An Investigation of Reliability of the Sunderland Tracheosophageal Voice Perceptual Scale.

BACKGROUND: The Sunderland Tracheosophageal Voice Perceptual scale (SToPS) is the only perceptual rating scale designed specifically for tracheosophageal voice [Hurren et al.: Clin Otolaryngol. 2009 Dec; 34(6): 533-8]. OBJECTIVE: To investigate the inter rater reliability of the SToPS when analyzing alaryngeal voice. METHODS: Prospective evaluation of inter rater reliability of the SToPS based on audio recordings of 230 voice samples from 41 laryngectomy patients rated by 3 experts. Interval data were analyzed using intraclass correlation coefficients (ICC) while categorical data were analyzed using Kappa. RESULTS: ICC of above 0.6 was observed between raters for each prosthesis on a majority of parameters demonstrating a good level of reliability. Reliability was fair (ICC of between 0.40 and 0.59) on Q11 (Articulatory precision) and Q12 (Paralinguistics). Reliability was also fair (0.21-0.40) or slight (0.00-0.20) for Q2 (Tonicity), which was analyzed using Kappa. Kappa above 0.61 signified a good level of reliability. CONCLUSIONS: This study demonstrates good rater reliability for the majority of parameters on the SToPS scale, supporting the use of this tool within the clinical realm. However, further research is required to ascertain if any methods of increasing inter rater reliability on those parameters which did not reach good reliability can be identified.

Double Blind Study Investigating the Effect of Different Voice Prostheses on Ease of Swallowing and Residue Post Laryngectomy.

Voice prostheses have been examined for their effect on voice production but there is little datum on their effect on swallow function. This study investigated the difference between six commonly available voice prostheses in terms of swallowing. Laryngectomy patients had up to six voice prostheses placed in a random order over two visits. Swallowing was evaluated for each prosthesis using FEES (Fibreoptic Endoscopic Evaluation of Swallowing). After each prosthesis trial, patients self-evaluated their experience of swallowing. Three independent experts indicated which prosthesis they considered best for swallowing for each patient and judged residue on the voice prosthesis and in the upper esophagus. Raters were blinded to participant details, voice prosthesis type and scores of other raters. On patient self-evaluation, scores were equally distributed across all prostheses for swallowing. Experts most frequently chose the Blom Singer Low pressure and Blom Singer Classic Indwelling voice prostheses as best for swallowing but consensus was poor for most patients. Experts found that the Blom Singer Classic Indwelling and the Provox Vega had least residue on the voice prosthesis on thin liquid (p ≤ 0.001) and soft (p = 0.001), respectively. Experts also found that the Blom Singer Low Pressure had least residue in the upper esophagus on soft consistency (p ≤ 0.001). While self-evaluation by patients did not identify a consistently preferred prosthesis for swallow, many patients expressed personal preferences, suggesting benefits to involving patients in the choice of prosthesis. Some voice prostheses may be associated with lower levels of residue on the prosthesis and upper esophagus with certain consistencies.

An Investigation of the Post-laryngectomy Swallow Using Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing (FEES).

This study investigates the post-laryngectomy swallow. Presence and degree of residue on the post-laryngectomy swallow as observed on videofluoroscopy and FEES is described. In addition, videofluoroscopy and FEES are assessed for reliability and inter-instrument agreement. 30 laryngectomy subjects underwent dysphagia evaluation using simultaneous videofluoroscopy and FEES. These were reviewed post-examination by three expert raters using a rating scale designed for this purpose. Raters were blinded to subject details, type of laryngectomy surgery, pairing of FEES and videofluoroscopy examinations and the scores of other raters. There was a finding of residue in 78% of videofluoroscopy ratings, and 83% of FEES ratings. Comparison of the tools indicated poor inter-rater reliability and poor inter-instrument agreement. Dysphagia is an issue post laryngectomy as measured by patient self-report and by instrumental evaluation. However, alternative dysphagia rating tools and dysphagia evaluation tools are required to enable accurate identification and intervention for underlying swallow physiology post laryngectomy.

Evaluating the effect of different voice prostheses on alaryngeal voice quality.

OBJECTIVE: To investigate the difference between voice prostheses in terms of voice quality as experienced by patients and as judged by expert raters. METHODS: Subjects had up to six voice prostheses placed in a random order. A voice sample was elicited for each patient on each prosthesis. Auditory perceptual voice analysis of each voice sample was undertaken by expert raters using the Sunderland Tracheoesophageal Voice Perceptual Scale (SToPS). Raters also identified the best overall prosthesis for voice for each patient. Raters were blinded to patient details, type of laryngectomy surgery, type of voice prosthesis, and scores of other raters. After each prosthesis trial, patients self-evaluated voice using a questionnaire developed for this purpose. RESULTS: Expert raters were not able to identify a best overall voice prosthesis using SToPS. Expert raters most frequently chose the Blom-Singer Classic Indwelling (InHealth Technologies, Carpinteria, CA) as the overall best prosthesis for voice for each patient. Patient self-evaluation scores indicated a preference for the Blom-Singer Classic Indwelling Prosthesis (InHealth Technologies) for voice, whereas preference for best overall prosthesis was for the Provox NID (Atos Medical AB, Hörby, Sweden) CONCLUSION: Expert raters did not identify a best prosthesis for voice using SToPS, although the Blom-Singer Classic Indwelling (InHealth Technologies) was most frequently chosen as best for voice. Patient self-evaluation indicated a difference between preference of prosthesis for voice and preference for best overall voice prosthesis. Individual patients had their own personal preferences, suggesting they should be involved in the choice of their voice prosthesis. LEVEL OF EVIDENCE: 4. Laryngoscope, 2460-2466, 2018.