Analysis of Google Searches in Laryngology: Where Do People Look and Are the Answers They Find Credible?

OBJECTIVES: Patients recently diagnosed with a new medical condition frequently search the internet to learn about their diagnosis. We aimed to identify specific questions people ask regarding common laryngological diagnoses by evaluating "People Also Ask" (PAA) questions generated by Google, search volume of these diagnoses, and to determine if the sources accessed were credible. STUDY DESIGN: Descriptive study. METHODS: The terms "subglottic stenosis" (SS), "Zenker's diverticulum" (ZD), "vocal fold paralysis" (VFP), and related terms were entered into Google. PAA questions and associated websites were then extracted using Ahrefs software. Questions were categorized into specific topics. Websites were categorized by type and then assessed using the Journal of the American Medical Association (JAMA) benchmark criteria. A search engine optimization tool was used to determine search volume for individual topics. RESULTS: One hundred and forty-four PAA questions (SS n = 52, ZD n = 49, and VFP n = 43) and their associated websites were extracted. Inquiries were most related to disease etiology (34%), management (27.1%), and signs/symptoms (16.7%). Sources most commonly linked to PAA questions were academic (37.6%), government (25.6%), and commercial (16.2%) websites, while medical practice (7.69%), single surgeon (3.42%), and social media (9.40%) websites were less frequently referenced. JAMA scores were highest for government websites (mean 3.35, standard deviation = 0.54) and lowest for academic websites (mean 0.77, standard deviation = 0.14). CONCLUSIONS: The most asked questions regarding SS, ZD, and VFP are related to etiology and management. Academic medical institution websites are most frequently viewed to answer these questions. Therefore, academic laryngological professionals should ensure the information on their websites is current and accurate.

Efficacy of Speech-Language Pathology Interventions for Globus Pharyngeus: A Scoping Review.

OBJECTIVE: This scoping review aims to provide an overview of the literature investigating the efficacy of speech-language pathology (SLP) interventions in the treatment of globus pharyngeus (GP), identify gaps in knowledge, and guide future research. STUDY DESIGN: Scoping review. METHODS: Search terms were selected for five databases (PubMed, Embase, Web of Science, CINAHL, and Google Scholar). Inclusion criteria were broad and focused on any SLP intervention used to treat GP. Title and abstract and then full-text screening were performed. RESULTS: Of 420 unique abstracts identified, five studies met inclusion criteria. SLP interventions included explanation, education on normal swallow, laryngopharyngeal tension reduction exercises, "voice" exercises, neck/shoulder exercises, general relaxation, postural advice, diaphragmatic breathing, manual therapy, swallowing exercises, laryngeal hygiene, throat clearing suppression, stress management, and reassurance. All included studies reported statistically significant improvement in GP following SLP intervention based on the various outcome measures reported. CONCLUSIONS: This scoping review yields very little high-quality evidence supporting the efficacy of SLP interventions in the treatment of GP. Further prospective studies with systematic investigations and the use of validated outcome measures are needed to study the efficacy of SLP interventions as either adjuvant or stand-alone treatment for GP.

Evaluating Geographic Access to Interdisciplinary Laryngology and Speech-Language Pathology Clinic Models in the Southeast Region of the United States.

OBJECTIVE: An interdisciplinary model of care for the evaluation and treatment of voice, swallowing, and upper airway disorders with laryngologists and specialized speech-language pathologists is known to increase revenue, attendance to visits, patient adherence, and most importantly, improve patient outcomes. Individuals who live outside of areas with high population density often have reduced geographic access to this specialized care. The primary aim of this study is to identify the percentage of the population that has an "extended drive time" to access an interdisciplinary clinic in the Southeast region of the United States. STUDY DESIGN: NA. METHODS: Interdisciplinary laryngology and speech-language pathology clinics were identified via publicly accessible information including an internet search and state department of public health databases. Included clinics had at least one full-time fellowship-trained laryngologist and at least one full-time speech-language pathologist on staff. Descriptive statistics and visual representation of the results were achieved with the use of Smappen, a location intelligence online platform, to identify the percent of the population with a drive time greater than 1 hour. RESULTS: 47.24% of the Southeast population of the United States must drive over 1 hour to access an interdisciplinary clinic. Visual representations of these data are included and generated by Smappen. CONCLUSIONS: While close geographic proximity does not ensure access to care, it can increase the likelihood that healthcare services will be used. This study identified the population in the Southeast region of the United States with extended drive time to interdisciplinary voice and swallowing centers due to their geographic distance from these centers. The results from this study support the need for increased geographic access to specialty care clinics, specifically voice, swallowing, and upper airway care, and provide insight into potential sites for interdisciplinary centers based on population density in areas that are underserved.

