Prevalence of Dysphonia and Dysphagia Among Adults in the United States in 2012 and 2022.

PURPOSE: The purpose of this study was to compare the prevalence of dysphonia and dysphagia among adults in the United States between 2012 and 2022. METHOD: A retrospective and cross-sectional design with national surveys was used. The 2012 and 2022 National Health Interview Surveys were utilized to estimate the number of adults reporting dysphonia and dysphagia in the past 12 months. Multivariate logistic regression models were used to examine associations between the survey year (2022 vs. 2012) and the prevalence rate of dysphonia and dysphagia while accounting for demographics and clinical characteristics. RESULTS: The population-estimated mean age was 46.63 years in 2012, which increased to 48.12 years in 2022. In 2012, adults reporting dysphonia and dysphagia were 17.89 million (7.62%) and 9.44 million (4.02%), respectively. In 2022, these estimates increased to 29.92 million adults (11.71%) and 15.10 million adults (5.91%), respectively. Adults in 2022 had significantly higher odds for reporting dysphonia (odds ratio [OR] = 1.602, 95% confidence intervals [CIs] [1.486, 1.726], p < .0001) and dysphagia (OR = 1.461, 95% CI [1.328, 1.606], p < .0001) in the past 12 months compared to adults in 2012. CONCLUSIONS: The population-estimates indicated that in 2022, dysphonia affected one in 8.5 adults and dysphagia affected one in 17 adults. The increase in prevalence of these disorders should serve as a call-to-action to improve access to care and research for voice and swallowing disorders.

Impact of Reducing Fluoroscopy Pulse Rate on Adult Modified Barium Swallow Studies.

Modified Barium Swallow Studies (MBSS) are a critical part of the evaluation, treatment planning, and outcome assessment for persons with swallowing disorders. Since MBSSs use ionizing radiation with associated cancer risks, many clinicians have reduced radiation exposure by reducing the fluoroscopic pulse rate. However, by reducing pulse rate, we also decrease the temporal resolution of MBSSs which has been shown in pilot studies to significantly reduce diagnostic accuracy. Two hundred MBSSs from patients routinely undergoing MBSS as standard of care conducted at 30 pulses per second (pps) using the Modified Barium Swallow Study Impairment Profile (MBSImP™) standardized administration protocol were selected. A stratified sampling method ensured that a full range of swallowing impairments (etiology, type, and severity) was represented. Recordings were down sampled from 30 pps to 15, 7.5, and 4 pps. MBSSs were rated using the MBSImP components and Penetration-Aspiration Scale (PAS) score for each swallow. Percent agreement was calculated across raters for MBSImP and PAS scores by bolus type and volume. The Least-Squares Method was used for hypothesis testing. Statistically significant and clinically meaningful changes in scores of swallowing physiology and penetration/aspiration occurred when reducing pulse rate below 30pps. These changes were evident across bolus types and volumes. Given the impact on diagnostic accuracy and the low radiation risks to adults undergoing MBSSs, reducing pulse rate to 15pps or below is not aligned with the As Low As Reasonably Achievable (ALARA) principle and should not be used as a viable method to reduce radiation exposure from MBSSs.

Characterizing Swallowing Impairment in a Post-Lung Transplant Population.

