The Association Between Dysphagia Symptoms, DIGEST Scores, and Severity Ratings in Individuals with Parkinson's Disease.

The Swallow Disturbance Questionnaire (SDQ) is a screening tool developed to identify patients with Parkinson's Disease (PD) in need of objective swallowing evaluation. In a previous investigation, the SDQ did not predict abnormal airway protection on a videofluoroscopic swallowing study (VFSS). This investigation was undertaken to determine whether SDQ scores were more accurate when a global measure was used. The Dynamic Imaging Grade for Swallowing Toxicity (DIGEST) is a validated measure that provides a safety, efficiency, and total severity grade based on VFSS. A secondary analysis was performed using data from 20 patients with PD who had participated in a standardized VFSS protocol. The study sample was predominantly male (80%) with an average age of 71 years, and an average PD duration of 9 years. Using an established cut-off score, participants were subdivided into those with "normal" (n = 10) and "abnormal" SDQ scores (n = 10). Recordings were scored using the DIGEST protocol by two blinded raters who also rated overall dysphagia severity from the VFSS. There was good agreement between the two raters on the DIGEST and strong correlations between DIGEST scores and clinician perceptions of dysphagia severity. Higher SDQ scores were associated with poorer Efficiency on the DIGEST but not Safety or Total scores. Consistent with other PD studies, subjective perceptions of dysphagia were poorly predictive of objective findings on VFSS. There is little information about the validity of the DIGEST for rating neurogenic dysphagia. Our study provides preliminary support for the use of the DIGEST in the PD population.

The Association between Paradoxical Vocal Fold Motion and Dysphonia in Adolescents.

OBJECTIVE: Associations between dysphonia and paradoxical vocal fold motion (PVFM) have been previously reported in adults, but it is unclear whether similar associations exist for adolescents. The goals of this study were to identify the prevalence and severity of voice disorders in adolescent patients with PVFM, identify differences between those with and without clinician-identified dysphonia, and investigate what factors were associated with voice handicap in this population. METHODS: A retrospective review of eligible adolescent patients diagnosed with PVFM over a 1-year period at a single institution was undertaken. Data collected from the medical record included demographic background, medical history and workup, patient- and family-reported symptoms, and findings from the laryngeal examination. The presence or absence of clinician-diagnosed dysphonia was used to subdivide the sample for analysis. RESULTS: Forty-eight patients with PVFM were included. The sample was primarily female (73%) with a median age of 15 years. Few patients had voice complaints (5%), but clinician-diagnosed dysphonia was common (52%) and ranged from mild to moderate. Vocal hyperfunction was frequently observed (55%), but anatomic abnormalities associated with dysphonia were rare (6%). Adolescents with dysphonia were significantly older, more likely to have vocal hyperfunction on laryngoscopy, and more likely to return for therapy than those without dysphonia. No notable differences existed in the number of behavioral therapy sessions or in the likelihood of completing treatment between the two groups. The majority of participants (79%) had at least one "confounding factor" (i.e., were currently taking a medication for asthma, allergies, or reflux, or had a laryngeal abnormality) but this did not differ significantly between those with and without dysphonia. A minority of individuals (28%) had abnormal scores on the Voice Handicap Index (VHI). Age was positively correlated with dysphonia severity but no other significant associations were observed. CONCLUSION: Although voice complaints are rare, dysphonia among adolescents with PVFM is common and can occur in the absence of laryngeal abnormalities and medical comorbidities, typically as a result of vocal hyperfunction. Dysphonia does not appear to be a barrier to PVFM treatment and may be a useful target in therapy.

Functional Outcomes after Behavioral Treatment of Paradoxical Vocal Fold Motion in Adults.

OBJECTIVE: Paradoxical vocal fold motion (PVFM) is responsive to behavioral therapy, often resulting in a remission of symptoms, but little is known about whether treatment is beneficial with regard to PVFM-associated psychological symptoms or functional limitations. The goal of the study was to identify patient perceptions of the impact of treatment for PVFM and characteristics associated with treatment outcomes. METHODS: A survey was conducted of all adults who had received at least 1 session of treatment for PVFM in our outpatient clinic over a 2-year period. RESULTS: The 39 participants ranged in age from 18 to 82 and had received a median of 3 treatment sessions. At a median follow-up of 10 months following treatment, respondents reported improvements in a wide range of areas, including sports and leisure, daily activities, and social participation. The majority reported improvements in feelings of anxiety, helplessness, and control. Poorer outcomes were associated with more severe voice symptoms, fewer treatment sessions, and needing oral steroids for asthma control. CONCLUSION: There was a reduction in a wide range of activity limitations after treatment. Feelings of control were strongly associated with positive outcomes. The therapy appeared to be equally effective for adults with exercise-induced and environmental variants of PVFM.

