Nasal/Oral Vowel Perception in French-Speaking Children With Cochlear Implants and Children With Typical Hearing.

PURPOSE: The present study investigates the perception of vowel nasality in French-speaking children with cochlear implants (CIs; CI group) and children with typical hearing (TH; TH group) aged 4-12 years. By investigating the vocalic nasality feature in French, the study aims to document more broadly the effects of the acoustic limitations of CI in processing segments characterized by acoustic cues that require optimal spectral resolution. The impact of various factors related to children's characteristics, such as chronological/auditory age, age of implantation, and exposure to cued speech, has been studied on performance, and the acoustic characteristics of the stimuli in perceptual tasks have also been investigated. METHOD: Identification and discrimination tasks involving French nasal and oral vowels were administered to two groups of children: 13 children with CIs (CI group) and 25 children with TH (TH group) divided into three age groups (4-6 years, 7-9 years, and 10-12 years). French nasal vowels were paired with their oral phonological counterpart (phonological pairing) as well as to the closest oral vowel in terms of phonetic proximity (phonetic pairing). Post hoc acoustic analyses of the stimuli were linked to the performance in perception. RESULTS: The results indicate an effect of the auditory status on the performance in the two tasks, with the CI group performing at a lower level than the TH group. However, the scores of the children in the CI group are well above chance level, exceeding 80%. The most common errors in identification were substitutions between nasal vowels and phonetically close oral vowels as well as confusions between the phoneme /u/ and other oral vowels. Phonetic pairs showed lower discrimination performance in the CI group with great variability in the results. Age effects were observed only in TH children for nasal vowel identification, whereas in children with CIs, a positive impact of cued speech practice and early implantation was found. Differential links between performance and acoustic characteristics were found within our groups, suggesting that in children with CIs, selective use of certain acoustic features, presumed to be better transmitted by the implant, leads to better perceptual performance. CONCLUSIONS: The study's results reveal specific challenges in children with CIs when processing segments characterized by fine spectral resolution cues. However, the CI children in our study appear to effectively compensate for these difficulties by utilizing various acoustic cues assumed to be well transmitted by the implant, such as cues related to the temporal resolution of stimuli. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25328704.

Vowel production: a potential speech biomarker for early detection of dysarthria in Parkinson's disease.

Objectives: Our aim is to detect early, subclinical speech biomarkers of dysarthria in Parkinson's disease (PD), i.e., systematic atypicalities in speech that remain subtle, are not easily detectible by the clinician, so that the patient is labeled "non-dysarthric." Based on promising exploratory work, we examine here whether vowel articulation, as assessed by three acoustic metrics, can be used as early indicator of speech difficulties associated with Parkinson's disease. Study design: This is a prospective case-control study. Methods: Sixty-three individuals with PD and 35 without PD (healthy controls-HC) participated in this study. Out of 63 PD patients, 43 had been diagnosed with dysarthria (DPD) and 20 had not (NDPD). Sustained vowels were recorded for each speaker and formant frequencies were measured. The analyses focus on three acoustic metrics: individual vowel triangle areas (tVSA), vowel articulation index (VAI) and the Phi index. Results: tVSA were found to be significantly smaller for DPD speakers than for HC. The VAI showed significant differences between these two groups, indicating greater centralization and lower vowel contrasts in the DPD speakers with dysarhtria. In addition, DPD and NDPD speakers had lower Phi values, indicating a lower organization of their vowel system compared to the HC. Results also showed that the VAI index was the most efficient to distinguish between DPD and NDPD whereas the Phi index was the best acoustic metric to discriminate NDPD and HC. Conclusion: This acoustic study identified potential subclinical vowel-related speech biomarkers of dysarthria in speakers with Parkinson's disease who have not been diagnosed with dysarthria.

Features of Mild-to-Moderate COVID-19 Patients With Dysphonia.

