Using a novel in-mask non-invasive ventilator microphone to improve talker intelligibility in healthy and hospitalised adults.

Purpose: Non-invasive ventilation (NIV) provides respiratory support without invasive endotracheal intubation but can hinder patients' ability to communicate effectively. The current study presents preliminary results using a novel in-mask ventilator microphone to enhance talker intelligibility while receiving NIV.Method: A proof-of-concept study assessed sentence intelligibility of five healthy adult talkers using a prototype model of the microphone under continuous positive airway pressure (CPAP; 5/5 cm H2O) and bilevel positive airway pressure (BiPAP; 8/4 cm H2O) ventilator conditions. A pilot study then assessed intelligibility, subjective comprehensibility and naturalness, and patient- and conversation partner-reported communication outcomes for eight patients undergoing therapeutic NIV while being treated in an intensive care unit (ICU).Result: Intelligibility increased significantly with the microphone on in the BiPAP condition for healthy volunteers. For patients undergoing NIV in an ICU, intelligibility, comprehensibility, and patient and conversation partner ratings of conversation satisfaction significantly improved with the microphone on. Patients with lower baselines without the microphone in certain measures (intelligibility, comprehensibility) generally showed a greater microphone benefit than patients with higher baselines.Conclusion: Use of a novel microphone integrated into NIV improved intelligibility during ventilation for both healthy volunteers and patients undergoing therapeutic NIV. Additional clinical studies will define precise benefits and implications of such improved intelligibility.

Psychometric Properties of the Infant and Child Feeding Questionnaire.

OBJECTIVES: To report the updated psychometric properties of a child feeding questionnaire and to report the psychometric properties of a screening tool developed from this questionnaire. A secondary objective was to consider if items from a behavior checklist embedded within the Infant and Child Feeding Questionnaire may be useful in making referrals for feeding problems. STUDY DESIGN: Caregivers of children younger than the age of 4 years with pediatric feeding disorders (as defined by International Classification of Diseases, Ninth Revision, criteria) were recruited from 2 outpatient clinics. A comparison group with no feeding problems was recruited during well child checks from community clinics. Caregivers completed a demographic questionnaire and a child feeding questionnaire. Exploratory and confirmatory analyses identified questionnaire items that differentiated groups. Remaining items were summed and area under the curve, sensitivity, and specificity values were calculated to describe the resulting screening tool. ORs of behaviors from the embedded behavior checklist were calculated to determine whether specific behaviors could be useful for referrals. RESULTS: Responses of 989 caregivers (pediatric feeding disorders, n = 331; no feeding problems, n = 650) were obtained. Six questions of the child feeding questionnaire differentiated groups accounting for 60% of variance. Sensitivity (73%) and specificity (93%) were greater when any 2 or more of these 6 items was endorsed. Three items of the embedded feeding behaviors checklist show promise for referrals to specific provider disciplines. CONCLUSIONS: A pediatric feeding disorders screening tool consisting of 6 questions from a child feeding questionnaire is psychometrically sound. Use of this tool may expedite referrals for treatment. Further study of the embedded behavior checklist may be useful for clinical referrals.

Prevalence, incidence, and characteristics of dysphagia in those with unilateral vocal fold paralysis.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to investigate the impact of dysphagia definition on the incidence and overall prevalence of dysphagia in patients with unilateral vocal fold paralysis (UVP) stratified by etiology. STUDY DESIGN: Retrospective medical chart review. METHODS: Data was collected from the records of individuals diagnosed with UVP from 2013 to 2018, including patient demographics, dysphagia questionnaire total scores, clinical evaluation dysphagia symptoms, and instrumental swallow assessment outcomes. The annual incidence and overall prevalence of dysphagia were calculated by etiology as counts and percentages across five operational definitions of dysphagia. RESULTS: A total of 415 individuals met inclusion criteria for the study. Annual prevalence estimates ranged from 19% to 55%, depending on the definition of dysphagia used. The highest prevalence of dysphagia occurred when defined by symptoms or signs identified by the clinician (55%). The lowest prevalence of dysphagia occurred using a definition of abnormal swallowing function documented during instrumental assessment (19%). Dysphagia questionnaire scores were more frequently abnormal in those with iatrogenic than idiopathic etiology of UVP (adjusted P = 0.014). Rate of instrumental assessment and documentation of aspiration was highest for central UVP etiology (33%). On average, pneumonia was rare (6%) irrespective of UVP etiology. CONCLUSION: Up to 55% of patients diagnosed with UVP complained of dysphagia, but only 21% had dysphagia symptoms severe enough to prompt instrumental assessment. Incidence and severity of dysphagia varied depending on UVP etiologic category as well as dysphagia definition. The etiology of UVP may impact dysphagia risk and severity in this population and warrants further investigation. LEVEL OF EVIDENCE: IV Laryngoscope, 130:2397-2404, 2020.