SpectralAnalysis: Software for the Masses.

The amount of data produced by spectral imaging techniques, such as mass spectrometry imaging, is rapidly increasing as technology and instrumentation advances. This, combined with an increasingly multimodal approach to analytical science, presents a significant challenge in the handling of large data from multiple sources. Here, we present software that can be used through the entire analysis workflow, from raw data through preprocessing (including a wide range of methods for smoothing, baseline correction, normalization, and image generation) to multivariate analysis (for example, memory efficient principal component analysis (PCA), non-negative matrix factorization (NMF), maximum autocorrelation factor (MAF), and probabilistic latent semantic analysis (PLSA)), for data sets acquired from single experiments to large multi-instrument, multimodality, and multicenter studies. SpectralAnalysis was also developed with extensibility in mind to stimulate development, comparisons, and evaluation of data analysis algorithms.

Serial 3D imaging mass spectrometry at its tipping point.

Since biology is by and large a 3-dimensional phenomenon, it is hardly surprising that 3D imaging has had a significant impact on many challenges in the life sciences. Imaging mass spectrometry (MS) is a spatially resolved label-free analytical technique that recently maturated into a powerful tool for in situ localization of hundreds of molecular species. Serial 3D imaging MS reconstructs 3D molecular images from serial sections imaged with mass spectrometry. As such, it provides a novel 3D imaging modality inheriting the advantages of imaging MS. Serial 3D imaging MS has been steadily developing over the past decade, and many of the technical challenges have been met. Essential tools and protocols were developed, in particular to improve the reproducibility of sample preparation, speed up data acquisition, and enable computationally intensive analysis of the big data generated. As a result, experimental data is starting to emerge that takes advantage of the extra spatial dimension that 3D imaging MS offers. Most studies still focus on method development rather than on exploring specific biological problems. The future success of 3D imaging MS requires it to find its own niche alongside existing 3D imaging modalities through finding applications that benefit from 3D imaging and at the same time utilize the unique chemical sensitivity of imaging mass spectrometry. This perspective critically reviews the challenges encountered during the development of serial-sectioning 3D imaging MS and discusses the steps needed to tip it from being an academic curiosity into a tool of choice for answering biological and medical questions.

Use of the G8 Geriatric Screening Tool in Surgical Head and Neck Cancer Patients Requiring Rehabilitation: A Multisite Investigation.

OBJECTIVES: The G8 is a well-validated screening test for older cancer patients. The current study was undertaken to determine whether the G8 is predictive of short-term post-operative outcomes after head and neck cancer (HNC) surgery. METHODS: Consecutive patients aged 65 years or more and referred for a preoperative assessment by a speech-language pathologist were consecutively screened by clinicians at 2 academic medical centers using the G8. The G8 was used to screen for vulnerability prior to surgery. Patients were deemed vulnerable if they had a total G8 score ≤14 according to published guidelines. Data were also collected on demographic characteristics, tumor staging, post-operative course, and tracheostomy and feeding tube (FT) status. RESULTS: Ninety patients were consecutively screened during the study period. Using the G8, 64% of the patients were deemed vulnerable. Vulnerable patients differed significantly from non-vulnerable patients with regard to age, health, tumor stage, and baseline dysphagia, and underwent more extensive surgery. Postoperatively, vulnerable patients had a significantly longer hospital length of stay (LOS; 10.17 vs 5.50 days, respectively, P < .001), were less likely to discharge home (76% vs 94%, P = .044), and were more likely to be FT dependent for over a month (54% vs 21%, P = .006) compared to non-vulnerable patients. In regression models, controlling for T-stage and surgical variables, the G8 independently predicted 2 post-operative outcomes of interest, namely LOS and FT dependency. CONCLUSIONS: The G8 may be a useful screening tool for identifying older adults at risk of a protracted postoperative medical course after HNC surgery. Future research should aim to identify the optimal screening protocol and how this information can be incorporated into clinical pathways to enhance the post-operative outcomes of older HNC patients.