INTRODUCTION: To explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients. METHODS: The clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general, and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and nondysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis. RESULTS: A total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (P = 0.022). The proportion of smokers was significantly higher in the dysphonic group (P = 0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with nondysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea, and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain, and nasal obstruction was higher in dysphonic group compared with nondysphonic group. There were significant associations between the severity of dysphonia, dysphagia, and cough. CONCLUSION: Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than nondysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation.

Impact of Acid, Weakly Acid and Alkaline Laryngopharyngeal Reflux on Voice Quality.

OBJECTIVES: To analyze pre to posttreatment voice changes regarding the type of reflux in patients with acid, weakly acid or alkaline laryngopharyngeal reflux (LPR). METHODS: Patients with LPR, diagnosed using hypopharyngeal-esophageal multichannel intraluminal impedance pH-monitoring (HEMII-pH), were prospectively recruited from three University Hospitals. Patients were treated with a combination of diet, proton pump inhibitors, magaldrate and alginate for 3 months. The following clinical and voice quality outcomes were studied pre to posttreatment according to the type of reflux (acid, weakly acid, nonacid): HEMII-pH, gastrointestinal endoscopy features, reflux symptom score (RSS), reflux sign assessment (RSA), voice handicap index (VHI), perceptual voice assessment (grade of dysphonia and roughness), aerodynamic and acoustic measurements. RESULTS: From December 2018 to March 2021, 160 patients completed the evaluations, accounting for 60 acid, 52 weakly acid, and 48 alkaline cases of LPR. There were no baseline differences in clinical and voice quality outcomes between groups. RSS and RSA significantly improved from pre to posttreatment in the entire cohort and in all patient groups. VHI, dysphonia and roughness, maximum phonation time, Jitter, Shimmer and noise to harmonic ratio significantly improved from pre to posttreatment. Individuals with alkaline reflux reported better voice quality improvements as compared to acid and weakly acid reflux patients. CONCLUSION: Patients with acid and alkaline reflux reported better posttreatment voice quality outcomes as compared to weakly acid reflux patients. Future basic science and clinical studies are needed to better understand the histological changes of the vocal folds due to reflux of varying pH types and gastroduodenal enzyme content.

Phonetic Inflexibility in Autistic Adults.

This study examined whether the atypical speech style that is frequently reported in autistic adults is underpinned by an inflexible production of phonetic targets. In a first task, 20 male autistic adults and 20 neuro-typicals had to read and produce native vowels. To assess the extent to which phonetic inflexibility is due to an overall fine-grained control of phonetic behavior or to a lack of flexibility in the realization of one's phonological repertoire, the second task asked participants to reproduce artificial vowel-like sounds. Results confirmed the presence of a greater articulatory stability in the production of native vowels in autistic adults. When instructed to imitate artificial vowel-like sounds, the autistic group did not better approximate the targets' acoustic properties relative to neuro-typicals but their performance at reproducing artificial vowels was less variable and influenced to a greater extent by the articulatory properties of their own vocalic space. These findings suggest that the greater articulatory stability observed in autistic adults arises from a lack of flexibility in the production of their own native vowels. The two phonetic tasks are devoid of any pragmatic constraint, which indicates that phonetic inflexibility in autism is partly independent of register selection. LAY SUMMARY: Autistic and neuro-typical adults took part in two tasks: one in which they produced vowels from French, their native tongue, and the other where they imitated unfamiliar vowels. Autistic adults displayed significantly less variation in their production of different French vowels. In imitating unfamiliar vowels, they were more influenced by the way they pronounce French vowels. These results suggest that the atypical speech style, frequently attested in autistic individuals, could stem from an unusually stable pronunciation of speech sounds.

Are the Acoustic Measurements Reliable in the Assessment of Voice Quality? A Methodological Prospective Study.

