International consensus (ICON) on assessment of oropharyngeal dysphagia.

OBJECTIVE: To present international recommendations regarding the proper evaluation of oropharyngeal dysphagia (OD), both objectively and subjectively (self-evaluation). METHODS: Following a thorough review of the literature, 5 experts in the field from 4 different continents answered separately a questionnaire regarding the work-up of OD. Individual answers were presented and discussed during the world ENT conference that was held in Paris in June 2017. This article will present the recommendations issued from that meeting. RESULTS: For the initial objective assessment of OD, it is recommended to perform either a functional endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallowing study (VFSS). FEES is the more popular investigation given its increased ease of use and accessibility. When evaluating for the presence of aspiration during the objective evaluation of OD, it is recommended to perform either a FEES or a VFSS. In this case, FEES is the favored investigation given its likely increased sensitivity. In order to highlight the presence of oropharyngeal food residue following the deglutition process, it is recommended to perform either a FEES or a VFSS; FEES likely being the more sensitive investigation while VFSS allows a better quantification of the amount of pharyngeal residue. Is it also recommended to objectify the quality of the deglutition process by means of a score during the objective evaluation of OD. Finally, it is recommended to utilize a self-evaluation questionnaire during research studies exploring the deglutition process.

Efficacy of the accent method of voice therapy.

There is an increasing need for studies of efficacy of behavior readjustment therapy procedures in human communicative disorders. Legal, social, scientific and professional considerations point up the need for more careful documentation of the effects of treatment techniques used by phoniatricians and speech-language pathologists. This study is conducted in order to evaluate the efficacy of the accent method of voice therapy (AM). The AM is one of the holistic approaches for behavior readjustment voice therapy. It tackles collectively and simultaneously the various parameters of voice such as pitch, loudness and timbre. The results of intervention utilizing the AM in this clinical trial are assessed in a relatively controlled setup. Patients with voice problems resulting from various etiologic vocal pathologies are distributed randomly into two groups. Group 1 (G1) is given the full aspect of the AM, that is, voice hygiene advice plus the accent exercises to correct the faulty vocal technique (habit). Group 2 (G2) receives only voice hygiene advice. The AM is administered in individual sessions 20 min each, twice a week, while the voice hygiene advice counseling is given once a week. The assessment of the vocal pathology is done following a diagnostic protocol utilizing subjective as well as quasi-objective measures of evaluation. The initial assessment presents the baseline (pretest) data for both groups. The follow-up evaluations are done at mid intervention (mid-test), that is, 10 sessions for G1 and 5 sessions for G2, and at the termination of intervention/therapy (post-test). The difference in improvement between G1 and G2 at the end of the observation was generally significant in favor of G1. There were significant improvements in G1 in certain items specific for the various etiologic categories. The improvement from pretest to mid-test to post-test values followed a linear tendency. The significance of the results is discussed and the conclusions are outlined and criticized.