Persistent Shortness of Breath in Post-COVID-19 Patients: Inducible Laryngeal Obstruction Can Be a Cause.

BACKGROUND: Inducible laryngeal obstruction (ILO) is the adduction of the true vocal folds during inspiration or, less frequently, expiration. Its etiology is unknown. PURPOSE: This study aimed to identify ILO as a possible cause of shortness of breath (SOB) in post-COVID-19 patients. METHODS: A retrospective study was conducted on 59 post-COVID-19 adults complaining of SOB. We collected the cases' clinical and chest imaging data, including demographic data, pulmonary function test (PFT), CT chest, and laryngeal endoscopic examination. A visual score was used to assign the severity of the glottic obstruction. The grades of this score ranged from 0 (complete patency) to 3 (almost complete closure). RESULTS: ILO was detected in 8 out of 59 cases (13.5%). Two cases out of eight had glottic closure grade 1, while five cases had glottic closure grade 2, and one had glottic closure grade 3. There was a positive correlation between ILO grades (the severity of glottic closure) and PFT results (the degree of upper airway restriction). PFTs in ILO have a specific pattern. It was typical for the expiratory loop to be normal and the inspiratory loop to be flattened. CONCLUSION: ILO is a possible cause of SOB in post-COVID-19 adult cases. It should be considered during evaluation and management.

Developing the Mansoura Early Feeding Skills Assessment Scale for Preterm Infants.

Purpose: This study aimed to develop a new bedside scoring system scale that assesses preterm infants' oral feeding skills (OFS) in the neonatal intensive care unit (NICU). Methods: A literature review and critical appraisal of available oral feeding assessment tools/scores were performed. Subsequently, we developed the "Mansoura Early Feeding Skills Assessment" (MEFSA) scale, an 85-item observational measure of oral feeding skills with three main sections. Forty-one preterm infants who did not receive oral feeding but were clinically stable enough to initiate oral feeding were included in the study. Next, we applied and interpreted the MEFSA to describe and score their feeding skills. Results: Applying the MEFSA resulted in a smooth feeding transition, early start of oral feeding, full oral feeding, and discharge with a shorter period of tube feeding in preterm infants. Conclusion: The MEFSA is a successful bedside scoring system that assesses the OFS of preterm infants in the NICU.

Screening for oropharyngeal dysphagia in hospitalized COVID-19 patients: a prospective study.

PURPOSE: To screen for oropharyngeal dysphagia (OD) in hospitalized COVID-19 patients. METHODS: A descriptive longitudinal study was conducted on 500 adult patients with confirmed COVID-19 in the age range of 19-65 years who were admitted to the main university isolation hospital (whether admitted in the ward or the intensive care unit). Screening for OD was done using the Arabic version of the Eating Assessment Tool (EAT-10) and the Yale swallow protocol. RESULTS: 45.4% of the admitted and 40.97% of the discharged COVID-19 patients had a positive screen for OD. Several risk factors for OD could be detected. These include older age, longer duration of presenting symptoms of COVID-19, presence of ageusia and anosmia, presence of dysphonia, ICU admission, lower oxygen saturation, higher respiratory rate, presence of OD at admission, longer duration of hospital stay, and use of noninvasive ventilation (NIV) and/or invasive mechanical ventilation (IMV). CONCLUSIONS: Screening for OD in hospitalized COVID-19 patients is a mandatory procedure, whether for admitted or discharged patients.

Pharyngeal Residue Severity and Aspiration Risk in Stroke Patient Using Fiber-Optic Endoscopic Evaluation of Swallowing.

INTRODUCTION: Pharyngeal residue, defined as the material remaining in the pharynx post-swallow, is a sign of swallowing biomechanical impairment and a clinical predictor of aspiration. This study investigates the correlation between pharyngeal residue severity using the Mansoura FEES Residue Rating Scale (MFRRS) and penetration/aspiration scores using the penetration-aspiration scale (PAS) on FEES. METHODS: Two hundred ten (210) swallows were obtained during standard FEES assessments of thirty patients with poststroke dysphagia. Residue, in both vallecula and the pyriform sinuses' locations, and penetration/aspiration were scored using MFRRS and PAS, respectively. The Spearman's rank-order correlation was used to assess the correlation between residue and PAS scores. The significance of the obtained results was judged at the (p < 0.05) level. RESULTS: Significant strong positive correlations were demonstrated between PAS scores and each vallecular residue score (rs = 0.663, p = 0.000) and pyriform residue score (rs = 0.688, p = 0.001). CONCLUSION: There is a significant strong positive correlation between residue severity and penetration/aspiration in each anatomical site evaluated (valleculae and pyriform sinuses). Our results do not designate one site as riskier than the other because either can contribute to aspiration, but rather demonstrate penetration/aspiration to better correlate with the overall severity of the residue, perhaps as a better marker for pharyngeal inefficiency. This study offers insight into the association of residue severity with swallowing safety and efficiency.