OBJECTIVE: Acoustic parameters are widely used as voice quality therapeutic outcomes in many laryngological diseases. The aim of this study is to explore the impact of changes in the nature and duration of the analyzed time interval and the vowel choice on the significance of the acoustic measurements used as therapeutic outcomes in two different diseases. STUDY DESIGN: A prospective case series. MATERIAL AND METHODS: From September 2013 to January 2018, patients with laryngopharyngeal reflux (LPR) disease were recruited and treated with pantoprazole, diet, and behavioral changes for 3 months. The reflux symptom index and reflux finding score were used for both diagnosis and assessment of treatment effectiveness. Simultaneously, patients with early idiopathic Parkinson's disease (IPD) were enrolled and benefited from a levodopa challenge test. An Iowa Oral Performance Instrument was used for objective outcomes in the assessment of levodopa effectiveness on muscular strength of IPD patients. Acoustic measurements were performed in both groups pre- and postmedication intake at different time intervals, including the "most stable" time intervals of 1 second, 2 seconds, 3 seconds, 4 seconds, and 5 seconds and a 1 second-time interval positioned at mid-production. We also measured acoustic parameters on the entire signal of three vowels and on the signal of each vowel being taken separately. RESULTS: A total of 80 LPR and 19 IPD patients met our inclusion criteria and completed the study protocol. LPR and IPD patients had significant clinical improvements throughout treatment, according to reflux symptom index, reflux finding score, and Iowa Oral Performance Instrument scores. The acoustic analysis revealed that acoustic parameters significantly improved from pre- to post-treatment and varied across methods used for measurement. The duration and position of the analyzed time interval in the production and the vowel on which the acoustic measures were made yielded considerable differences in the results. CONCLUSION: Depending on the time interval over which the acoustic parameters are measured, the clinically demonstrated effect of the medication may or may not be statistically demonstrated irrespective of the disease. According to the results of this study and regarding the lack of standardization of acoustic measurement methods, a line of thought is proposed to bypass the interval selection problem.

Development and Validation of the Short Version of the Reflux Symptom Score: Reflux Symptom Score-12.

OBJECTIVE: To develop and validate a short version of the Reflux Symptom Score-the 12-question Reflux Symptom Score-12 (RSS-12)-for patients with laryngopharyngeal reflux disease (LPR). STUDY DESIGN: Prospective study. SETTING: Multicenter academic hospitals. METHODS: Patients with LPR diagnosed via multichannel intraluminal impedance pH monitoring were enrolled from 3 European hospitals. Healthy individuals completed the study. Individuals completed the Reflux Symptom Score, Reflux Symptom Index (RSI), and Voice Handicap Index (VHI) at baseline and 3 months posttreatment. The Reflux Symptom Score was completed twice within a 7-day period to assess test-retest reliability. Cronbach's α was used for assessing internal consistency. The RSS-12 was developed and validity assessed through a comparison of the RSS-12, RSI, and VHI. Responsiveness to change was evaluated through the pre- to posttreatment evolution of the RSS-12 total score. Receiver operating characteristic analysis was used to determine the RSS-12 threshold that is suggestive of LPR. RESULTS: The RSS-12 was characterized by high test-retest reliability (rs = 0.956) and adequate internal consistency reliability (α = 0.739). The RSS-12 was significantly correlated with the RSI (rs = 0.845), suggesting high external validity. The RSS-12 total and item scores were significantly higher in patients with LPR as compared with healthy individuals (P = .001), supporting high internal validity. RSS-12, VHI, and RSI significantly improved throughout treatment. Regarding the receiver operating characteristic curve, an RSS-12 score >11 is suggestive of LPR, exhibiting a sensitivity of 94.5% and a specificity of 86.2%. CONCLUSION: The RSS-12 is a shorter, reliable, and valid self-administered patient-reported outcome measure questionnaire that can be used in the outpatient setting to suggest and monitor LPR.

Orofacial Strength and Voice Quality as Outcome of Levodopa Challenge Test in Parkinson Disease.

