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Purpose: The purpose of this study was to investigate inter- and intrarater reliability among expert users, novice users, and speech-language pathologists with a semiautomated high-resolution manometry analysis program. We hypothesized that all users would have high intrarater reliability and high interrater reliability. Method: Three expert users, 15 novice users, and 5 speech-language pathologists participated in this study. Following a 20-min training session, users analyzed 30 high-resolution manometry plots using an automated analysis program. Output parameters included 2- and 3-dimensional pressure integrals over 5 anatomical regions of interest. Intraclass correlations were used to examine inter- and intrarater reliability. An analysis of variance was also performed to determine any differences in mean output parameter values. Results: Within-group interrater reliability ranged from 0.54 to 0.99, and intergroup reliability ranged from 0.92 to 0.99. Intrarater reliability ranged from 0.67 to 1.00 across all groups. There were no significant differences of output parameters among groups. Conclusions: The high reliability observed after a short training session demonstrates that individuals with little to no prior knowledge of swallowing physiology can perform at a similar level as those with expertise. Given the quickness and ease of training in the use of this program, it has the potential for research and clinical utility. Key Words: high-resolution manometry, reproducibility of results, speech-language pathologist, swallowing, dysphagia, The introduction of high-resolution manometry (HRM) to evaluate pharyngeal swallowing has provided dysphagia researchers and clinicians with unique physiological information not otherwise obtainable by other clinically accepted methods such as [...]

Purpose: To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Method: SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension asymmetry, mimicking unilateral SLNP. Two sets of weights were used, 1 light and 1 heavy. Five conditions were evaluated: (a) no tension, (b) symmetrical light tension, (c) asymmetrical light tension, (d) symmetrical heavy tension, and (e) asymmetrical heavy tension. Results: Perturbation parameters were not significantly different across conditions: percent jitter, [chi square](4) = 3.70, p = .451; percent shimmer, F(4) = 0.95, p = .321. In addition, many measurements were invalid (error values >10). Second-order entropy was significantly different across conditions, F(4) = 5.432, p = .002, whereas correlation dimension was not, F(4) = 0.99, p = .428. Validity of these nonlineardynamic parameters was demonstrated by low standard deviations. Phonation threshold pressure, [chi square] (4) = 22.50, p < .001, and power, [chi square] (4) = 9.50, p = .05, differed significantly across conditions, whereas phonation threshold flow did not, [chi square] (4) = 4.08, p = .396. Conclusions: Nonlinear dynamic analysis differentiated between symmetrical and asymmetrical tension conditions, whereas traditional perturbation analysis was less useful in characterizing type 2 or 3 vocal signals. Supplementing acoustic with aerodynamic parameters may help distinguish among laryngeal disorders of neuromuscular origin. Key Words: superior laryngeal nerve paralysis, tension asymmetry, nonlinear dynamic analysis, acoustic analysis, aerodynamic analysis, Paralysis of the superior laryngeal nerve (SLN) impairs voice production by decreasing stimulation to the cricothyroid (CT) muscle, thereby preventing normal vocal fold elongation. Superior laryngeal nerve paralysis (SLNP) often [...]

Purpose: The authors present 3 methods of performing pattern recognition on spatiotemporal plots produced by pharyngeal high-resolution manometry (HRM). Method: Classification models, including the artificial neural networks (ANNs) multilayer perceptron (MLP) and learning vector quantization (LVQ), as well as support vector machines (SVM), were evaluated for their ability to identify disordered swallowing. Data were collected from 12 control subjects and 13 subjects with swallowing disorders; for this experiment, these subjects swallowed 5-ml water boluses. Following extraction of relevant parameters, a subset of the data was used to train the models, and the remaining swallows were then independently classified by the networks. Results: All methods produced high average classification accuracies, with MLP, SVM, and LVQ achieving accuracies of 96.44%, 91.03%, and 85.39%, respectively. When evaluating the individual contributions of each parameter and groups of parameters to the classification accuracy, parameters pertaining to the upper esophageal sphincter were most valuable. Conclusion: Classification models show high accuracy in segregating HRM data sets and represent 1 method of facilitating application of HRM to the clinical setting by eliminating the time required for some aspects of data extraction and interpretation. Key Words: artificial neural network, classification model, pharyngeal manometry, high-resolution manometry, deglutition, dysphagia, The pharyngeal swallow is a complex physiological event that requires muscle contraction and consequent pressure generation to move a bolus from the mouth to the esophagus (Cook, 1991; Kim, McCulloch, [...]

Purpose: Digital kymography and vocal fold curve fitting are blended with detailed symmetry analysis of kymograms to provide a comprehensive characterization of the vibratory properties of injured vocal folds. Method: Vocal fold vibration of 12 excised canine larynges was recorded under uninjured, unilaterally injured, and bilaterally injured conditions. Kymograms were created at 25%, 50%, and 75% of the vocal fold length, and vibratory parameters were compared quantitatively among conditions and were studied with respect to right-left and anterior-posterior symmetries. Results: Anterior-posterior amplitude asymmetry was found in the bilateral condition. The unilateral condition showed significant right-left amplitude asymmetry, and it showed the lowest right-left phase symmetry among the conditions. In condition comparisons, vertical phase difference did not show significant differences among conditions, whereas amplitudes were significantly different among conditions at all line scan positions and most vocal fold lips. Significant differences in frequency were found among the conditions at all 4 vocal fold lips, with the bilateral condition exhibiting the greatest frequency. Conclusion: Digital kymography and curve fitting provide detailed information about the vibratory behavior of injured vocal folds. Awareness of vibratory properties associated with vocal fold injury may aid in diagnosis, and the quantitative abilities of digital kymography may allow for objective treatment selection. Key Words: digital kymography, vocal fold injury, excised larynx, anterior-posterior symmetry, right-left symmetry, Vocal fold scarring presents a significant impediment to normal mucosal wave and voice function. It is a common vocal pathology observed in the clinical setting that can be induced by [...]

Objectives/Hypothesis: Vocal fold (VF) fibroblasts are the central target for developing new strategies for the treatment of VF scarring and fibrosis. Asiatic acid (AA) is a triterpenoid derivate with antifibrotic properties. However, the effect of AA in VF scarring is poorly understood. The objective of this study was to investigate the potential application of AA as a therapeutic treatment in VF scarring. Study Design: Xxxxx. Methods: The functional expression of SMAD7 was knocked down with recombinant adenoviruses and adeno‐associated viruses carrying shRNAs in the in vitro and in vivo models, which were constructed to investigate AA's antifibrotic function. The expression of collagens and SMADs in cultured human and rabbit cell lines and animal models was evaluated with quantitative reverse transcription polymerase chain reaction and immunohistochemistry labeling, respectively. Cell migration capacity and contraction in VF fibroblast cell lines were also evaluated. Results: AA downregulated the downstream fibrotic activation in a dose‐dependent manner. Meanwhile, AA attenuated VF scarring/fibrosis by reducing collagen deposition. Furthermore, the antifibrotic effects of AA were associated with the upregulation of SMAD7. In contrast, knockdown of SMAD7 inhibited the effect of AA on transforming growth factor‐beta‐1 (TGF‐β1) stimulation, which suggests a central role for SMAD7 in AA‐induced antifibrotic activities during VF fibrosis. Conclusion: We concluded that AA, which is a novel therapeutic candidate for preventing VF scarring/fibrosis, might exert its antifibrotic effect via the TGF‐β1/SMAD signaling pathway. Level of Evidence: NA Laryngoscope, 132:1237–1244, 2022 [ABSTRACT FROM AUTHOR]