Randomized approximation methods for the efficient compression and analysis of hyperspectral data.

Hyperspectral imaging techniques such as matrix-assisted laser desorption ionization (MALDI) mass spectrometry imaging produce large, information-rich datasets that are frequently too large to be analyzed as a whole. In addition, the "curse of dimensionality" adds fundamental limits to what can be done with such data, regardless of the resources available. We propose and evaluate random matrix-based methods for the analysis of such data, in this case, a MALDI mass spectrometry image from a section of rat brain. By constructing a randomized orthornormal basis for the data, we are able to achieve reductions in dimensionality and data size of over 100 times. Furthermore, this compression is reversible to within noise limits. This allows more-conventional multivariate analysis techniques such as principal component analysis (PCA) and clustering methods to be directly applied to the compressed data such that the results can easily be back-projected and interpreted in the original measurement space. PCA on the compressed data is shown to be nearly identical to the same analysis on the original data but the run time was reduced from over an hour to 8 seconds. We also demonstrate the generality of the method to other data sets, namely, a hyperspectral optical image of leaves, and a Raman spectroscopy image of an artificial ligament. In order to allow for the full evaluation of these methods on a wide range of data, we have made all software and sample data freely available.

Memory efficient principal component analysis for the dimensionality reduction of large mass spectrometry imaging data sets.

A memory efficient algorithm for the computation of principal component analysis (PCA) of large mass spectrometry imaging data sets is presented. Mass spectrometry imaging (MSI) enables two- and three-dimensional overviews of hundreds of unlabeled molecular species in complex samples such as intact tissue. PCA, in combination with data binning or other reduction algorithms, has been widely used in the unsupervised processing of MSI data and as a dimentionality reduction method prior to clustering and spatial segmentation. Standard implementations of PCA require the data to be stored in random access memory. This imposes an upper limit on the amount of data that can be processed, necessitating a compromise between the number of pixels and the number of peaks to include. With increasing interest in multivariate analysis of large 3D multislice data sets and ongoing improvements in instrumentation, the ability to retain all pixels and many more peaks is increasingly important. We present a new method which has no limitation on the number of pixels and allows an increased number of peaks to be retained. The new technique was validated against the MATLAB (The MathWorks Inc., Natick, Massachusetts) implementation of PCA (princomp) and then used to reduce, without discarding peaks or pixels, multiple serial sections acquired from a single mouse brain which was too large to be analyzed with princomp. Then, k-means clustering was performed on the reduced data set. We further demonstrate with simulated data of 83 slices, comprising 20,535 pixels per slice and equaling 44 GB of data, that the new method can be used in combination with existing tools to process an entire organ. MATLAB code implementing the memory efficient PCA algorithm is provided.

Hyperspectral visualization of mass spectrometry imaging data.

The acquisition of localized molecular spectra with mass spectrometry imaging (MSI) has a great, but as yet not fully realized, potential for biomedical diagnostics and research. The methodology generates a series of mass spectra from discrete sample locations, which is often analyzed by visually interpreting specifically selected images of individual masses. We developed an intuitive color-coding scheme based on hyperspectral imaging methods to generate a single overview image of this complex data set. The image color-coding is based on spectral characteristics, such that pixels with similar molecular profiles are displayed with similar colors. This visualization strategy was applied to results of principal component analysis, self-organizing maps and t-distributed stochastic neighbor embedding. Our approach for MSI data analysis, combining automated data processing, modeling and display, is user-friendly and allows both the spatial and molecular information to be visualized intuitively and effectively.

Subjective and objective parameters of the adult female voice after cricotracheal resection and dilation.