OBJECTIVE: To assess the usefulness of orofacial strength and voice quality as assessment of response to levodopa challenge test (LCT) used in the diagnosis of early idiopathic Parkinson disease (IPD). STUDY DESIGN: Controlled Prospective Study. METHODS: From January 2014 to April 2019, patients with early IPD and healthy individuals were recruited and evaluated for clinical findings (Hoehn and Yahr scale; Unified Parkinson's Disease Rating Scale); Voice Handicap Index (VHI); grade of dysphonia, roughness, breathiness, asthenia, and strain and instability (GRBASI); maximal phonation time; phonation quotient; acoustic parameters; and orofacial muscle strength Oral Performance Instrument (IOPI; IOPI Medical, Woodinville, WA, USA) t) at baseline and 45 minutes after the levodopa intake (LCT). RESULTS: A total of 32 IPD patients and 20 healthy individuals completed the study. Healthy individuals exhibited better VHI, grade of dysphonia, breathiness, asthenia, strain, instability, and acoustic measurements (noise-related, tremor, F0 short- and mid-term and intensity short-term parameters) than healthy subjects. The mean values of muscle strength of lips, cheeks, fundamental frequency (F0), highest F0, and shimmer significantly improved from pre- to post-LCT in IPD patients. Healthy individuals did not exhibit significant changes of orofacial strength and voice quality assessment from pre- to post-LCT. Significant associations were found between clinical, orofacial strength, and some aerodynamic and acoustic measurements. CONCLUSION: Orofacial strength and acoustic voice quality measurements may be used as objective outcomes of the LCT responsiveness in patients with early IPD. LEVEL OF EVIDENCE: 3A. Laryngoscope, 2020.

Voice Quality as Therapeutic Outcome in Laryngopharyngeal Reflux Disease: A Prospective Cohort Study.

PURPOSE: To study the usefulness of voice quality as therapeutic outcome in laryngopharyngeal reflux disease. MATERIAL AND METHODS: A total of 80 patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, diet, and lifestyle recommendations for 3 months. The therapeutic effectiveness was assessed with RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability (GRBASI); aerodynamic and a panel of acoustic measurements before and after treatment. A correlation analysis between symptoms, videolaryngostroboscopic signs, and acoustic measurements was conducted. RESULTS: Compared to baseline, means of RSI, RFS, Voice Handicap Index, perceptual dysphonia, and roughness significantly decreased. Significant improvements of phonatory quotient, percent jitter, percent shimmer, Relative Average Perturbation, Pitch Perturbation Quotient, Phonatory F0 Range, Amplitude Perturbation Quotient, smooth Amplitude Perturbation Quotient, and Peak-to-Peak Amplitude Variation were found at the end of treatment. Studies of correlation did not identify relevant correlation between videolaryngostroboscopic signs, especially vocal folds edema, and objective voice quality evaluations. CONCLUSION: Voice quality assessments can help to better understand voice disorders and can be used as indicators of the treatment effectiveness in patients with laryngopharyngeal reflux-related symptoms.

Phonological and phonetic impairment in aphasic speech: an acoustic study of the voice onset time of six French-speaking aphasic patients.

The aim of the present study is to contribute to the description of the speech production deficits in French-speaking aphasic patients, so as to shed light on their potential phonetic and/or phonological disorders. Acoustic studies of aphasics' speech productions remain relatively infrequent, especially in French, and when entering into the specifics, often lead to inconsistent results. We conducted a multiple-case study on six aphasic patients, four with non-fluent aphasia and two with fluent aphasia. They were administered a variety of language and neuropsychological tasks, then they participated in a customized non-word repetition task. Acoustic analyses of their speech productions were performed, focussing on VOT as the main acoustic correlate of the voicing contrast for oral stops. Other atypicalities in their productions were also classified. Results showed variable and mainly "mixed" phonetic-phonological impairment profiles that differed from the traditional hypotheses made in the literature about the speech deficits to be expected as a function of type of aphasia. Our results support the use of acoustic analyses in order to complete language examination in aphasic patients but also suggest that the frontier between phonological and phonetic impairment is not clear-cut. These outcomes are better accounted for by theories and models postulating close relationships between the phonological and phonetic levels of processing.

Validity and reliability of the reflux symptom score.