BACKGROUND: Lung transplant recipients carry significant pre- and post-lung transplant dysphagia risk factors related to altered respiratory-swallow coordination as well as acute injury and decompensation resulting in the acute post-lung transplant recovery period. However, we are only beginning to understand the potential physiological contributors to altered swallowing in this population. METHOD: A retrospective, cross-sectional, cohort study of post-lung transplant patients was performed. All participants received a modified barium swallow study (MBSS) as part of standard care during their acute hospitalization using the Modified Barium Swallow Impairment Profile (MBSImP) protocol and scoring metric. A combination of MBSImP scores, Penetration-Aspiration Scale (PAS) scores, Functional Oral Intake Scale (FOIS) scores, International Dysphagia Diet Standardization Initiative (IDDSI) scale levels, and the time from lung transplant to MBSS was collected, as well as measures of swallowing impairment and swallowing-related outcomes. Differences in swallowing physiology and swallowing-related outcomes between participants with typical versus atypical PAS were explored. RESULTS: Forty-two participants met our prespecified inclusion criteria. We identified atypical laryngeal penetration and/or aspiration in 52.4% of our post-lung transplant cohort. Silent aspiration occurred in 75% of those patients who aspirated. Comparing typical versus atypical PAS scores, we found statistically significant associations with laryngeal elevation (Component 8), p < .0001; anterior hyoid excursion (Component 9), p = .0046; epiglottic movement (Component 10), p = .0031; laryngeal vestibule closure (Component 11), p < .0001; pharyngeal stripping (Component 12), p = .0058; pharyngeal total scores, p = .0001; FOIS scores, p = .00264; and IDDSI liquid levels, p = .0009. CONCLUSIONS: Swallowing impairment resulting in abnormal bolus invasion is prevalent in post-lung transplant patients. Airway invasion in this cohort was related to pharyngeal swallow impairment and resulted in modified oral intake. Our findings help expand upon prior literature, which only reported the incidence of aspiration and pathological laryngeal penetration. Our results suggest that the potential for aerodigestive system impairment and negative sequela should not be underestimated in the post-lung transplant population.

Stakeholder Perspectives on Radiation Use and Interdisciplinary Collaboration in Adult Modified Barium Swallow Studies.

The Modified Barium Swallow Study (MBSS) is a videofluoroscopic examination of the anatomy and physiology involved in swallowing. Like other fluoroscopic examinations, the MBSS uses ionizing radiation with related radiation risks. Thus, the procedures and protocols related to MBSSs must balance the benefit of the diagnostic information gained with the risk of radiation exposure. This requires complex decision-making for any given clinician but becomes complicated due to the interprofessional nature of conducting MBSSs, namely the direct involvement of both the speech-language pathologist and radiologist with indirect involvement of the medical physicist and the referring physician. This editorial provides the perspectives of the various stakeholder groups related to radiation use in adult MBSSs, identifies barriers to conducting MBSSs in an evidence-based manner, and suggests areas for improvement.

Relating Physiologic Swallowing Impairment, Functional Swallowing Ability, and Swallow-Specific Quality of Life.

Many studies include functional swallowing ability and quality of life information to indicate a response to a specific swallowing intervention or to describe the natural history of dysphagia across diseases and conditions. Study results are difficult to interpret because the association between these factors and actual swallowing impairment is not understood. We set out to test the associations between components of physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life using standardized and validated measurement tools: Modified Barium Swallow Impairment Profile (MBSImP), Functional Oral Intake Scale (FOIS), Eating Assessment Tool (EAT-10), and Dysphagia Handicap Index (DHI). We specifically aimed to understand which factors may contribute to the overall relationships between these measurement tools when analyzed using total scores and item-level scores. This study included a heterogeneous cohort of 273 outpatients who underwent a modified barium swallow study (MBSS). We found significant correlations between MBSImP total scores and FOIS scores and DHI total scores, but not between MBSImP total scores and EAT-10 total scores. Significant correlations were also found between MBSImP item-level component scores and FOIS scores, EAT-10 total scores, and DHI total scores. Detailed item-level analyses revealed the MBSImP components of bolus transport/lingual motion, oral residue, and tongue base retraction were correlated with EAT-10 item-level scores and DHI item-level scores. The clinically modest associations between physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life reveal different factors that uniquely contribute to patients' overall dysphagic profile, emphasizing the clinical impact of a comprehensive swallowing assessment.

Abnormal Esophageal Clearance Identified During Modified Barium Swallow Study in an Acute Poststroke Cohort.

