgery should be based on demography and characteristics of the stenosis found during endoscopy and the associated comorbidities of the patient. Open airway reconstruction for treatment of LTS is effective but careful preoperative evaluation and patient selection are important. Ongoing research focuses on improving swallowing and voice outcomes.