Postswallow voice modification: compatibility with videofluoroscopy findings

Santos, Karoline Weber dos; Scheeren, Betina; Maciel, Antônio Carlos; Cassol, Mauriceia

doi:10.1590/2317-1782/20172017004

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Original Article • CoDAS 29 (6) • 2017 • https://doi.org/10.1590/2317-1782/20172017004 linkcopy

Postswallow voice modification: compatibility with videofluoroscopy findings

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose Verify whether voice modification after swallowing is associated with videofluoroscopic examination data.

Methods 27 patients with oropharyngeal dysphagia underwent recording of sustained phonation of vowel /a/ before and after swallowing during videofluoroscopy. The GRBAS scale and the wet voice parameter were used to evaluate the data. Videofluoroscopy results showed stasis of food in the valleculae and piriform recesses, laryngeal penetration, tracheal aspiration, and degree of dysphagia.

Results Decreased dysphonia grade and asthenia and increased strain were observed after swallowing, with no difference for the wet voice parameter. Sensitivity and specificity of ± 50% were observed for food stasis in the valleculae and piriform recesses. Sensitivity values of 80 and 66-75% were observed for detection of laryngeal penetration and tracheal aspiration and modification of vocal strain, respectively. Negative predictive values of 77-91% were found for the three assessment parameters with no correlation with the degree of oropharyngeal dysphagia.

Conclusion Modification of the GRBAS scale parameters after swallowing showed good compatibility with videofluoroscopy findings.

Keywords
Deglutition; Voice Quality; Deglutition Disorders; Voice; Respiratory Aspiration

Compared stage of deglutition Pre- and postswallow	G	p	R	p	B	p
Pasty consistency (n = 27)	0.21 (0.37)	0.008	-0.17 (0.56)	0.134	0.07 (0.55)	0.5
Liquid consistency (n = 26)	0.14 (0.48)	0.156	-0.10 (0.65)	0.439	0.01 (0.55)	0.91
Solid consistency (n = 21)	0.14 (0.55)	0.267	-0.08 (0.63)	0.581	0.02 (0.64)	0.914

Compared stage of deglutition Pre- and postswallow	A	p	S	p	WV	p
Pasty consistency (n = 27)	0.30 (-1;1.33)	0.011	-0.25 (-2;0.66)	0.028	-0.12 (-1;1.33)	0.142
Liquid consistency (n = 26)	0.19 (-1.33;1.33)	0.71	-0.20 (-1.33;1.66)	0.077	-0.07 (-1;1.33)	0.345
Solid consistency (n = 21)	0.09 (-1.66;1.33)	0.428	-0.10 (-1.66;1.66)	0.586	-0.07 (-1.33; 0.66)	0.444

Videofluoroscopy examination	Measurement	Auditory-perceptual assessment Pasty consistency postswallow
Videofluoroscopy examination	Measurement	GP (%)	AP (%)	SP (%)
Food stasis in valleculae	Sensitivity	57	50	64
	Specificity	54	31	54
	Positive predictive value	57	44	60
	Negative predictive value	54	36	58
Food stasis in piriform recesses	Specificity	50	60	70
	Specificity	47	41	53
	Positive predictive value	36	37	41
	Negative predictive value	61	63	75
Laryngeal penetration	Specificity	40	80	80
	Specificity	45	45	50
	Positive predictive value	14	25	26
	Negative predictive value	76	90	91
Tracheal aspiration	Specificity	25	75	66
	Specificity	43	43	47
	Positive predictive value	7	18	26
	Negative predictive value	77	91	83

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[1] Caption: Dysphonia grade (G); Roughness (R); Breathiness (B); mean (standard deviation); p<0.05 (bold)