OBJECTIVES: We compared the voice outcomes after cricotracheal resection (CTR) and airway dilation in adult women. METHODS: We performed long-term comprehensive voice assessments in 23 adult women treated for laryngotracheal stenosis, including acoustic and perceptual measurements of voice, videostroboscopy, the Voice Handicap Index, and an open-ended subjective questionnaire. RESULTS: Voice measures were abnormal in both groups. Objective pitch and loudness measurements were significantly more impaired after CTR than after dilation. Perceptual ratings of voice were worse after CTR than after dilation, particularly with regard to breathiness, pitch, and loudness. The CTR group was more likely to report a voice disorder, reported significantly more voice symptoms, and had higher voice handicap scores. Videostroboscopy was frequently abnormal in both groups, with more evidence of vocal hyperfunction after CTR. Self-ratings of breathing and swallowing were generally high in both groups, but voice satisfaction was rated lower after CTR. CONCLUSIONS: Voice was more significantly negatively impacted by CTR than by dilation. Surprisingly, many individuals in both groups reported improvements--a finding that possibly highlights the impact of laryngotracheal stenosis on airflow and vocal function before surgery. The importance of patient selection and preoperative counseling is emphasized, along with the potential need for voice therapy.

Longitudinal Voice Outcomes and Neoglottic Function After Supracricoid Partial Laryngectomy: The Development of a New Scale.

OBJECTIVES: Supracricoid partial laryngectomy (SCPL) is an oncologically sound alternative to total laryngectomy that results in long-term alterations in vocal function. Little is known about long-term improvements in dysphonia and the mechanism of vocal recovery is unclear due to the lack of a standardized rating tool: The Pattern, Degree, and Vibration (PDV) Scale. METHODS: Data from 24 individuals were compared over 3 post-operative timepoints after SCPL: 3 to 11, 12 to 35, and over 35 months. Voice outcomes were assessed using the Voice Handicap Index (VHI) and the GRBAS scale. Laryngeal exams were deidentified and rated using a novel rating scheme developed using literature review and consensus panel discussions. RESULTS: There were significant improvements in VHI scores, Grade, and Strain over time. There was an increase in the Degree of Closure and a decline in Mucosal Vibration across timepoints. Pattern of Movement (P) was associated with dysphonia Grade. Better Degree of Closure (D) was associated with lower VHI scores and better Grade and Roughness. Mucosal Vibration (V) was associated with reduced Breathiness and Strain but variable Roughness. Age, T-stage, radiation treatment, surgery type, and time to feeding-tube removal were also associated with voicing characteristics. CONCLUSIONS: There is evidence of improvement in several voice parameters over time after the first post-operative year. Various subcomponents of the new PDV rating scale were associated with voice outcomes. Its utility for research and clinical practice merits further investigation.

Characteristics associated with communicative participation after total laryngectomy.

PURPOSE: The purpose of this study was to identify individual characteristics that are associated with communicative participation after total laryngectomy (TL). METHODS: This study was a single-institution investigation of individuals who had undergone TL. Data were collected at a single timepoint via patient self-report and medical record review. Thirty-five participants completed a questionnaire containing a communication survey as well as several published, validated instruments. Independent variables included characteristics related to demographics, health and medical history, social network composition, and communication. The dependent variable was communicative participation, which was assessed using the Communicative Participation Item Bank (CPIB). Correlations between the independent variables and CPIB scores were calculated to assess the influence of these characteristics on communicative participation. The study participants were subdivided into three distinct groups based on whether their primary method of communication was spoken or non-spoken and the frequency of using alternate methods of communication. Outcomes across the three groups were then compared. A follow-up survey was also conducted to examine the impact of "stay at home" orders during the COVID-19 pandemic of 2020-21. RESULTS: There were significant correlations between communicative participation and some non-communication-related characteristics. Reduced communicative participation was associated with younger age, less time since TL, a history of reconstructive surgery, poorer self-rated health, more depressive symptoms, worse quality of life, and a weaker social network of friends. Several communication-related characteristics were also associated with CPIB scores. Increased communicative participation was associated with using fewer non-spoken communication methods, higher levels of satisfaction with speech and communication, and better communicative effectiveness. There were significant differences between the three groups for communicative effectiveness and satisfaction with speech. The three groups did not differ significantly for satisfaction with communication or communicative participation. There were no significant differences in CPIB scores measured before and during the pandemic. CONCLUSIONS: Communicative participation is a complex measure that may be affected by a variety of factors related to demographics, health, social network status, and communication. Despite poorer communicative effectiveness and lower levels of satisfaction, individuals who use non-spoken methods of communication after TL did not demonstrate worse communicative participation than those using spoken methods. Surprisingly, CPIB scores did not decline as a result of social distancing.