PURPOSE: Dysphagia impacts many poststroke survivors with wide-ranging prevalence in the acute and chronic phases. One relatively unexplored manifestation of poststroke swallowing impairment is that of primary or co-occurring esophageal dysphagia. The incidence of esophageal dysphagia in this population is unknown despite the shared neuroanatomy and physiology with the oropharynx. We aimed to determine the presence of abnormal esophageal clearance in an acute poststroke sample using the Modified Barium Swallow Impairment Profile (MBSImP) Component 17 (esophageal clearance) as our outcome measure. METHOD: We performed a retrospective, cross-sectional, cohort study of 57 poststroke patients with acute, first-ever, ischemic strokes. All participants received a modified barium swallow study (MBSS) using the MBSImP protocol and scoring metrics. Swallowing impairment was determined using a combination of MBSImP scores and Penetration-Aspiration Scale scores. Swallowing outcome measures were collected including Functional Oral Intake Scale and International Dysphagia Diet Standardization Initiative (IDDSI) scores. We performed tests of association and logistic regression analysis to determine if statistically significant associations exist between judgments of esophageal clearance and other swallowing impairments and/or swallowing outcome measures. RESULTS: In our study of poststroke patients who received an MBSS as part of their care, 57.9% had abnormal esophageal clearance. Statistically significant associations were also identified in measures of pharyngeal physiology (MBSImP scores) and swallowing outcome measures (IDDSI scores and alternate means of nutrition). CONCLUSIONS: Abnormal esophageal clearance was identified in greater than half of our poststroke patients. There is a dearth of scientific research regarding esophageal function poststroke. While esophageal visualization during the MBSS is not diagnostic of esophageal impairment, it may serve as an indicator for those poststroke patients who require dedicated esophageal testing to best determine the full nature of their swallowing pathophysiology and make the most effective treatment recommendations.

State of the science in inflammation and stroke recovery: A systematic review.

Stroke is a major cause of mortality worldwide, and survivors often have major life-changing disabilities. Annually in the United States, an estimated 795,000 people experience a new or recurrent stroke. All types of stroke involve an inflammatory reaction that follows the initial phase of incidence. However, investigations into any links between inflammatory markers and recovery processes in the context of post-stroke rehabilitation are lacking. In this systematic review, we searched the literature in PubMed, SCOPUS, and CINAHL databases to gather information on inflammatory biomarkers related to stroke and their association with rehabilitation outcomes, according to PRISMA guidelines. Eleven articles (n=1.773 stroke patients) were selected. Immune markers (interleukin 6 [IL-6], C-reactive protein, IL-1α, tumor necrosis factor α, soluble intercellular adhesion molecule 1) and functional status assessments (Modified Rankin Score, National Institutes of Health Stroke Scale, Functional Independence Measure, etc.) were the primary measures used in the reviewed studies. We found preliminary evidence for the evaluation of inflammatory biomarkers post-stroke, including the role of inflammation in functional recovery and the influence of rehabilitation on inflammation. This is the first systematic review of the topic. The review identifies several gaps in the literature that are critical for understanding the potential use of inflammatory markers to improve post-stroke outcomes.

Voice and Respiratory Characteristics of Men and Women Seeking Treatment for Presbyphonia.

BACKGROUND AND OBJECTIVES: Impaired respiratory function could potentially explain why some older speakers experience voice-related handicap whereas others do not, despite presenting with similar age-related laryngeal characteristics. The objectives of this study were therefore to (1) describe voice and respiratory function across men and women in a sample of treatment-seeking patients with presbyphonia; (2) assess how respiratory function differed from the general elderly population, based on normative data; and 3) discuss how respiratory function may play a role in the development of voice symptoms across men and women. METHODS: Twenty one participants with presbyphonia underwent respiratory assessments (spirometry and respiratory muscle strength testing) in addition to standard of care voice assessments. Respiratory variables included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP). RESULTS: Voice features were consistent with the diagnosis of presbyphonia and values did not different significantly between males and females, although some trends were noted. Regarding respiratory variables, one-third of the participants (n = 7) presented with FVC and FEV1 less than 80% of predicted, and 57% (n = 12) were <90% of predicted. Nine percent of the males (n = 1) and none of the females had a MIP below the lower limit of normal (LLN) expected for their age, sex, and weight. Eighteen percent of the males (n = 2) and 20% of the females (n = 2) fell below the LLN for MEP. CONCLUSION: Our sample of participants with presbyphonia included a non-negligible proportion of patients with decreased percent predicted values of FVC and FEV1, and with respiratory muscle strength (MEP) below the LLN. Standardized values of pulmonary function were not different across sexes, indicative of a similar respiratory health. However, a lower raw pulmonary function and respiratory muscle strength in women may compound laryngeal changes and have an impact on perceived voice-related handicap. Together, findings warrant further studies to explore the impact of decreased respiratory function on voice and, ultimately, on the response to voice therapy in patients with presbyphonia.

The Impact of Respiratory Function on Voice in Patients with Presbyphonia.