Effect of Ventral Intermediate Nucleus Deep Brain Stimulation on Vocal Tremor in Essential Tremor.

Background: There is a paucity of literature examining the effect of Ventral Intermediate Nucleus (VIM) deep brain stimulation (DBS) on voice in patients with vocal tremor (VT). Objective: Investigate the effect of unilateral and bilateral VIM DBS on voice in patients with Essential Tremor (ET) and VT. Methods: All patients receiving VIM DBS surgery underwent voice evaluation pre- and six-months post-operatively. We collected patient-reported quality-of-life outcome measures and acoustic voice measures of sustained phonation and connected speech. Acoustic measures specific to VT included amplitude tremor intensity index (ATRI), frequency tremor intensity index (FTRI), rate and extent of F0 modulation, and rate and extent of intensity modulation. Results: Five patients, age 72.8 ± 2.6 years, 4 female, 1 male with mean disease duration of 29 ± 26.2 years met the inclusion criteria and were included. Two subjects had bilateral procedure and three had unilateral. We observed significant improvements in measures of vocal tremor including ATRI, FTRI, rate of F0 modulation, rate of intensity modulation, and extent of intensity modulation, as well as patient reported voice-related quality of life measured by VHI-10. Bilateral VIM DBS cases showed greater improvement in VT than unilateral cases. Conclusion: Both unilateral and bilateral VIM DBS resulted in significant improvement of VT, with more improvement demonstrated in patients having bilateral as compared to unilateral VIM DBS. In addition, patients also reported significant improvements in voice-related quality of life. If larger studies confirm our results, VIM DBS has the potential to become a treatment specifically for disabling VT.

Chronic Cough: Evaluation of Patients' Motivation to Undergo Cough Suppression Therapy.

INTRODUCTION: Chronic cough is a persistent cough lasting greater than eight weeks. The prevalence rate is estimated to be 9% to 33% in the United States. There are several treatment modalities described in current literature including medical, surgical, and behavioral interventions. Behavioral intervention with a speech-language pathologist (SLP) includes education on laryngeal hygiene and the voluntary control of cough as well as respiratory retraining to suppress or reduce the duration of cough. Cough suppression therapy, like other behavioral therapies, requires patient motivation and commitment to participation and completion in therapy. METHODS: This study was a prospective cross-sectional survey at a single academic institution. Adult patients evaluated by a laryngologist for chronic cough regardless of their primary etiology were included. Patients who were tracheostomy dependent, on oxygen therapy, had vocal fold paralysis/immobility, or had undergone previous laryngeal surgery were excluded. Patients were surveyed at the end of the initial clinic visit or at the beginning of the first cough suppression therapy session. Subjects reported their motivational factors for undergoing cough suppression therapy. RESULTS: The majority of patients, 21 (58.33%), identified as female, 15 patients (41.20%) identified as male, and no patients identified as transgender, nonbinary, and/or other gender. The patients in this study had a mean age of 57.75 (12.12) years. 35 patients (97.22%) were interested in cough suppression therapy. The mean presenting cough severity index (CSI) was 19.39 (10.28) with the mean cough duration of 8.69 (12.10) years. CONCLUSIONS: Patients primarily sought cough suppression therapy due to intrinsic factors rather than extrinsic influence. By understanding the relationship between symptomatology and patient motivation, clinicians can better counsel their patients and improve methods to assess candidacy for behavioral treatment.

Comprehensive Evaluation of Voice-Specific Outcomes in Patients With Essential Tremor Before and After Deep Brain Stimulation.