The impact of Lee Silverman Voice Treatment (LSVT LOUD®) on voice, communication, and participation: Findings from a prospective, longitudinal study.

BACKGROUND: Lee Silverman Voice Treatment (LSVT LOUD®), an intensive 4-week program of voice therapy, is regarded as the most well-researched, efficacious treatment for hypokinetic dysarthria in individuals with Parkinson's disease (PD). Although numerous studies have published acoustic and perceptual findings, there is comparatively little information about the impact of LSVT LOUD® on functional communication outcomes. METHODS: This prospective, longitudinal study investigated the impact of treatment on daily communication in 25 individuals with PD. Three validated communication measures (the Voice Handicap Index, the Communicative Effectiveness Scale, and the Communicative Participation Item Bank) were given before and after treatment and again 4-8 weeks and 3-6 months following treatment. Communication partners were also asked to rate communication effectiveness at all four timepoints. RESULTS: Significant improvements were found for all three self-reported scales which remained above baseline across all post-treatment timepoints. In addition, self-reported communicative effectiveness was significantly correlated with the assessments of communication partners. Particular benefits were reported for more complex communicative activities such as asking questions, giving detailed information, communicating in noisy situations, and speaking in groups. CONCLUSIONS: Overall, the findings suggested that LSVT LOUD® promotes an increased sense of personal control over the communication difficulties resulting from PD by decreasing voice handicap and improving communication effectiveness and communicative participation. For individuals with PD, LSVT LOUD® may reduce the risk of social isolation by improving communication and facilitating social participation. LEARNING OUTCOMES: As a result of this activity, the participant will be able to (1) describe the impact of PD on voice and communication, (2) discuss how these characteristics may be associated with more global measures of functional communication and particularly communicative participation, (3) explain which aspects of functional communication were affected by LSVT LOUD® as assessed by study participants and their communication partners.

Dysphagia in Parkinson's disease patients prior to deep brain stimulation: Is screening accurate?

BACKGROUND: Swallowing problems are common in Parkinson's Disease (PD) and aspiration pneumonia is the leading cause of death. Deep brain stimulation (DBS) surgery can successfully manage the motor symptoms of PD when pharmacological management begins to fail. Before DBS it is important to identify baseline dysfunction, but no consensus regarding swallowing screening exists. OBJECTIVES: This study was undertaken to: 1) identify the prevalence of dysphagia prior to DBS; and 2) determine if screening measures or other characteristics were predictive for reduced airway protection. METHODS: A standardized protocol was performed for 137 consecutive patients with idiopathic PD and no confounding medical conditions, including those referred for work-up of dysphagia (n = 57) and those prior to DBS (n = 80). Three validated screening measures were completed before videofluoroscopic evaluation. RESULTS: On videofluoroscopy, there were significant differences in reduced airway protection by group (dysphagia group: 44 %; pre-DBS group: 21 %). Aspiration also differed by group (dysphagia group: 18 %; pre-DBS group: 8 %) although not significantly. Although there were significant between-group differences, none of the screening measures was predictive of reduced airway protection or aspiration in the sample overall. Male gender, previous videofluoroscopic evaluation, history of pneumonia, and previous DBS surgery were associated with increased aspiration-risk. Age also showed a modest correlation. CONCLUSIONS: Dysphagia is not uncommon prior to DBS. No screening measure accurately predicted reduced airway protection on videofluoroscopy. Abnormal findings on clinical assessment prior to DBS, particularly in patients that are older, male, or have a history of pneumonia, may identify individuals requiring an objective dysphagia evaluation.

Current and Future Roles of Artificial Intelligence in Medicinal Chemistry Synthesis.

Artificial intelligence and machine learning have demonstrated their potential role in predictive chemistry and synthetic planning of small molecules; there are at least a few reports of companies employing in silico synthetic planning into their overall approach to accessing target molecules. A data-driven synthesis planning program is one component being developed and evaluated by the Machine Learning for Pharmaceutical Discovery and Synthesis (MLPDS) consortium, comprising MIT and 13 chemical and pharmaceutical company members. Together, we wrote this perspective to share how we think predictive models can be integrated into medicinal chemistry synthesis workflows, how they are currently used within MLPDS member companies, and the outlook for this field.

The Impact of Communication Impairments on the Social Relationships of Older Adults: Pathways to Psychological Well-Being.

