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Purpose: This study explored the effects of high-concentration taste manipulation trials on swallow function in persons with sensory-based dysphagia. Method: Dysphagia researchers partnered with clinical providers to prospectively identify traumatically injured U.S. military service members (N = 18) with sensory-based dysphagia as evidenced by delayed initiation and/or decreased awareness of residue/penetration/aspiration. Under videofluoroscopy, participants swallowed trials of 3 custom-mixed taste stimuli: unflavored (40% weight/volume [wt/vol] barium sulfate in distilled water), sour (2.7% wt/vol citric acid in 40% wt/vol barium suspension), and sweet-sour (1.11% wt/vol citric acid plus 8% wt/vol sucrose in 40% wt/vol barium suspension). Trials were analyzed and compared via clinical rating tools (the Modified Barium Swallow Impairment Profile [Martin-Harris et al., 2008] and the Penetration-Aspiration Scale [Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996]). Additionally, a computational analysis of swallowing mechanics (CASM) was applied to a subset of 9 swallows representing all 3 tastants from 3 participants. Results: Friedman's tests for the 3 stimuli revealed significantly (p < 0.05) improved functional ratings for Penetration-Aspiration Scale and pharyngoesophageal opening. CASM indicated differences in pharyngeal swallowing mechanics across all tastant comparisons (p = 0.0001). Eigenvectors revealed increased tongue base retraction, hyoid elevation, and pharyngeal shortening for sweet-sour and, to a lesser extent, sour than for unflavored boluses. Conclusion: Advantageous changes in certain parameters of oropharyngeal swallowing physiology were noted with high-intensity tastants per both clinical ratings and subsequent CASM, suggesting potential therapeutic application for taste manipulation.

Purpose: Artificial airway procedures such as intubation and Sare common in the treatment of traumatic injuries, and bolus modifications may be implemented to help manage swallowing disorders. This study assessed artificial airway status, bolus properties (volume and viscosity), and the occurrence of laryngeal penetration and/or aspiration in relation to mechanical features of swallowing. Method: Coordinates of anatomical landmarks were extracted at minimum and maximum hyolaryngeal excursion from 228 videofluoroscopic swallowing studies representing 69 traumatically injured U.S. military service members with dysphagia. Morphometric canonical variate and regression analyses examined associations between swallowing mechanics and bolus properties based on artificial airway and penetration-aspiration status. Results: Significant differences in swallowing mechanics were detected between extubated versus tracheotomized (D = 1.32, p < 0.0001), extubated versus decannulated (D = 1.74, p < 0.0001), and decannulated versus tracheotomized (D = 1.24, p < 0.0001) groups per post hoc discriminant function analysis. Tracheotomy-in-situ and decannulated subgroups exhibited increased head/neck extension and posterior relocation of the larynx. Swallowing mechanics associated with (a) penetration-aspiration status and (b) bolus properties were moderately related for extubated and decannulated subgroups, but not the tracheotomized subgroup, per morphometric regression analysis. Conclusion: Specific differences in swallowing mechanics associated with artificial airway status and certain bolus properties may guide therapeutic intervention in trauma-based dysphagia.

Purpose: In this study, the authors aimed to determine reliability of the airflow perturbation device (APD) to measure respiratory resistance within and across sessions during resting tidal (RTB) and postexercise breathing in healthy athletes, and during RTB across trials within a session in athletes with paradoxical vocal fold motion (PVFM) disorder. Method: Prospective, repeated-measures design. The APD measured respiratory resistance during 3 baseline assessments in 24 teenage female athletes, 12 with and 12 without PVFM. Control athletes provided data at rest and following a customized exercise challenge during each of 3 sessions. Intraclass correlation coefficient (ICC) analysis assessed strength of relationships, and repeated-measures analysis of variance assessed differences across trials and sessions. Results: ICC analyses confirmed strong correlations across RTB trials for inspiratory, expiratory, and mean respiratory resistance in both groups. Inspiratory resistance decreased ~5% between sessions for control participants; expiratory and mean respiratory resistances were stable. Data from control athletes across sessions and following rigorous exercise were strongly correlated when taken at comparable intervals. Conclusions: APD-measured respiratory resistance, including separate assessments for the inspiratory and expiratory phases, has strong test--retest reliability during RTB and after exercising. This suggests that the APD is a useful measurement tool for the assessment of airway function in patients suspected of having PVFM.

