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2. Utility of Ultrasound in the Assessment of Swallowing and Laryngeal Function: A Rapid Review and Critical Appraisal of the Literature

Author

Allen, Jodi E., Clunie, Gemma M., Slinger, Claire, Haines, Jemma, Mossey-Gaston, Corinne, Zaga, Chariss J., Scott, Becky, Wallace, Sarah, and Govender, Roganie

Abstract

Background: Ultrasound (US) is not widely used as part of the speech and language therapy (SLT) clinical toolkit. The COVID-19 pandemic has intensified interest in US as an alternative to SLT instrumental tools such as the videofluoroscopic swallowing study (VFSS), fibreoptic endoscopic evaluation of swallowing (FEES) and endoscopic evaluation of the larynx (EEL) as a non-invasive, non-aerosol-generating procedure that can be delivered at the bedside to assess swallowing and/or laryngeal function. To establish the appropriacy of routine US use, and in response to a national professional body request for a position statement, a group of expert SLTs conducted a rapid review of the literature. Aim: To explore critically the clinical utility of US as an assessment tool for swallowing and laryngeal function in adults. Methods & Procedures: A rapid review of four databases was completed to identify articles using US to assess swallowing and/or laryngeal function in adults compared with reference tests (VFSS/FEES/EEL/validated outcome measure). Screening was completed according to predefined inclusion/exclusion criteria and 10% of abstracts were rescreened to assess reliability. Data were extracted from full texts using a predeveloped form. The QUADAS-2 tool was used for quality ratings. Information from included studies was summarized using narrative synthesis and visual illustration. Outcomes & Results: Ten papers used US to assess swallowing, and 13 to assess laryngeal function. All were peer-reviewed primary studies across a range of clinical populations and with a wide geographical spread. Four papers had an overall low risk of bias, but the remaining 19 had at least one domain where risk of bias was judged as high or unclear. Applicability concerns were identified in all papers. The papers that used US to assess swallowing varied widely in terms of the anatomical structures assessed and methodology employed. The papers assessing laryngeal function were more homogenous in their methodology. Sensitivity and specificity data were provided for 12 of the laryngeal function papers with ranges of 64.3-100% and 48.5-100%, respectively. Conclusions & Implications: There is burgeoning evidence to support the use of US as an adjunct to SLT clinical assessment of swallowing and laryngeal function. However, the current literature does not support its use as a tool in isolation. Further research is required to establish reliability in US assessment as well as clear SLT-driven protocols and training.

Published
2021
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3. Is trans-laryngeal ultrasound (TLUS) an accurate and acceptable tool in the assessment of inducible laryngeal obstruction? A protocol for the ILOTUS: A cross-sectional, two-stage feasibility study

Author

Slinger, Claire, Leong, Paul, Spencer, Sally, Slinger, Richard, and Govender, Roganie

Abstract

Inducible laryngeal obstruction (ILO) describes an inappropriate narrowing of the larynx during breathing in. ILO can lead to several respiratory symptoms and be misidentified and treated as asthma, with associated patient morbidity and healthcare cost. ILO is also known as vocal cord dysfunction, or paradoxical vocal fold movement. The current reference assessment tool for diagnosing ILO is a video-laryngoscopy. However, timely access to specialist diagnostic laryngoscopy services may be challenging, and laryngoscopy may be poorly tolerated. The aim of this cross-sectional, two-stage feasibility study is to determine whether abnormal vocal fold movements associated with ILO can be adequately visualised using trans-laryngeal ultrasound (TLUS) namely, the ILOTUS study: (ILO assessment via trans- laryngeal ultrasound). The second aim is to compare TLUS with a reference standard diagnostic tool to ascertain whether it may serve as a less invasive screening tool to assess ILO. Participants’ opinions about the acceptability of TLUS will also be gathered and compared with responses to a validated symptom score questionnaire. In stage one, healthy volunteers (n = 30) will undergo TLUS to assess whether the vocal folds can be visualised,and whether narrowing of the vocal folds can be seen when they mimic ILO. Stage 2 will be conducted with a patient population(n = 30) referred to a tertiary airways service for breathlessness assessment. Participants in stage 2 will undergo the reference standard laryngoscopy as well as simultaneous TLUS. The level of agreement between TLUS and laryngoscopy will be evaluated, as well as comparison of symptom scores. This study will help inform future studies of the utility of TLUS in the assessment of ILO. This will be valuable for understanding whether TLUS could be offered as a non-invasive option for patients in the assessment of ILO if they are not able to tolerate or access laryngoscopy diagnostic services. It is not intended that TLUS will replace the current reference standard of video-laryngoscopy but may have potential as an early screening tool if found to be non-inferior.

Published
2024
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4. Comment on Chatwin et al. Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders. J. Clin. Med. 2024, 13 , 2643.