BACKGROUND AND OBJECTIVE: Presbyphonia is an age-related voice disorder characterized by vocal fold atrophy and incomplete glottal closure during phonation. The extent to which the effects of presbyphonia may be compounded by age-related declines in the respiratory system and further impact communication and quality of life remains unknown. Therefore, the objective of this study was to determine how variations in respiratory function impacts voice measures in a sample of participants with presbyphonia. METHODS: In this pilot study, 21 participants with presbyphonia underwent respiratory assessments (spirometry and respiratory muscle strength testing) and voice assessments (videostroboscopy, acoustic analysis, auditory-perceptual ratings, aerodynamic assessment, and self-assessments). Factor and cluster analyses were conducted to extract voice and respiratory constructs and to identify groups of participants with similar profiles. Correlations and regression analyses were conducted to better describe the relationships between voice and respiratory function. RESULTS: Respiratory function was found to impact voice via two main pathways: through its physiological effect on voice and through its impact on general health and impairment. A lower respiratory function was associated with a lower vocal fold pliability and regularity of vibration and with an elevated aerodynamic resistance accompanied by laryngeal hyperfunction. Standardized measures of respiratory function were associated with perceived voice-related handicap. Respiratory function did not associate with voice quality, which was mostly influenced by the severity of vocal fold atrophy. CONCLUSION: Poor respiratory health exacerbates the burden of vocal fold atrophy and, therefore, implementation of respiratory screening prior to starting voice therapy may significantly affect the treatment plan and consequently the outcomes of voice therapy in this patient population.

Respiratory Muscle Strength Training to Improve Vocal Function in Patients with Presbyphonia.

BACKGROUND AND OBJECTIVE: The effects of presbyphonia are compounded by the decline in respiratory function that occurs with age. Commonly recommended exercises to optimize the use of respiratory muscles during speech, such as diaphragmatic breathing, are unlikely to be intensive enough to induce respiratory changes and impact vocal function. The objective of this study was to assess the effect of adding a targeted intervention, respiratory muscle strength training, to voice exercises in a sample of patients with presbyphonia. METHODS/DESIGN: In this prospective, randomized-controlled trial, 12 participants received either (1) vocal function exercises (VFE), (2) VFE combined with inspiratory muscle strength training (IMST), or (3) VFE combined with expiratory muscle strength training (EMST). Data collected prior to and following 4 weekly intervention sessions included respiratory measures (pulmonary function and respiratory muscle strength) and voice measures (videostroboscopy, acoustic, auditory-perceptual, aerodynamic, and self-assessment measures). RESULTS: Participants who received IMST improved their voice quality during connected speech (smoothed cepstral peak prominence and ratings of overall voice quality) and their scores on the three self-assessment questionnaires with large to very large within-group effect sizes (|d| = 0.82-1.61). In addition, participants in the IMST group reduced their subglottal pressure with a large effect size (d = -0.92). Participants who received EMST improved their maximum expiratory strength and smoothed cepstral peak prominence with large effect sizes (d = 0.80 and 0.99, respectively) but had limited improvements in other outcomes. Participants who received only VFE decreased their amount of vocal fold bowing, improved their voice quality on a sustained vowel (amplitude perturbation quotient), and improved their Glottal Function Index score with large effect sizes (|d| = 0.74-1.00). CONCLUSION: Preliminary data indicate that adding IMST to voice exercises may lead to the greatest benefits in patients with presbyphonia by promoting improved subglottal pressure control as well as increasing air available for phonation, resulting in improved self-assessment outcomes.

Radiation Effective Doses to Adults Undergoing Modified Barium Swallow Studies.

Modified Barium Swallow Studies (MBSSs) are important tests to aid the diagnosis of swallowing impairment and guide treatment planning. Since MBSSs use ionizing radiation, it is important to understand the radiation exposure associated with the exam. This study reports the average radiation dose in routine clinical MBSSs, to aid the evidence-based decision-making of clinical providers and patients. We examined the MBSSs of 200 consecutive adult patients undergoing clinically indicated exams and used kilovoltage (kV) and Kerma Area Product to calculate the effective dose. While 100% of patients underwent the exam in the lateral projection, 72% were imaged in the upper posterior-anterior (PA) projection and approximately 25% were imaged in the middle and lower PA projection. Average kVs were 63 kV, 77 kV, 78.3 kV, and 94.3 kV, for the lateral, upper, middle, and lower PA projections, respectively. The average effective dose per exam was 0.32 ± 0.23 mSv. These results categorize a typical adult MBSS as a low dose examination. This value serves as a general estimate for adults undergoing MBSSs and can be used to compare other sources of radiation (environmental and medical) to help clinicians and patients assess the risks of conducting an MBSS. The distinction of MBSS as a low dose exam will assuage most clinician's fears, allowing them to utilize this tool to gather clinically significant information about swallow function. However, as an X-ray exam that uses ionizing radiation, the principles of ALARA and radiation safety must still be applied.