This study evaluates the utility of perioperative spectral and cepstral acoustic analyses to monitor voice change after thyroidectomy. Perceptual and acoustic analyses were conducted on speech samples (sustained vowel /[alpha]/ and CAPE-V sentences) provided by 70 participants (36 women and 34 men) at four study time points: prior to thyroid surgery and 2 weeks, 3 months and 6 months after thyroidectomy. Repeated measures analyses of variance focused on the relative amplitude of the dominant harmonic in the voice signal (cepstral peak prominence, CPP), the ratio of low-to-high spectral energy, and their respective standard deviations (SD). Data were also examined for relationships between acoustic measures and perceptual ratings of overall severity of voice quality. Results showed that perceived overall severity and the acoustic measures of the CPP and its SD (CPPsd) computed from sentence productions were significantly reduced at 2-week post-thyroidectomy for 20 patients (29% of the sample) who had self-reported post-operative voice change. For this same group of patients, the CPP and CPPsd computed from sentence productions improved significantly from 2-weeks post-thyroidectomy to 6-months post-surgery. CPP and CPPsd also correlated well with perceived overall severity (r = -0.68 and -0.79, respectively). Measures of CPP from sustained vowel productions were not as effective as those from sentence productions in reflecting voice deterioration in the post-thyroidectomy patients at the 2-week post-surgery time period, were weaker correlates with perceived overall severity, and were not as effective in discriminating negative voice outcome (NegVO) from normal voice outcome (NormVO) patients as compared to the results from the sentence-level stimuli. Results indicate that spectral/cepstral analysis methods can be used with continuous speech samples to provide important objective data to document the effects of dysphonia in a post-thyroidectomy patient sample. When used in conjunction with patient's self-report and other general measures of vocal dysfunction, the acoustic measures employed in this study contribute to a complete profile of the patient's vocal condition. (Contains 1 note, 2 tables and 7 figures.)

Purpose: To determine whether experienced and inexperienced listeners rate postthyroidectomy voice samples similarly using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Method: Prospective observational study of voice quality ratings of randomized and blinded voice samples was performed. Twenty-one postthyroidectomy patients' voices, representing a wide range of severities, were rated using a custom-automated version of the CAPE-V. Ten male and 11 female voices were rated by 10 experienced and 10 inexperienced listeners. Experienced listeners consisted of 5 otolaryngologists (ENTs) and 5 speech-language pathologists (SLPs); inexperienced listeners were medical professionals with no formal training or experience in voice disorders. Results: Inexperienced listeners rated voices as more severely impaired than experienced listeners for all CAPE-V parameters (p less than or equal to 0.003). Those without experience in voice disorders had lower intra- and interrater reliability (e.g., r = 0.838 and 0.528, respectively, for overall severity) than those with experience in voice disorders (e.g., r = 0.911 and 0.722, respectively, for overall severity) for all parameters. Among experienced listeners, ENTs and SLPs rated voices similarly for most parameters. Conclusions: Experienced and inexperienced listeners judged voice quality differently given minimal training with the use of the CAPE-V. SLPs and ENTs rated postthyroidectomy voice quality similarly. These findings indicate that the CAPE-V can be used reliably and similarly by professionals who specialize in voice disorders. (Contains 4 tables and 1 figure.)

Recent literature suggests that phonological neighborhood density and word frequency can affect speech production, in addition to the well-documented effects that they have on speech perception. This article describes 2 experiments that examined how phonological neighborhood density influences the durations and formant frequencies of adults' productions of vowels in real words. In Experiment 1, 10 normal speakers produced words that covaried in phonological neighborhood density and word frequency. Infrequent words with many phonological neighbors were produced with shorter durations and more expanded vowel spaces than frequent words with few phonological neighbors. Results of this experiment confirmed that this effect was not related to the duration of the vowels constituting the high- and low-density words. In Experiment 2, 15 adults produced words that varied in both word frequency and neighborhood density. Neighborhood density affected vowel articulation in both high- and low-frequency words. Moreover, frequent words were produced with more contracted vowel spaces than infrequent words. There was no interaction between these factors, and the vowel duration did not vary as a function of neighborhood density. Taken together, the results suggest that neighborhood density affects vowel production independent of word frequency and vowel duration.KEY WORDS: phonological neighborhood density, word frequency, vowels, acoustic measurements, adults

Assessment of tongue strength and endurance is common in research and clinical contexts. It is unclear whether the results reveal discrete function by the tongue or combined abilities of the tongue and jaw. One way to isolate the movement of the tongue is to constrain the jaw kinematically by using a bite block. In this study, 10 neurologically normal young adults performed tongue strength and endurance tasks without a bite block ("jaw-free") and with bite blocks of various heights (2, 5, 10, and 15 mm for strength; 5 mm for endurance). Data signals included tongue pressure exerted on an air-filled bulb, surface electromyography (SEMG) from the superior tongue blade, and SEMG from 1 masseter. On average, tongue strength (pressure in kPa) was greatest with no bite block and generally decreased as bite blocks increased in height. Pairwise analyses revealed statistically significant differences for all but 3 comparisons (jaw-free to 2 mm, 2 to 5 mm, and 5 to 10 mm). After removing outlying data from 1 participant, tongue endurance at 50% of tongue strength was significantly greater without a bite block than with one. SEMG data did not differ significantly for the strength task across bite block conditions, but inspection of the individual data revealed a tendency for masseter activity to be lower when the jaw was unconstrained. These results suggest that maximar tongue strength and endurance are best assessed with an unconstrained mandible or with a very small bite block.