Clinical and videofluoroscopic evaluation of feeding and swallowing in infants with oropharyngeal dysphagia.

BACKGROUND: Dysphagia impacts infants' health and well-being and may result in aspiration pneumonia. OBJECTIVE: This study aimed to evaluate feeding and swallowing functions in infants with dysphagia to determine the possible causes of dysphagia and their relationship with the medical diagnoses. Clinical and videofluoroscopic findings were compared to determine the diagnostic accuracy of clinical evaluation and identify clinical predictors of laryngeal penetration and aspiration. METHODS: This study was conducted on 60 infants in the age range 2-19 months (median seven months) with suspected aspiration and/or feeding problems. All cases were subjected to both clinical and videofluoroscopic evaluation of swallowing. RESULTS: The two most frequently observed videofluoroscopic findings were aspiration and suck-swallow-breathing incoordination. Infants with structural laryngeal abnormalities were significantly more likely to experience aspiration. A significant association was found between the presence of aspiration and the presence of both recurrent chest infection and gurgly voice combined, which increased the risk of aspiration by 3.57 times. However, the presence of gagging alone and gagging combined with a recurrent chest infection significantly reduced the risk of aspiration. The clinical assessment accuracy presented 56.70%, with 55.60% sensitivity, 58.30% specificity, and a positive predictive value higher than the negative. CONCLUSION: The study highlights the importance of complementing clinical evaluation, in infants with dysphagia, with an objective evaluation of swallowing such as videofluoroscopy due to the high proportion of false positives noticed in clinical evaluation and the high prevalence of silent aspiration in infants.

Can sleep profiles predict autistic traits in siblings of children with autism spectrum disorder?

INTRODUCTION: As the prevalence of ASD (autism spectrum disorder) continues to rise, so does the need to evaluate the impact of associated difficulties on both the diagnosed child and the immediate family. OBJECTIVES: The aim of the present study was to assess reports of sleep disturbance or abnormal sleep behaviours (sleep profiles) in the siblings of diagnosed autistic children (referred to throughout this study as high-risk siblings, or HR-sibs) and to determine if these sleep patterns correlated with evidence of disturbed sleep among their siblings who had full symptoms of autistic spectrum disorder. MATERIAL AND METHODS: This case control cross-sectional study investigated 64 autistic children, 80 HR-sibs, and 80 typically developing children. Each study subject was assessed for sleep problems and autistic traits through the use of a sleep-wake diary, a school sleep habit survey, and a childhood autism spectrum test. RESULTS: Children with autism spectrum disorders and their HR-sibs showed no significant differences regarding their sleep profiles. Typically, developing children had more middle insomnia than HR-sibs and had more wake latency. CONCLUSION: Increased risks for sleep problems in children with autism and their HR-sibs emphasized the importance of early screening for sleep problems in children with autism and their siblings.

Mansoura Fiberoptic Endoscopic Evaluation of Swallowing Residue Rating Scale (MFRRS): An Anatomically Based Tool - A Preliminary Study.