Purpose Social contact is known to be vital for older adults' mental and physical health but, because communication impairments often co-occur with other types of disability, it is difficult to generalize about the relative impact of a communication impairment on the social relationships of older adults. Specific aims of the study were to examine whether the severity of a communication impairment was associated with a range of social measures and to examine the association between these characteristics and psychological well-being. Method Community-dwelling older adults ranging in age from 65 to 94 were recruited for the study of Communication, Health, Aging, Relationship Types and Support. The sample included 240 participants with communication disorders arising from a variety of etiologies including hearing impairment, voice disorders, head and neck cancer, and neurologic disease, as well as older adults without a communication disorder. Results Communication impairment was a significant independent predictor for key characteristics of social relationships, including the number of friends in the social network, two types of social support, the frequency of social participation, and social self-efficacy. Communication impairment was also a significant predictor for higher levels of loneliness and depression. In addition, two distinct pathways between communication impairment and psychological well-being were identified, with social self-efficacy and reassurance of worth as mediators. Conclusions Even after controlling for age, gender, health, and disability, communication impairment is a significant independent predictor for key aspects of the social function of older adults and demonstrates two distinct pathways to loneliness and depression. Supplemental Material https://doi.org/10.23641/asha.7250282.

The Safety and Efficacy of Expiratory Muscle Strength Training for Rehabilitation After Supracricoid Partial Laryngectomy: A Pilot Investigation.

OBJECTIVES: Expiratory muscle strength training (EMST) is a safe, effective intervention that can be performed at home and may be beneficial for individuals with voice and swallowing disorders. To date there have been few studies of EMST in the head and neck cancer population, and there are no previous reports of its use after supracricoid partial laryngectomy (SCPL). The current prospective clinical pilot study was undertaken to determine the safety and efficacy of a 4-week treatment program. METHODS: Six participants were recruited who had previously undergone SCPL, were medically stable, and had no contraindications for use of the device. At baseline, objective respiratory measurements were collected, dietary status was recorded, and participants were asked to complete a series of validated self-report instruments relating to voice, swallowing, breathing, and cough. Following the completion of treatment, baseline measures were repeated, and participant feedback was solicited. RESULTS: The majority of individuals found the device easy to use (83%) and beneficial (83%). The side effects of treatment were relatively minor and included dizziness, muscle inflammation, and vocal fatigue. There were improvements in 2 measures from before to after treatment, namely, an average 21% increase in peak cough flow (from 371.67 to 451.33 L/min) and a 38% decrease on the Dyspnea Index (from 6.17 to 3.83). Other measures showed inconsistent changes. CONCLUSIONS: EMST appeared to improve cough strength and reduce dyspnea symptoms after SCPL. Further study of the relative efficacy of EMST compared to other rehabilitation protocols after SCPL is needed.

Long-term Functional and Quality-of-Life Outcomes After Transoral Robotic Surgery in Patients With Oropharyngeal Cancer.