Visualizing the Esophagus During Modified Barium Swallow Studies: A Systematic Review.

Purpose Despite the emphasis on using evidence-based practice for patient care, as clinicians, we sometimes find that there is insufficient evidence to support our clinical practices. One example of this is the "contentious" inclusion of routine, standardized visualization of the esophagus during modified barium swallow studies (MBSSs). This review sought to investigate the evidence for inclusion of routine esophageal visualization during the MBSS, a practice that is supported by the long-established interrelationship between all aspects of the oral, pharyngeal, and esophageal swallowing continuum. Method Searches were conducted in PubMed, Scopus, and CINAHL databases. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed to identify articles that met prespecified inclusion and exclusion terms. Results Five articles were included in this review, which identified that esophageal findings were present in 48.67% of those participants whose MBSS included esophageal visualization. Conclusion This review supports a standardized, validated, reliable visualization protocol of the esophagus during the MBSS as a critical component to the accurate diagnosis and formulation of treatment recommendations for patients with swallowing disorders.

Radiation exposure in modified barium swallow studies.

PURPOSE OF REVIEW: The modified barium swallow study (MBSS) is an X-ray examination of swallowing used to detect the presence and type impairment, aspiration risk, and to develop intervention plans. In this review, we will cover the use of ionizing radiation in MBSSs and review recent literature concerning radiation exposure and cancer risks to patients undergoing MBSSs. Lastly, we will discuss the clinical implications of these findings. RECENT FINDINGS: Recent literature confirms that the MBSS is a low-dose examination and that reducing pulse rate negatively impacts diagnostic accuracy. Importantly, cancer risks to adults undergoing MBSSs were also reported to be low. SUMMARY: An adult undergoing MBSS using a standardized, valid protocol, like the Modified Barium Swallow Impairment Profile (MBSImP), has low-radiation exposure and very low associated cancer risks. MBSSs should be used whenever relevant to adult patient care without undue concern regarding radiation exposure. Children also have low radiation exposure from MBSSs; however, cancer risks from that exposure remain unknown. Best practices in radiation safety must always be followed. Reducing pulse rates in the adult or pediatric population to reduce radiation exposure is not a valid strategy because of the resulting reduction in diagnostic accuracy.

Introduction to the Special Issue: Select Papers From the 2018 Charleston Swallowing Conference at Northwestern University.

The Charleston Swallowing Conference at Northwestern University is a clinical multidisciplinary conference designed for dysphagia clinicians who practice across all care settings and treat individuals of all ages. This special issue of the American Journal of Speech-Language Pathology contains selected articles from the July 2018 conference dedicated to innovation and implementation of dysphagia practice. The collection of articles includes clinical best practices, new patient-centered assessment and treatment discoveries, re-examination and application of current practices across the age spectrum, and the role of novel technology and data science initiatives. Clinicians and researchers will gain practical, tangible, and directly translatable information toward advanced skill sets in swallowing assessment and treatment.

Best Practices in Modified Barium Swallow Studies.