OBJECTIVE: The aim of this work was to design an anatomically based scale for judging post-swallow residue in the pharyngeal cavities, for use during the fiberoptic endoscopic evaluation of swallowing (FEES) in patients with dysphagia, and to assess its feasibility. METHODS: Two 7-point ordinal scales (one for vallecular residue and one for pyriform sinus residue), were developed using detailed anatomic landmarks to denote residue levels. Hard copy color images of a specified frame, from 210 videos of 30 adult FEES evaluations demonstrating the range of all possible residue patterns, were selected (n = 56 valleculae, 62 pyriform sinuses). Half of these images were used to train 4 raters. The remaining half of the images were randomly ordered and rated by the trained raters. Two weeks later the same images were randomized again, and each rater re-analyzed them. The inter- and intra-rater reliability and criterion validity were determined using the kappa statistics and their standard errors. The internal consistency of the items in MFRRS was examined. RESULTS: MFRRS showed strong inter-rater reliability (valleculae, κ = 0.832 ± 0.038; pyriform sinus, κ = 0.855 ± 0.034), almost perfect intra-rater reliability (valleculae, κ = 0.964 ± 0.018; pyriform sinus, κ = 0.962 ± 0.02), almost perfect concurrent validity (valleculae, κ = 0.968 ± 0.020; pyriform sinus, κ = 0.0971 ± 0.017), and excellent internal consistency (valleculae, Cronbach's α = 0.990; pyriform sinus, Cronbach's α = 0.985). CONCLUSION: MFRRS is a feasible and reliable, anatomically based tool that can provide more accurate pharyngeal residue judgments. The optimized description of residue accumulation patterns can contribute to a better overall description of the functional problem and future description of dysphagia phenotypes.

Developing a functional assessment tool for the auditory performance of Arabic-speaking Egyptian hearing impaired children.

BACKGROUND: Auditory performance outcome of children with hearing impairment has been widely studied, and the related factors of the performance have been explored among different age groups for English speaking hearing impaired children. OBJECTIVES: The objective of this study was to construct Arabic questionnaires for the evaluation of the auditory abilities of hearing impaired Egyptian Arabic-speaking children. METHODS: Three Arabic questionnaires targeting the auditory abilities were constructed by selecting items from different English-based questionnaires and translating them into Arabic and adapted to Egyptian culture. The questionnaires were administered to 210 Arabic-speaking Egyptian children in the age range 1-12 years who were divided into three age groups. They included 90 hearing impaired children fitted with hearing aids and 30 hearing impaired children with a cochlear implant and 90 children with normal hearing (as a control group). Participants' responses were statistically analyzed to assess the validity and reliability of the questionnaires and to compare hearing impaired children with normal hearing children. RESULTS: There were non-significant differences between cochlear implanted children and children with hearing aids regarding auditory abilities performances. Language age and aided pure tone audiometry were considered the best predictors of auditory abilities of hearing impaired Egyptian children. CONCLUSION: The constructed Arabic questionnaires proved to be reliable and valid functional assessment tools that provide information about auditory behaviors of hearing impaired Egyptian children in everyday life and would complement other objective test results in evaluating and monitoring the performance of these children.

Identification of phonological processes in Arabic-speaking Egyptian children by single-word test.

PURPOSE: Phonological processes are systematic changes in sound classes, sound sequences or syllable structure. The aim of this study was to develop an assessment tool for identification of developmental phonological processes in Arabic-speaking Egyptian children in order to provide normative data of phonological processes in typically developing children and distinguish between normal children and children with phonological impairment. METHOD: The study design was a cross-sectional descriptive one. Mansoura Arabic Test for Phonological Processes (MATPP) was developed to elicit children's single-word productions through picture naming task. After being pilot-tested, the MATPP was presented to a group of 120 typically developing children in the age range 2-5 years and another group of 30 children with developmental language disorder (DLD) in the age range 2½ - 5years for test validation. RESULTS: Assimilation processes were the commonest phonological processes followed by syllable structure processes and substitution processes. In contrast to English language, prevocalic devoicing, backing of fricatives and glottal replacement were considered normal for Egyptian children. The face validity was demonstrated by judging all words of the MATPP for being completely relevant to the purpose for which it was meant and Criterion -related validity was demonstrated by higher scores of the DLD children in all phonological processes. MATPP presented test-retest reliability when re-administered by the same examiner or a different examiner to the same child within a two week interval. CONCLUSION: MATPP is a valid and reliable assessment tool for identification of phonological processes in Arabic-speaking Egyptian children and can differentiate typically developing children from those with a phonological impairment.

Developing an Arabic Screening Test for Adult-Onset Chronic Aphasia.