OBJECTIVES/HYPOTHESIS: To develop and validate the Reflux Symptom Score (RSS), a self-administered patient-reported outcome questionnaire for patients with laryngopharyngeal reflux (LPR). STUDY DESIGN: Prospective controlled study. METHODS: A total of 113 patients with LPR were enrolled and treated with diet and 3 months of pantoprazole, alginate, and/or magaldrate depending on the LPR characteristics (acid, nonacid, or mixed). Eighty asymptomatic individuals completed the study. Patients and controls completed the RSS twice within a 7-day period to assess test-retest reliability. Internal consistency was measured using Cronbach's α for the RSS items in patients and controls. Validity was assessed by comparing the baseline RSS with the Reflux Symptom Index (RSI) and Voice Handicap Index (VHI). Seventy-seven patients completed the RSS at baseline and after 6 and 12 weeks of treatment to assess responsiveness to change. The RSS cutoff for determining the presence and absence of LPR was examined by receiver operating characteristic analysis. RESULTS: Test-retest reliability (rs = 0.921) and internal consistency reliability (α = 0.969) were high. RSS exhibited high external validity indicated by a significant correlation with the RSI (rs = 0.831). Internal validity was excellent based on the higher RSS in patients compared with controls (P = .001). RSS, RSI, and VHI scores significantly improved from pre- to posttreatment, indicating a high responsiveness to change. RSS >13 can be considered suggestive of LPR-related symptoms. RSS was not influenced by the occurrence of gastroesophageal reflux disease, LPR subtypes, or patient characteristics. CONCLUSIONS: RSS is a self-administered patient-reported outcome questionnaire that demonstrates high reliability and excellent criterion-based validity. RSS can be used in diagnosing and monitoring LPR disease. LEVEL OF EVIDENCE: 3b Laryngoscope, 130:E98-E107, 2020.

Clinical and Acoustical Voice Quality Evolutions Throughout Empirical Treatment for Laryngopharyngeal Reflux Disease According to Gender: A Preliminary Study.

OBJECTIVE: To compare symptoms, signs, and acoustical voice quality changes throughout the 6-month course of empirical treatment between laryngopharyngeal reflux (LPR) males and females. MATERIALS AND METHODS: Forty clinically diagnosed LPR females and 40 males with a reflux finding score (RFS) >7 and a reflux symptom index (RSI) >13 were treated with pantoprazole and diet recommendations during 3 or 6 months according to their evolution. RSI, RFS, and acoustic parameters were assessed at baseline and 3 and 6 months posttreatment. A correlation analysis between videolaryngostroboscopic findings and acoustic measurements was performed. RESULTS: RSI, RFS, and many acoustic measurements (i.e., percent jitter, percent shimmer, phonatory fundamental frequency range, fundamental frequency variation, and peak-to-peak amplitude variation) significantly improved from baseline to 3 months posttreatment in male group. In female group, RSI and RFS total score significantly improved along the 3 first months of treatment. However, some clinical outcomes (i.e., RSI total score, hoarseness, cough, and globus) continued to improve from 3 to 6 months of treatment. We did not identify significant improvement of acoustic measurements in female group. The correlation study did not reveal significant correlation between videolaryngostroboscopic findings and acoustic measurements. CONCLUSION: This preliminary study suggests the occurrence of gender-related differences in the LPR therapeutic response. Further studies need to clarify whether females require a longer course of therapy than males.

Validity and Reliability of the Reflux Sign Assessment.