Purpose The modified barium swallow study (MBSS) is a widely used videofluoroscopic evaluation of the functional anatomy and physiology of swallowing that permits visualization of bolus flow throughout the upper aerodigestive tract in real time. The information gained from the examination is critical for identifying and distinguishing the type and severity of swallowing impairment, determining the safety of oral intake, testing the effect of evidence-based frontline interventions, and formulating oral intake recommendations and treatment planning. The goal of this review article is to provide the state of the science and best practices related to MBSS. Method State of the science and best practices for MBSS are reviewed from the perspectives of speech-language pathologists (SLPs) and radiologists who clinically practice and conduct research in this area. Current quandaries and emerging clinical and research trends are also considered. Results This document provides an overview of the MBSS and standards for conducting, interpreting, and reporting the exam; the SLPs' and radiologist's perspectives on standardization of the exam; radiation exposure; technical parameters for recording and reviewing the exam; the importance of an interdisciplinary approach with engaged radiologists and SLPs; and special considerations for examinations in children. Conclusions The MBSS is the primary swallowing examination that permits visualization of bolus flow and swallowing movement throughout the upper aerodigestive tract in real time. The clinical validity of the study has been established when conducted using reproducible and validated protocols and metrics applied according to best practices to provide accurate and reliable information necessary to direct treatment planning and limit radiation exposure. Standards and quandaries discussed in this review article, as well as references, provide a basis for understanding the current best practices for MBSS.

The Impact of Respiratory Exercises on Voice Outcomes: A Systematic Review of the Literature.

INTRODUCTION: The role of respiratory exercises in voice therapy remains unclear as many patients do not need extensive breath support to meet their voice demands. However, since these exercises are commonly used in clinical practice and ubiquitous in voice therapy textbooks, there is a need to determine the evidence for using respiratory exercises to improve vocal function. OBJECTIVE: The goal of the present review is to determine the state of the evidence regarding the effectiveness of respiratory interventions to improve respiratory and voice outcomes. METHODS: A review of the literature was conducted using three electronic databases: Pubmed, Scopus, and CINAHL. A search strategy was developed to highlight two main concepts: (1) voice and (2) respiratory exercises. RESULTS: Out of 650 articles identified through the search, 23 articles met the inclusion criteria, spanning nine types of respiratory exercises: (1) expiratory muscle strength training; (2) inspiratory muscle strength training; (3) incentive spirometry; (4) isocapnic hyperpnea; (5) respiratory effort treatment; (6) abdominal directives; (7) "easy breathing"; (8) stimulation training; and (9) vocalization with abdominal breath support. Respiratory improvements were reported in 12 articles. Nine of 12 articles also reported some voice improvements, although these were limited to subsets of participants. CONCLUSIONS: The results of this review suggest that the evidence to support using respiratory exercises to improve vocal function is specific to a patient's respiratory and vocal needs. That is, current evidence does not support using respiratory exercises for all patients with voice disorders. Emerging evidence also indicates the importance of generalizing the outcomes of respiratory exercises to voice tasks. It is critical that the mechanism of action through which respiratory exercises can impact voice outcomes be thoroughly understood, and it is hoped that future research will help provide more information in this regard.

Relationships Between Radiation Exposure Dose, Time, and Projection in Videofluoroscopic Swallowing Studies.

Purpose Clinicians are trained to rely on radiation exposure time as an indicator of patient radiation exposure in Videofluoroscopic Swallowing Studies (VFSSs). However, it has been shown in other medical uses of fluoroscopy that dose area product (DAP), the amount of radiation delivered to the patient, is a better indicator of overall patient radiation exposure than radiation exposure time. This study sought to understand the relationship of DAP in VFSSs with radiation exposure time and projection used (lateral vs. posterior-anterior [PA]). Method DAP, radiation exposure time, and projection were recorded in 200 adults undergoing clinically indicated VFSSs conducted in accordance with the Modified Barium Swallow Impairment Profile guidelines. Data were analyzed using Spearman correlation and related sample Wilcoxon test. Results DAP and radiation exposure time did not correlate significantly in the lateral or upper PA projections. DAP was significantly higher in the PA compared to lateral projection (p < .01); however, time was shorter in PA versus lateral (p < .01). The average mGy-cm2 per second was 7 for lateral projections, 14 for upper PA projections, 17 for middle PA projections, and 34 for lower PA projections. Conclusions Radiation exposure time and DAP do not strongly correlate across VFSSs. Specifically, this means that 1 patient can have a low radiation exposure time with a high DAP relative to another person with a higher radiation exposure time but a lower DAP. The results of this study question the common clinical practice of using time (specifically the 5-min indicator) as a threshold for radiation exposure during a VFSSs.

Radiation Risks to Adult Patients Undergoing Modified Barium Swallow Studies.