AIM: To develop a time-efficient Arabic test battery for adult-onset chronic aphasia that provides information about the type and the severity of the disorder. PATIENT AND METHODS: A total of 90 participants were recruited and divided into 3 groups. The groups consisted of 30 adult-onset post-stroke chronic aphasic patients, 30 adult non-aphasic adults with central neurological disorders, and a group of 30 non-brain-damaged healthy adults. All participants were assessed using the Mansoura Arabic Screening Aphasia Test (MASAT), which consists of 4 main sections: (1) language expression abilities including repetition and naming items, (2) language comprehension questions, (3) fluency, and (4) reading, writing and calculation items. The content validity, internal consistency, clinical validity, and convergent validity of the MASAT were evaluated. RESULTS: The MASAT demonstrated statistically high reliability and validity. The high α-values in all subtotal scores among the 3 groups were judged to denote excellent intercorrelation among the screening test items. CONCLUSION: The MASAT is a valid and a reliable brief assessment tool that can be completed on the first clinic appointment that detects the type and severity of Arabic-speaking aphasic patients.

Developing Viscosity Modelling for Traditional Liquids in Egypt.

OBJECTIVES: The aim of this study was to develop a low-cost methodology for preparing different thickened liquids with different consistencies and viscosities that mimic the viscosities of culturally relevant traditional Egyptian liquids, which can be easily used in the fiberoptic-endoscopic evaluation of swallowing. MATERIALS AND METHODS: The textures of 9 traditional Egyptian liquids were quantified with the International Dysphagia Diet Standardisation Initiative (IDDSI) Flow Test and spanned the entire range of the IDDSI scale. We then developed texture-modified fluids that matched each dietary fluid texture for endoscopic dysphagia assessment using a regionally available, inexpensive, starch-based thickening agent. RESULTS: Our results indicate simple methods of assuring that fluids used during swallowing testing with endoscopy can be matched to dietary fluids to ensure appropriate dietary prescriptions for people with dysphagia. The changes in the thickness and viscosity of the prepared liquid samples were detected and studied separately. The measured samples include some traditional Egyptian fluids (molokhia, lentil soup) in addition to commercially available fluids and pudding. CONCLUSION: The method can be applied to develop thickened liquids with different consistencies to model the traditional, naturally thickened liquids in Egypt and many other developing countries.

Language and cognitive outcome for high-risk neonates at the age of 2-3 years - experience from an Arab Country.

AIM: To investigate the effect of different neonatal risk factors on different language parameters as well as cognitive abilities among Arabic speaking Egyptian children at the age of two to three years of life and to find out which risk factor(s) had the greatest impact on language and cognitive abilities. METHODS: This retrospective cohort study was conducted on 103 children with age range of 2-3 years (median age 31 mo). They were 62 males and 41 females who were exposed to different high-risk factors in the perinatal period, with exclusion of metabolic disorders, sepsis/meningitis, congenital anomalies and chromosomal aberrations. The studied children were subjected to a protocol of language assessment that included history taking, clinical and neurological examination, audiological evaluation, assessment of language using modified preschool language scale-4, IQ and mental age assessment and assessment of social age. RESULTS: The studied children had a median gestational age of 37 wk, median birth weight of 2.5 kg. The distribution of the high-risk factors in the affected children were prematurity in 25 children, respiratory distress syndrome in 25 children, hypoxic-ischemic encephalopathy in 15 children, hyperbilirubinemia in 10 children, hypoglycemia in 13 children, mixed risk factors in 15 children. The results revealed that high-risk neonatal complications were associated with impairment of different language parameters and cognitive abilities (P < 0.05). The presence of prematurity, in relation to other risk factors, increases the risk of language and cognitive delay significantly by 3.9 fold. CONCLUSION: Arabic-speaking children aged 2-3 years who were exposed to high-risk conditions in the perinatal period are likely to exhibit delays in the development of language and impairments in cognitive abilities. The most significant risk factor associated with language and cognitive impairments was prematurity.

Validation and Adaptation of the Singing Voice Handicap Index for Egyptian Singing Voice.