OBJECTIVE: Deep brain stimulation (DBS) is a treatment for medically refractory essential tremor (ET), but there is a paucity of literature examining the effects of DBS on voice in patients with ET pre-DBS and post-DBS. This study aimed to report a comprehensive evaluation of voice in patients with ET pre-DBS and 6-months post-DBS. STUDY DESIGN: Case series. METHODS: Five patients receiving DBS for ET underwent voice evaluations pre-DBS and 6-months post-DBS. One patient had concurrent ET of the vocal tract (ETVT). The evaluation included patient-reported, perceptual, acoustic, and phonatory aerodynamic analyses of voice. Voice Handicap Index-10, Grade, Roughness, Breathiness, Asthenia, Strain Scale, perturbation measures, cepstral spectral index of dysphonia, cepstral peak prominence, and mean phonatory airflow measures were also among the data collected. RESULTS: Patients with ET presented with minimal changes in perceptual, acoustic, and phonatory aerodynamic parameters. Perceived vocal roughness significantly increased 6-months post-DBS (P = 0.047). The patient with ETVT presented with clinically significant improvement in almost all collected voice parameters 6-months post-DBS. CONCLUSION: This is the first study to provide data encompassing auditory perceptual voice analysis, voice-specific patient-reported quality of life measures, acoustic, and phonatory aerodynamic outcomes in patients pre-DBS and 6-months post-DBS for ET. The results of our preliminary study have implications for the use of a comprehensive voice assessment to identify and measure change in voice outcomes in patients with ET and ETVT pre- and postsurgery.

Auditory-perceptual voice and speech evaluation in ATP1A3 positive patients.

INTRODUCTION: Bulbar symptoms are frequent in patients with rapid-onset dystonia-parkinsonism (RDP). RDP is caused by ATP1A3 mutations, with onset typically within 30 days of stressor exposure. Most patients have impairments in speech (dysarthria) and voice (dysphonia). These have not been quantified. We aimed to formally characterize these in RDP subjects as compared to mutation negative family controls. METHODS: We analyzed recordings in 32 RDP subjects (male = 21, female = 11) and 29 mutation negative controls (male = 15, female = 14). Three raters, blinded to mutation status, rated speech and vocal quality. Dysarthria was classified by subtype. Dysphonia was rated via the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. We used general neurological exams and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) to assess dysarthria, dystonia, and speech/swallowing dysfunction. RESULTS: The presence of dysarthria was more frequent in RDP subjects compared to controls (72% vs. 17%, p < 0.0001). GRBAS voice ratings were worse in the RDP cohort across nearly all categories. Dysarthria in RDP was associated with concordant cranial nerve 9-11 dysfunction (54%, p = 0.048), speech/swallowing dysfunction (96%, p = 0.0003); and oral dystonia (88%, p = 0.001). CONCLUSIONS: Quantitative voice and speech analyses are important in assessing RDP. Subjects frequently experience dysarthria and dysphonia. Dystonia is not the exclusive voice abnormality present in this population. In our analysis, RDP subjects more frequently experienced bulbar symptoms than controls. GRBAS scores are useful in quantifying voice impairment, potentially allowing for better assessments of progression or treatment effects. Future directions include using task-specific diagnostic and perceptual voice evaluation tools to further assess laryngeal dystonia.

Auditory-Perceptual Evaluation of Deep Brain Stimulation on Voice and Speech in Patients With Dystonia.

OBJECTIVE: To determine the effects of globus pallidus interna (GPi) deep brain stimulation (DBS) on speech and voice quality of patients with primary, medically refractory dystonia. METHODS: Voices of 14 patients aged ≥18 years (males = 7 and females = 7) with primary dystonia (DYT1 gene mutation dystonia = 4, cervical dystonia = 6, and generalized dystonia = 4) with bilateral GPi DBS were assessed. Five blinded raters (two fellowship-trained laryngologists and three speech/language pathologists) evaluated audio recordings of each patient pre- and post-DBS. Perceptual voice quality was rated using the Grade, Roughness, Breathiness, Asthenia, and Strain scale and changes in speech intelligibility were assessed with the Clinical Global Impression scale of Severity instrument. Inter-rater and intrarater reliability rates for perceptual voice ratings were assessed using the kappa coefficient. RESULTS: Voice quality parameters showed mean improvements in Grade (P < 0.0001), Roughness (P = 0.0043), and Strain (P < 0.0001) 12 months post-DBS. Asthenia increased from baseline to 6 months (P = 0.0022) and declined significantly from 6 to 12 months (P = 0.0170). Breathiness did not change significantly over time. Speech intelligibility also improved from 6 to 12 months (P = 0.0202) and from pre-DBS to 12 months post-DBS (P = 0.0022). Grade and Strain ratings had nearly perfect and substantial inter-rater agreement (0.84 and 0.71, respectively). CONCLUSIONS: Voice and speech intelligibility improved after bilateral GPi DBS for dystonia. GPi DBS may emerge as a potential treatment option for patients with medically refractory laryngeal dystonia.