Medialization thyroplasty: vocal outcome of silicone and titanium implant.

Unilateral vocal fold paralysis can result in incomplete glottic closure, compromising the vocal efficiency and increasing the risk of aspiration. The glottic gap can be reduced by medialization thyroplasty. Both silicone and titanium implants have been described to be efficient in the improvement of the vocal outcome. The aim of this study was to assess the vocal outcome after medialization thyroplasty using silicone and titanium implants and to compare the results of the two implanted materials using prospective sequential cohort study. 24 patients underwent medialization thyroplasty, performed under local anaesthesia with intravenous sedation: 10 patients were included in the silicone cohort and 14 in the titanium cohort. All patients underwent vocal assessment preoperatively and postoperatively, using the Voice Handicap Index, the GRBASI scale, maximum phonation time and the Dysphonia Severity Index. Postoperative analysis of the entire population showed statistically significant improvement for the Voice Handicap Index, maximum phonation time, Dysphonia Severity Index and the parameters G, B and A of the GRBASI scale (83% follow up). Subgroup analysis showed a statistically significant greater improvement of Voice Handicap Index of the titanium cohort compared with the silicone cohort. Improvement of maximum phonation time, Dysphonia Severity Index and GRBASI scale of the titanium cohort was greater than improvement of the silicone cohort, but this difference was not statistically significant. Both silicone and titanium medialization implants showed improvement of vocal outcome, the results of the titanium implant being superior.

Oral health screening: feasibility and reliability of the oral health assessment tool as used by speech pathologists.

BACKGROUND: The aim of this study was to investigate the feasibility and reliability of the Oral Health Assessment Tool (OHAT) as used by speech pathologists, to become part of a comprehensive clinical swallowing examination. METHODS: A multicentre study in 132 elderly subjects was conducted by speech pathologists. The inter-rater, test-retest and intra-rater reliabilities of the OHAT were assessed in R statistics, version 3.0.1. Intraclass correlation coefficients (ICCs) were used for the total OHAT, and Kappa statistics were used for the individual categories. RESULTS: Total OHAT scores showed good inter-rater (ICC = 0.96), intra-rater (ICC ≥ 0.95) and test-retest (ICC ≥ 0.78) agreement. The inter-rater Kappa statistics were almost perfect (κ ≥ 0.83) for seven of the eight individual categories of the OHAT and perfect for 'dental pain' (κ = 1.00). The test-retest Kappa statistics indicated excellent agreement for 'natural teeth' and 'dentures' (κ ≥ 0.86). The intra-rater per cent agreement was excellent for all categories except 'gums and tissues'. CONCLUSIONS: This is the first study to examine the feasibility and reliability of the OHAT as used by speech pathologists. As the results showed both good feasibility and reliability, the OHAT has the potential to add to the clinical swallowing examination. However, future research investigating actual referral strategies and adaptation of care strategies following assessment with OHAT is needed.