Modified Barium Swallow Studies (MBSSs) are a fluoroscopic exam that exposes patients to ionizing radiation. Even though radiation exposure from MBSSs is relatively small, it is necessary to understand the excess cancer risk to the patient, in order to ensure a high benefit-to-risk ratio from the exam. This investigation was aimed at estimating the excess radiation risks during MBSSs. We examined 53 adult MBSSs performed using the full Modified Barium Swallow Impairment Profile (MBSImP) protocol. For each exam, the radiation dose (in terms of dose area product), patient age, and sex was recorded. Using published methodology, we determined the effective dose and organ specific dose then used BEIR VII data to calculate the excess cancer incidence related to radiation exposure from MBSSs in adults. Excess cancer incidence risks due to MBSSs were 11 per million exposed patients for 20-year-old males, 32 per million exposed patients for 20-year-old females, 4.9 per million exposed patients for 60-year-old males, and 7.2 per million exposed patients for 60-year-old females. Radiation exposure to the thyroid, lung, and red bone marrow contributed over 90% of the total cancer incidence risk. For the 20-year-old males, the excess cancer incidence risk is 4.7%/Sv, which is reduced to 1.0%/Sv in the 80-year-olds. For the 20-year-old females, the excess cancer incidence risk is 14%/Sv, which is reduced to 1.3%/Sv for 80-year-olds. Overall, the risk per unit effective dose from MBSSs is lower than the risk estimates for uniform whole-body irradiation. Patient age is the most important determinant of patient cancer risk from MBSSs.

Estimating Thyroid Doses From Modified Barium Swallow Studies.

This study sought to obtain factors to convert entrance air kerma into thyroid doses for patients undergoing modified barium swallow studies. A commercial software package (PCXMC 2.0.1) was used to calculate patient thyroid doses from modified barium swallow studies, which were divided by the entrance air kerma to yield fthyroid ratios. Exposure in the lateral and posterior-anterior projections were considered where the thyroid was directly irradiated. Calculations were obtained for adult patients as well as children ranging from birth to 10 y old. The average value of fthyroid in a normal-sized adult was 0.63 ± 0.11 in the lateral projection and 0.18 ± 0.06 for an upper gastrointestinal posterior-anterior projection. Increasing the beam quality from the lowest (60 kV + 3 mm aluminum) to the highest (110 kV + 3 mm aluminum + 0.2 mm copper) values investigated nearly doubled the value of fthyroid from 0.42 to 0.79 in the lateral projection and quadrupled the value from 0.07 to 0.29 in the upper gastrointestinal posterior-anterior projection. Values of fthyroid decreased with increasing body mass index. Average values of fthyroid in 10 y olds were similar to those of adults but always increased as the age of the exposed child was reduced. The average fthyroid for newborns was 0.84, nearly one-third higher than the corresponding ratio for normal-sized adults.

Parameters and Scales Used to Assess and Report Findings From Stroboscopy: A Systematic Review.

OBJECTIVE: Laryngeal endoscopy with stroboscopy, a critical component of the assessment of voice disorders, is rarely used as a treatment outcome measure in the scientific literature. We hypothesized that this is because of the lack of a widely used standardized, validated, and reliable method to assess and report laryngeal anatomy and physiology, and undertook a systematic literature review to determine the extent of the inconsistencies of the parameters and scales used in voice treatment outcome studies. STUDY DESIGN: Systematic literature review. METHODS: We searched PubMed, Ovid, and Cochrane for studies where laryngeal endoscopy with stroboscopy was used as a treatment outcome measure with search terms representing "stroboscopy" and "treatment" guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. RESULTS: In the 62 included articles, we identified 141 terms representing 49 different parameters, which were further classified into 20 broad categories. The six most common parameters were magnitude of glottal gap, mucosal wave amplitude, location or shape of glottal gap, regularity of vibration, phase symmetry, and presence and size of specific lesions. Parameters were assessed on scales ranging from binary to 100 points. The number of scales used for each parameter varied from 1 to 24, with an average of four different scales per parameter. CONCLUSIONS: There is a lack of agreement in the scientific literature regarding which parameters should be assessed to measure voice treatment outcomes and which terms and scales should be used for each parameter. This greatly diminishes comparison and clinical implementation of the results of treatment outcomes research in voice disorders. We highlight a previously published tool and recommend it for future use in research and clinical settings.