OBJECTIVE: To develop and validate the Reflux Sign Assessment (RSA), a clinical instrument evaluating the physical findings of laryngopharyngeal reflux (LPR). METHODS: A total of 106 patients completed a 3-month treatment based on the association of diet, pantoprazole, alginate, or magaldrate with the LPR characteristics (acid, nonacid, mixed). Forty-two asymptomatic individuals completed the study (control group). The RSA results and reflux finding score (RFS) were documented for the LPR patients at baseline and after treatment. Intrarater reliability was assessed through a test-retest blinded evaluation of signs (7-day intervals). Interrater reliability was assessed by comparing the RSA evaluations of three blinded otolaryngologists through Kendall's W. Responsiveness to change was evaluated through a comparison of the baseline and 3-month posttreatment findings. The RSA cutoffs for determining the presence and absence of LPR were examined by receiver operating characteristic (ROC) analysis. RESULTS: A total of 102 LPR patients completed the study (68 females). The mean age was 53 years. The mean RSA at baseline was 25.95 ± 9.58; it significantly improved to 18.96 ± 7.58 after 3 months of therapy (P < .001). RSA exhibited good intra- (r = 0.813) and interrater (Kendall's W = 0.663) reliabilities (N = 56). There was no significant association between the RSA, gastrointestinal endoscopy findings, and the types of reflux (acid, nonacid, or mixed) according to impedance-pH monitoring. An RSA >14 may be suggestive of LPR. CONCLUSION: The RSA is a complete clinical instrument evaluating both laryngeal and extralaryngeal findings associated with LPR. The RSA demonstrated high intra- and interrater reliabilities and responsiveness to change.

Development of scores assessing the refluxogenic potential of diet of patients with laryngopharyngeal reflux.

OBJECTIVE: To develop clinical tools assessing the refluxogenic potential of foods and beverages (F&B) consumed by patients with laryngopharyngeal reflux (LPR). METHODS: European experts of the LPR Study group of the Young-Otolaryngologists of the International Federation of Oto-rhino-laryngological societies were invited to identify the components of Western European F&B that would be associated with the development of LPR. Based on the list generated by experts, four authors conducted a systematic review to identify the F&B involved in the development of esophageal sphincter and motility dysfunctions, both mechanisms involved in the development of gastroesophageal reflux disease and LPR. Regarding the F&B components and the characteristics identified as important in the development of reflux, experts developed three rational scores for the assessment of the refluxogenic potential of F&B, a dish, or the overall diet of the patient. RESULTS: Twenty-six European experts participated to the study and identified the following components of F&B as important in the development of LPR: pH; lipid, carbohydrate, protein composition; fiber composition of vegetables; alcohol degree; caffeine/theine composition; and high osmolality of beverage. A total of 72 relevant studies have contributed to identifying the Western European F&B that are highly susceptible to be involved in the development of reflux. The F&B characteristics were considered for developing a Refluxogenic Diet Score (REDS), allowing a categorization of F&B into five categories ranging from 1 (low refluxogenic F&B) to 5 (high refluxogenic F&B). From REDS, experts developed the Refluxogenic Score of a Dish (RESDI) and the Global Refluxogenic Diet Score (GRES), which allow the assessment of the refluxogenic potential of dish and the overall diet of the LPR patient, respectively. CONCLUSION: REDS, RESDI and GRES are proposed as objective scores for assessing the refluxogenic potential of F&B composing a dish or the overall diet of LPR patients. Future studies are needed to study the correlation between these scores and the development of LPR according to impedance-pH study.

Perceptual, Aerodynamic, and Acoustic Characteristics of Voice Changes in Patients with Laryngopharyngeal Reflux Disease.

Laryngopharyngeal reflux (LPR) is an inflammatory condition suspected to be associated with dysphonia. In this study, we investigated multidimensional perceptual, aerodynamic, and acoustic voice changes in patients with clinically diagnosed LPR compared to healthy participants. We prospectively included 80 outpatients with Reflux Finding Score (RFS) >7 and Reflux Symptom Index (RSI) >13 from September 2013 to April 2016 and we compared clinical and voice quality assessments of these patients with 80 healthy participants. Statistically significant differences were found between groups with regard to Voice Handicap Index, perceptual voice quality (grades of dysphonia, roughness, strain, breathiness, asthenia, and instability), phonatory quotient, percentage jitter, percentage shimmer, peak-to-peak amplitude variation, standard deviation of fundamental frequency, and noise to harmonic ratio. Granulation score of RFS was found to affect the highest number of acoustic parameters. We did not identify significant correlation between vocal fold edema and objective voice quality measurements. This study supports that patients with LPR have significant deterioration of both subjective and objective voice quality compared to healthy participants.