Author

Allen, Jodi, Clunie, Gemma, Newman, Helen, and Slinger, Claire

Subjects
TRACHEAL cartilage, VOCAL cords, PATIENT experience, HYOID bone, NEUROMUSCULAR diseases, MYOCARDIAL infarction
Abstract

This document is a letter written in response to a paper published in the Journal of Clinical Medicine. The authors of the letter express their interest in the paper and congratulate the authors for their informative review on the use of new tools to evaluate the efficacy of mechanical in-exsufflation (MI-E) in neuromuscular disorders. However, they raise concerns about the lack of reference to contemporary literature on two key upper airway assessment methods: cervical auscultation and ultrasound. They argue that a balanced critique of current literature is necessary to ensure that readers are well-informed and that the limitations of emerging assessment tools are recognized. The authors also provide insights into the limitations of cervical auscultation and ultrasound in assessing the upper airway, and they propose recommendations for future practice and collaboration between professionals in order to improve outcomes for patients. [Extracted from the article]

Published
2024
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7. UK consensus statement on the diagnosis of inducible laryngeal obstruction in light of the COVID‐19 pandemic

Author

Haines, Jemma, primary, Esposito, Karen, additional, Slinger, Claire, additional, Pargeter, Nicola, additional, Murphy, Jennifer, additional, Selby, Julia, additional, Prior, Kathryn, additional, Mansur, Adel, additional, Vyas, Aashish, additional, Stanton, Andrew E., additional, Sabroe, Ian, additional, Hull, James H., additional, and Fowler, Stephen J., additional

Published
2020
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12. Heliox for inducible laryngeal obstruction (vocal cord dysfunction):A systematic literature review

Author

Slinger, Claire, Slinger, Richard, Vyas, Aashish, Haines, Jemma, Fowler, Stephen J., Slinger, Claire, Slinger, Richard, Vyas, Aashish, Haines, Jemma, and Fowler, Stephen J.

Abstract

Objectives: To perform a systematic literature review on the use of Heliox with patients with inducible laryngeal obstruction/vocal cord dysfunction to: i) identify current evidence base; and ii) establish the methodological quality of published research. Methods: Articles published up to March 2018 were searched for key words and terms using Cochrane Library, MEDLINE, PubMed, CINAHL, EMBASE and Dynamed. Studies were included if they presented original research into the use of Heliox for vocal cord dysfunction. Results: Only three studies met the inclusion criteria for review. All reported favorable results for the use of Heliox as an adjunctive therapy for vocal cord dysfunction but none had sufficient methodological quality to support their conclusions. Conclusion: Despite review articles recommending the use of Heliox in vocal cord dysfunction, there is a lack of good quality research to support this conclusion. There is a need for further research to investigate the effectiveness of Heliox as an adjunctive therapy for vocal cord dysfunction. Level of Evidence: 4

Published
2019

13. Speech and language therapy for management of chronic cough

Author

Slinger, Claire, Mehdi, Syed B., Milan, Stephen, Dodd, Steven, Matthews, Jessica, Vyas, Aashish, Marsden, Paul A., Slinger, Claire, Mehdi, Syed B., Milan, Stephen, Dodd, Steven, Matthews, Jessica, Vyas, Aashish, and Marsden, Paul A.

Abstract

Background Cough both protects and clears the airway. Cough has three phases: breathing in (inspiration), closure of the glottis, and a forced expiratory effort. Chronic cough has a negative, far‐reaching impact on quality of life. Few effective medical treatments for individuals with unexplained (idiopathic/refractory) chronic cough (UCC) are known. For this group, current guidelines advocate the use of gabapentin. Speech and language therapy (SLT) has been considered as a non‐pharmacological option for managing UCC without the risks and side effects associated with pharmacological agents, and this review considers the evidence from randomised controlled trials (RCTs) evaluating the effectiveness of SLT in this context. Objectives To evaluate the effectiveness of speech and language therapy for treatment of people with unexplained (idiopathic/refractory) chronic cough. Search methods We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, trials registries, and reference lists of included studies. Our most recent search was 8 February 2019. Selection criteria We included RCTs in which participants had a diagnosis of UCC having undergone a full diagnostic workup to exclude an underlying cause, as per published guidelines or local protocols, and where the intervention included speech and language therapy techniques for UCC. Data collection and analysis Two review authors independently screened the titles and abstracts of 94 records. Two clinical trials, represented in 10 study reports, met our predefined inclusion criteria. Two review authors independently assessed risk of bias for each study and extracted outcome data. We analysed dichotomous data as odds ratios (ORs), and continuous data as mean differences (MDs) or geometric mean differences. We used standard methods recommended by Cochrane. Our primary outcomes were health‐related quality of life (HRQoL) and serious adverse events (SAEs). Main results We found two studies involving 162

Published
2019

14. Heliox for inducible laryngeal obstruction (vocal cord dysfunction) : A systematic literature review

Author

Slinger, Claire, Slinger, Richard, Vyas, Aashish, Haines, Jemma, Fowler, Stephen J., Slinger, Claire, Slinger, Richard, Vyas, Aashish, Haines, Jemma, and Fowler, Stephen J.

Abstract

Objectives: To perform a systematic literature review on the use of Heliox with patients with inducible laryngeal obstruction/vocal cord dysfunction to: i) identify current evidence base; and ii) establish the methodological quality of published research. Methods: Articles published up to March 2018 were searched for key words and terms using Cochrane Library, MEDLINE, PubMed, CINAHL, EMBASE and Dynamed. Studies were included if they presented original research into the use of Heliox for vocal cord dysfunction. Results: Only three studies met the inclusion criteria for review. All reported favorable results for the use of Heliox as an adjunctive therapy for vocal cord dysfunction but none had sufficient methodological quality to support their conclusions. Conclusion: Despite review articles recommending the use of Heliox in vocal cord dysfunction, there is a lack of good quality research to support this conclusion. There is a need for further research to investigate the effectiveness of Heliox as an adjunctive therapy for vocal cord dysfunction. Level of Evidence: 4

Published
2019

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