BACKGROUND: Measuring the severity of a voice disorder is difficult. This can be achieved by both subjective and objective measures. The Voice Handicap Index is the most known and used self-rating tool for voice disorders. The Classical Singing Handicap Index (CSHI) is a self-administered questionnaire measuring the impact of vocal deviation on the quality of life of singers. OBJECTIVES: The objective of this study was to develop an Arabic version of the CSHI and to test its validity and reliability in Egyptian singers with different singing styles with normal voice and with voice disorders. METHODS: The interpreted version was administered to 70 Egyptian singers including artistic singers (classical and popular) and specialized singers (Quran reciters and priests) who were divided into 40 asymptomatic singers (control group) and 30 singers with voice disorders. Participants' responses were statistically analyzed to assess the validity and reliability, and to compare the patient group with the control group. RESULTS AND CONCLUSIONS: Quran reciters, patients with no previous professional training, and patients with vocal fold lesions demonstrated the highest scores. The Arabic version of CSHI is found to be a reliable, valid, and sensitive self-assessment tool that can be used in the clinical practice for the evaluation of the impact of voice disorders on singing voice.

Evaluating the diagnostic accuracy of Arabic SNAP test for children with hypernasality.

UNLABELLED: Nasometry is a method of measuring the acoustic correlates of resonance through a computer-based instrument called nasometer. High nasalance scores in comparison to normative data suggest hypernasality and/or other nasality disorders, while low scores suggest hyponasality. Normative values of nasalance for Egyptian Arabic speakers were established using the Arabic SNAP (Simplified Nasometric Assessment Procedures) test. OBJECTIVES: to evaluate the diagnostic accuracy of Arabic SNAP test to allow for its use in the differentiation between normal and hypernasal speech in Egyptian Arabic-speaking children. METHODS: Nasalance scores of normal children (n=92) on Arabic SNAP test were compared to those of 30 children with velopharyngeal insufficiency due to cleft palate. Receiver operating characteristic (ROC) curve was used to determine cutoff points with the highest sensitivity and specificity. RESULTS: Statistically significant differences were found between both groups for all items in nasometric evaluation (p<0.05) except for prolonged/m/sound (p>0.05). Cutoff points were determined and certain items were selected for routine nasometric evaluation. CONCLUSION: The Arabic SNAP test is a sensitive and specific tool for evaluation of children with hypernasality and can be used for both diagnosis and follow up of these cases.

Assessment of Arabic phonological awareness and its relation to word reading ability.

Phonological awareness (PA) is one of the most important components in the development of normal reading ability. It refers to the ability to detect and manipulate the sound structure of words independently of their meaning. The current study aimed to assess Arabic PA skills and the relation to word reading abilities in Egyptian Arabic-speaking children. The designed assessment was applied to 80 typically developing children, divided into two subgroups ranging in age from 5 years 6 months to 8 years 6 months. The design of assessment involved six PA tasks covering three levels: rhyme awareness, syllabic awareness, and phonemic awareness, as well as the assessment of reading abilities that include real word and nonsense word reading tasks. Descriptive statistics (mean, standard deviation), Student's t tests, and Pearson correlation coefficient tests were used to analyze the data. The reliability of the test was proven using the test-retest procedure. Validity of the test was estimated through internal consistency validity. The results revealed that the Arabic PA assessment test (APAAT) proved to be a reliable and valid tool for assessing Arabic reading skills. Findings from the study provided important insights into the developmental patterns of Arabic PA. In addition, the findings revealed a strong relationship between phonological awareness skills and the proficiency in word reading abilities in Arabic school-aged children.

The nature of articulation errors in Egyptian Arabic-speaking children with velopharyngeal insufficiency due to cleft palate.

UNLABELLED: Even with early surgical repair, the majority of cleft palate children demonstrate articulation errors and have typical cleft palate speech. OBJECTIVE: Was to determine the nature of articulation errors of Arabic consonants in Egyptian Arabic-speaking children with velopharyngeal insufficiency (VPI). SUBJECTS AND METHODS: Thirty Egyptian Arabic-speaking children with VPI due to cleft palate (whether primary repaired or secondary repaired) were studied. Auditory perceptual assessment (APA) of children speech was conducted. Nasopharyngoscopy was done to assess the velopharyngeal port (VPP) movements while the child was repeating speech tasks. Mansoura Arabic Articulation test (MAAT) was performed to analyze the consonants articulation of these children. RESULTS AND CONCLUSION: The most frequent type of articulatory errors observed was substitution, more specifically, backing. Pharyngealization of anterior fricatives was the most frequent substitution, especially for the /s/ sound. The most frequent substituting sounds for other sounds were /ʔ/ followed by /k/ and /n/ sounds. Significant correlations were found between the degrees of the open nasality and VPP closure and the articulation errors. On the other hand, the sounds (/ʔ/,/h/,/ʕ/,/n/,/w/,/j/) were normally articulated in all studied group. The determination of articulation errors in VPI children could guide the therapists for designing appropriate speech therapy programs for these cases.