Validity and reliability of the French version of Eating Assessment Tool (EAT-10).

OBJECTIVE: To develop a French version of the Eating Assessment Tool (Fr EAT-10) and to assess its internal consistency, reliability and clinical validity. METHODS: Fifty-six patients referred in the Swallowing Clinics of CHU Saint-Pierre Hospital (Brussels) and EpiCURA hospital (Ath, Belgium) for dysphagia were enrolled and completed fiberoptic endoscopic evaluation of swallowing and videofluoroscopy. Seventy-three asymptomatic subjects were included in the study. To assess reliability, Fr-EAT-10 was completed twice within a 7-day period. Validity was assessed by comparing Fr-EAT-10 scores with the scores of dysphagia handicap index (DHI) in all individuals. Normative value of EAT-10 was calculated and the receiver operating characteristic (ROC) curve was used to determine the best Fr-EAT-10 threshold associated with aspiration. RESULTS: Fifty-two patients completed the study. Cronbach's alpha was 0.95 indicating a high internal consistency. Test-retest reliability was high in the entire cohort (rs = 0.921). The correlation between Fr-EAT-10 total scores and DHI was high (rs = 0.827) indicating a high external validity. Patients had a significant higher score of Fr-EAT-10 than the controls (p < 0.001) exhibiting a high internal validity. The analysis of normative data reported that a score of Fr-EAT-10 > 3 should be considered as abnormal. The correlation between Fr-EAT-10 and the occurrence of aspiration is significant (rs = 0.327, p < 0.05). According to the ROC curve; aspirations need to be highly suspected for patients with Fr-EAT-10 ≥ 17. CONCLUSION: The Fr-EAT-10 developed in this study is a reliable and valid self-administered tool in the evaluation of dysphagia in French-speaking patients.

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

OBJECTIVES: To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF). METHODS: PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. RESULTS: Of the 155 relevant publications, 42 studies were included. Thirty-five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell-to-cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma. CONCLUSIONS: Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high-quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329-E341, 2019.

Clinical outcomes of laryngopharyngeal reflux treatment: A systematic review and meta-analysis.

OBJECTIVES: To investigate the therapeutic benefit of proton pump inhibitors (PPIs) over placebo in patients with laryngopharyngeal reflux (LPR) and to analyze the epidemiological factors of heterogeneity in the literature. METHODS: An electronic literature search was conducted to identify articles published between 1990 and 2018 about clinical trials describing the efficiency of medical treatment(s) on LPR. First, a meta-analysis of placebo randomized controlled trials (RCTs) comparing PPIs versus placebo was conducted according to diet. The heterogeneity, response to PPIs, and evolution of clinical scores were analyzed for aggregate results. Second, a systematic review of diagnosis methods, clinical outcome of treatment, and therapeutic regimens was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: The search identified 1,140 relevant publications, of which 72 studies met the inclusion criteria for a total of 5,781 patients. Ten RCTs were included in the meta-analysis. The combined relative risk was 1.31 in favor of PPIs and increased to 1.42 when patients did not receive diet recommendations. Randomized controlled trials were characterized by a significant heterogeneity due to discrepancies in clinical therapeutic outcomes, diagnosis methods (lack of gold standard diagnostic tools), and therapeutic scheme. The epidemiological analysis of all articles supports the existence of these discrepancies in the entire literature. In particular, many symptoms and signs commonly encountered in LPR are not assessed in the treatment effectiveness. The lack of diagnosis precision and variability of inclusion criteria particularly create bias in all reported and included articles. CONCLUSION: This meta-analysis supports a mild superiority of PPIs over placebo and the importance of diet as additional treatment but demonstrates the heterogeneity between studies, limiting the elaboration of clear conclusions. International recommendations are proposed for the development of future trials. Laryngoscope, 129:1174-1187, 2019.