The use of low-osmolar water-soluble contrast in videofluoroscopic swallowing exams.

The selection of the contrast agent used during fluoroscopic exams is an important clinical decision. The purpose of this article is to document the usage of a nonionic, water-soluble contrast (iohexol) and barium contrast in adult patients undergoing fluoroscopic exams of the pharynx and/or esophagus and provide clinical indications for the use of each. For 1 year, data were collected on the use of iohexol and barium during fluoroscopic exams. The contrast agent used was selected by the speech language pathologist (SLP) or the radiologist based on the exam's indications. A total of 1,978 fluoroscopic exams were completed in the 12-month period of documentation. Of these exams, 60.6 % were completed for medical reasons and 39.4 % for surgical reasons. Fifty-five percent of the exams were performed jointly by a SLP and a radiologist and 45 % were performed by a radiologist alone. Aspiration was present in 22 % of the exams, vestibular penetration occurred in 38 %, extraluminal leakage of contrast was observed in 4.6 %, and both aspiration and leakage were seen in 1 % of the exams. In cases with aspiration, iohexol was used alone in 8 %, iohexol and barium were both used in 45 %, and barium was used alone in 47 %. In cases with extraluminal leakage, iohexol was used alone in 58 %, iohexol and barium were both used in 31 %, and barium was used alone in 11 %. No adverse effects were seen with the use of iohexol. When barium was used in cases of aspiration and extraluminal leakage, the amount of aspirated barium was small and the extraluminal barium in the instances of leakage was small. Iohexol is a useful screening contrast agent and can safely provide information, and its use reduces the risk of aspiration and the chance of leakage of large amounts of barium.

Effect of syllable-initial voicing on vowel duration during simultaneous communication.

UNLABELLED: Vowel durations following the production of voiced and voiceless stop consonants produced during simultaneous communication (SC) were investigated by recording sign language users during SC and speech alone (SA). Under natural speaking conditions, or speaking alone (SA), vowels following voiced stop consonants are longer in duration than vowels following voiceless stops. Although the results indicated longer sentence durations for SC than SA, they showed no differences in the relative duration of vowels following voiced or voiceless stops. Vowel durations following voiced stop consonants were consistently longer than vowel durations following voiceless stops. This finding is consistent with previous research indicating that global temporal alterations in SC do not degrade temporal or spectral cues of spoken English. LEARNING OUTCOMES: As a result of this activity, the participant will be able to (1) describe simultaneous communication; (2) explain the role of simultaneous communication in communication with persons who are hearing-impaired; (3) describe how the voicing characteristic of syllable-initial consonants affects the duration of subsequent vowels; and (4) explain that simultaneous communication does not influence the relative durations of vowels following voiced and voiceless stop consonants.