IMPORTANCE: In recent years, transoral robotic surgery (TORS) has emerged as a useful treatment for oropharyngeal squamous cell carcinoma (OPSCC). In appropriately selected patients, the use of TORS may allow avoidance of adjuvant chemotherapy and/or radiotherapy, thereby avoiding the long-term adverse effects of these therapies. OBJECTIVE: To compare functional speech, swallowing, and quality-of-life outcomes longitudinally between those undergoing TORS only and those undergoing TORS and adjuvant radiotherapy (TORS+RT) or TORS and chemoradiotherapy (TORS+CRT). DESIGN, SETTING, AND PARTICIPANTS: This prospective, longitudinal cohort study performed from June 1, 2013, through November 31, 2015, included 74 patients undergoing TORS for initial treatment of OPSCC at a single tertiary academic hospital. MAIN OUTCOMES AND MEASURES: Data were collected at baseline, postoperatively (7-21 days), at short-term follow-up (6-12 months), and at long-term follow-up (>12 months). The quality-of-life metrics included the 10-item Eating Assessment Tool and the University of Michigan Head and Neck Quality of Life instrument. Data were also collected on tumor staging, surgical and adjuvant therapy details, patient comorbidities, tracheostomy and feeding tube use, and functional speech and swallowing status using the Performance Status Scale for Head and Neck Cancer Patients. RESULTS: Seventy-four patients were enrolled in the study (mean [SD] age, 61.39 [7.99] years; 68 [92%] male). Median long-term follow-up was 21 months (range, 12-36 months). The response rates were 86% (n = 64) postoperatively, 88% (n = 65) at short-term follow-up, and 86% (n = 64) at long-term follow-up. In all 3 groups, there was a significant worsening in pain and all swallowing-related measures postoperatively. There was subsequent improvement over time, with different trajectories observed across the 3 intervention groups. Postoperative dysphagia improved significantly more quickly in the TORS-only group. At long-term follow-up, weight loss differed between the TORS-only and TORS+RT groups (mean difference, -16.1; 97.5% CI, -29.8 to -2.4) and the TORS-only and TORS+CRT groups (mean difference, -14.6; 97.5% CI, -29.2 to 0) in a clinically meaningful way. In addition, the TORS-only group had significantly better scores than the TORS+CRT group on the Performance Status Scale-Eating in Public scale (mean difference, 21.8; 97.5% CI, 4.3-39.2) and Head and Neck Quality of Life-Eating scale (mean difference, 21.2; 97.5% CI, 4.0-38.3). CONCLUSIONS AND RELEVANCE: Patients who underwent TORS+CRT demonstrated poorer long-term outcomes, with continued dysphagia more than 1 year after surgery. These findings support the investigation of adjuvant de-escalation therapies to reduce the long-term adverse effects of treatment.

Dysphagia after endoscopic repair of Zenker's diverticulum.

OBJECTIVES/HYPOTHESIS: To determine whether patient outcomes after endoscopic staple-assisted diverticulectomy(ESD) were correlated with demographic or disease-specific patient characteristics. STUDY DESIGN: Retrospective chart review with followup. METHODS: A survey was sent to all eligible subjects who had undergone ESD from February 1995 to June 2004 to gather information about their postoperative weight, diet, dysphagia symptoms, distress, and overall satisfaction. RESULTS: Thirty-five individuals responded(49% response rate) at a mean of 29 (range,3-83) months postoperative. There was a significant reduction in the following symptoms: food avoidance,regurgitation, dysphagia for pills, choking, coughing,difficulty finishing a meal, heartburn/reflux, and halitosis. There was no significant difference for dysphonia.Swallow-related distress had decreased from a preoperative level of 7.86 to 2.23 at follow-up (P <.001). Overall satisfaction with the surgery was high. There were no significant differences in outcome by any demographic characteristic, duration of preoperative symptoms, presence of gastroesophageal reflux disease, Zenker's diverticulum size, time since surgery,or number of surgeries. Ninety-one percent of subjects reported improvement in their swallowing after surgery, but 22% reported some decline since that time. Symptomatic subjects reported significantly higher swallow-related distress and lower satisfaction(P < .01). Preoperative variables were not correlated with a return of symptoms. Individuals who underwent multiple procedures had similar levels of benefit and satisfaction as those who underwent a single ESD procedure. CONCLUSION: ESD results in high levels of patient satisfaction, significant reduction in postoperative symptoms, low levels of complications,and the opportunity to safely and successfully repeat the procedure if necessary.

The Use of Technology for Phone and Face-to-Face Communication After Total Laryngectomy.

PURPOSE: The purpose of this article is to describe the characteristics and experiences of individuals who use technology to support telephone or face-to-face communication after total laryngectomy. METHOD: An online questionnaire was used to identify potential participants. Seventeen individuals met inclusion criteria and participated in an in-depth survey. They were compared with a reference group matched for age, gender, and time postsurgery who did not use these technologies. Open-ended responses were summarized. RESULTS: Compared with the matched reference group, individuals who used technology to support verbal communication had undergone more aggressive cancer treatment and used more communication methods. They were less likely to use an alaryngeal speech method, had greater difficulty over the telephone, and used more repair strategies in face-to-face communication. The 2 groups did not differ significantly in the frequency or success of their communication, however. Open-ended responses revealed great variety with regard to their reasons, purposes, and timing of technology use. CONCLUSIONS: There is a subset of individuals using technology to support verbal communication very successfully after laryngectomy. Usage was not limited to those who were unable to communicate verbally and often continued long after the initial postoperative period in many settings, for various purposes, and in combination with other methods of communication.