Diadochokinetic tasks provide valuable clinical information regarding neuromuscular control and coordination. Laryngeal diadochokinesis (LDDK) has the potential to provide insight into the neuromotor functioning of the larynx, but interpretation is limited because of sparse normative data. This study provides normative data for LDDK tasks across the adult lifespan in men and women. Neurologically and vocally normal women (n = 216) and men (n = 188), ages 20–89 years, produced rapid repetitions of /ʔʌ/ and /hʌ/ to assess adductory and abductory laryngeal articulatory coordination, respectively. Outcome variables included average rate and regularity (% jitter) from a 5-second sample using a commercially available data acquisition and analysis system and verified by hand. Analyses of variance examined the data for task, sex, and age by decade. LDDK rate decreased significantly with age (F[6,390] = 10.67, P < 0.001) but variability did not differ systematically across age (F[6,390] = 0.595, P = 0.734). Neither LDDK rate nor variability differed significantly between the sexes (F[1,390] = 0.938, P = 0.334; F[1,390] = 0.050, P = 0.824, respectively). The tasks differed in that LDDK for /ʔʌ/ was significantly faster than for /hʌ/ (F[1,390] = 7.237, P = 0.007), but they did not differ significantly for variability (F[1,390] = 0.695, P = 0.405). No significant interactions were revealed. Normative data for LDDK tasks can be combined across the sexes. Separate norms should be used across age groups, especially for adults in their 20s and 80s, and across the two LDDK tasks. [ABSTRACT FROM AUTHOR]

Purpose: Instrumental assessments of tongue strength have provided clinicians with the ability to obtain quantitative measures to document lingual weakness. A technical challenge with a common instrument is that the surface of the of the bulb-shaped sensor is smooth and can be slippery when contacted by the tongue. This study evaluated whether adding a textured layer to the bulb leads to enhanced strength measures in neurologically normal adults. Methods: Maximum-effort maneuvers for anterior and posterior tongue elevation, right and left tongue lateralization, and tongue protrusion were available from 62 healthy adults using the Iowa Oral Performance Instrument (IOPI). The IOPI tongue bulb was either bare or covered with a single layer of gauze. The maximum pressure (Pmax) exerted on the bulb from three trials was used as the outcome variable for each task. Results: In addition to significant main effects for both bulb-cover and task, there was a significant interaction between the use of gauze and the direction of the tongue-strength maneuver. Pmax was significantly greater when a gauze-covered bulb was used for tongue lateralization and protrusion but not for tongue elevation maneuvers. Conclusion: Using a singlelayer of gauze on the smooth tongue-bulb helped reduce slippage of the tongue and resulted in greater Pmax values when evaluating tongue strength in the lateral and protrusive directions, but not for tongue elevation. Efforts to develop a more permanent solution to texturizing the bulb's surface are needed. [ABSTRACT FROM AUTHOR]

The phonetic characteristics of words are influenced by lexical characteristics, including word frequency and phonological neighborhood density (Baese-Berke & Goldrick, 2009; Wright, 2004). In our previous research, we replicated this effect with neurologically healthy young adults (Munson & Solomon, 2004). In research with the same set of participants, we showed that speech sounded less natural when produced with bite blocks than with an unconstrained jaw (Solomon, Makashay, & Munson, 2016). The current study combined these concepts to examine whether a bite-block perturbation exaggerated or reduced the effects of lexical factors on normal speech. Ten young adults produced more challenging lexical stimuli (i.e. infrequent words with many phonological neighbors) with shorter vowels and more disperse F1/F2 spaces than less challenging words (i.e. frequent words with few phonological neighbors). This difference was exaggerated when speaking with a 10-mm bite block, though the interaction between jaw positioning and lexical competition did not achieve statistical significance. Results indicate that talkers alter vowel characteristics in response both to biomechanical and linguistic demands, and that the effect of lexical characteristics is robust to the articulatory reorganization required for successful bite-block compensation. [ABSTRACT FROM AUTHOR]

Bite blocks are used to stabilize the jaw and to isolate tongue and lip movements from that of the mandible during speech and nonspeech activities. Ten normally speaking young adults produced sentences with an unconstrained jaw and with unilateral placement of 2-mm and 5-mm bite blocks. Six listeners rated sentences spoken without either bite block as the most natural sounding. Spectral characteristics of /s/, /f/ and /t/ (sibilant frication and stop bursts) differed significantly with than without bite blocks, such that mean spectral energy decreased, and variation and skew of spectral energy increased. Spectral kurtosis did not change for the group, but 2 participants exhibited highly kurtotic /s/ spectra without a bite block that normalized with bite blocks. The second formant frequency for the high vowel /i/ was lower with bite blocks; there was no systematic difference in F2 slope for diphthongs. Segmental and suprasegmental timing of speech articulation was not affected significantly by these small bite blocks. This study provides support for using small bite blocks to isolate the tongue from the jaw without large effects on speech, but cautions that speech is likely to sound less natural than when produced with an unconstrained jaw. [ABSTRACT FROM AUTHOR]

Exercise-induced laryngeal obstruction (EILO) occurs with paradoxical vocal fold motion or supraglottic collapse during moderate to vigorous exercise. Previously, Gallena et al (2015) reported lower-than-normal inspiratory (R i) and expiratory (R e) resistances during resting tidal breathing (RTB) in female teenage athletes with EILO. This study aimed to replicate that unexpected result. The Airflow Perturbation Device measured R i and R e during three 1-minute trials of RTB in 16 teenage female athletes with EILO and 16 sex-, age-, and height-matched controls. Multiple linear regression examined group, age, height, and weight as predictors of R i and R e. R i and R e tended to be lower in the EILO group than the control group [R i : F(1,30) = 3.58, P = 0.068, d = 0.686; R e : F(1,30) = 3.28, P = 0.080, d = 0.640], but there was no statistically significant difference in the overall effect [F(2,29) = 1.75, P = 0.192]. After one outlier for R e from the EILO group and her matched control were removed, the overall difference was statistically significant, F(2,27) = 3.38, P = 0.049, with R e primarily contributing to the difference [R i : F(1,28) = 3.66, P = 0.066, d = 0.719; R e : F(1,28) = 5.69, P = 0.024, d = 0.899]. These results did not replicate the robust differences found previously between R i and R e during RTB in teenage girls with and without EILO, but the results trended in the same direction and met criterion for statistical significance once an outlier was removed from analysis. Overall, the observation that resting respiratory resistances were lower in most teenage girls with EILO suggests that reduced tone of the laryngeal and/or lower airways may predispose young athletes to EILO. [ABSTRACT FROM AUTHOR]

Summary: Objectives/Hypotheses: The Voice Handicap Index (VHI) is a simple, reliable, self-administered questionnaire that has been used to identify negative voice outcomes after thyroidectomy. This study provides an updated report of a multiyear study examining the predictive ability of the VHI to classify normal versus negative voice outcomes (VOs). Study Design: Prospective observational, longitudinal study of the patient reported impact of voice changes after thyroidectomy using the VHI. Since the preliminary report, the sample size doubled and methods for classifying voice outcomes (VOs) were refined. Methods: Ninety-one adults provided voice assessment data preoperatively (baseline) and at approximately 2 weeks postthyroidectomy. VO was defined according to endoscopic laryngeal examination, acoustic, auditory perceptual, and patient report parameters. The VHI was tested for its sensitivity and specificity for identifying VO. Results: Twenty-two participants (24.2%) qualified as having adverse VOs during the early postoperative period. A change from baseline in VHI of 13–16 points had a diagnostic accuracy of 86% sensitivity and 88% specificity for classifying early VO and had 70% and 95% positive and negative predictive values, respectively. The Functional and Physical subscales of the VHI had higher predictive value than the Emotional subscale. Adjunctive analyses of a two-subscale version of the VHI and of the 10 items that comprises the VHI-10 also revealed high predictive value for differentiating groups by VO. Conclusions: Balanced sensitivity and specificity are achieved at a change in the total VHI score of 13–16. These results are generally consistent with several other studies examining voice problems over time. The VHI, as well as its alternate versions, appear to be useful and should be incorporated into the diagnostic process for identifying patients with voice problems after thyroidectomy. [Copyright &y& Elsevier]

Summary: Objective: To determine the correlation between respiratory resistance (R r) values measured with the Airflow Perturbation Device (APD) to laryngoscopic images of glottal area (GA) in feigned paradoxical vocal fold motion (PVFM), also known as vocal cord dysfunction. Hypothesis: There is a strong inverse relationship between R r and GA such that laryngeal constriction can be detected and quantified by APD-measured R r. Study Design: Prospective, single subject study. Methods: A healthy adult feigned breathing that was characteristic of PVFM. R r and GA were simultaneously recorded, synchronized, and analyzed for three complete breathing cycles with significant glottal constriction occurring during inspiration. Results: Cross-correlation analysis revealed a strong negative correlation (−0.824) between GA and R r during feigned PVFM breathing such that R r increased when GA decreased. Conclusion: APD-measured R r appears to be a viable noninvasive method for diagnostic screening and monitoring of treatment outcomes for individuals presenting with dyspnea related to PVFM. [Copyright &y& Elsevier]