A speech nasoendoscopy-based surgeon's decision for correction of velopharyngeal insufficiency following adenotonsillectomy.

Both sphincter pharyngoplasty (SP) and pharyngeal flap (PF) procedures have gained popularity among surgeons as effective surgical management for velopharyngeal insufficiency (VPI). Different centers prefer either SP or PF and have published their results to support this preference. But is one technique superior to the other? To answer this question, we have adopted the concept of differential therapeutic management, based on detailed assessment of velopharyngeal function. According to this assessment either SP or PF was performed for management of VPI (secondary to adenotonsillectomy). The aim of this work is to evaluate and compare the surgical results after SP and PF (based on the preoperative nasoendoscopy and phoniatrics' evaluation). This study was conducted on 31 patients with persistent hypernasality after adenotonsillectomy. All patients were subjected to perceptual speech evaluation and nasoendoscopic examination. According to this evaluation and data analysis, 18 patients were operated by SP and 13 patients underwent PF. Statistically, highly significant improvements were found when comparing pre- versus postoperative perceptual speech evaluation following both SP and PF (P < 0.001). When comparing the postoperative perceptual speech evaluation following both techniques, statistically non-significant differences were reported (P > 0.05). Preoperative differential diagnosis of VPI using perceptual speech assessment and nasoendoscopy of the velopharynx allows for tailored surgical management with either SP or PF. Both SP and PF procedures could yield good surgical outcomes, when patients are properly selected and the technique is chosen according to preoperative assessment.

Standardization of nasometry for normal Egyptian Arabic speakers.

OBJECTIVE: The aim of this study was to collect the normative values of nasalance for Egyptian Arabic speakers in different age groups, using Arabic speech samples in order to compare patients with disturbed nasality. MATERIAL AND METHODS: This study included 300 normal Egyptian volunteers divided into three groups according to their ages: group I = children (n = 92; age 3 years, 3 months to 9 years), group II = teenagers (n = 76; age 9-18 years) and group III = adults (n = 132; age above 18 years). The Nasometer II 6400 was used for the analysis of speech samples. All subjects were asked to perform four speech tasks that were based on the MacKay-Kummer SNAP Test-R and modified to be applicable to the Arabic language, especially to the Egyptian dialect. RESULTS: The normative values for nasometric assessment in the different age groups were studied. The results demonstrated nasalance score variations according to age and gender. Most of the nasalance score norms of the Egyptian children demonstrated statistically significant differences when compared with the norms of children for the MacKay-Kummer Test-R. CONCLUSION: The Egyptian Arabic SNAP test is an easy, noninvasive and objective procedure that is suitable for all age groups.

Developing an articulation test for Arabic-speaking school-age children.

OBJECTIVE: The aim of this study was to develop an Arabic articulation test using familiar and visually transparent words in order to be used as a criterion for comparing phonemes of both normal and phonologically disordered Arabic-speaking children. MATERIAL AND METHODS: A picture-naming test was designed for the Mansoura Arabic Articulation Test (MAAT) to elicit spontaneous single-word responses representing all possible consonant positions and vowels of Colloquial Egyptian Arabic. Three expert phoniatricians were asked to review MAAT and complete a questionnaire. The MAAT was presented to 100 normal Arabic-speaking Egyptian children randomly selected from the first- and second-grade kindergarten. They were 52 males and 48 females with ages ranging between 42 and 70 months. Children's responses were converted to a percent correct score for sound utterances and picture identification. RESULTS: Statistically non-significant differences were found among experts' opinions reflecting approval for the MAAT items. A statistically highly significant adequate correlation was found between correct word utterances and picture identification which proved the content validity of MAAT. Test-retest reliability proved the consistency of MAAT. CONCLUSION: MAAT is a valid and reliable test that can be applied to collect the phonetic inventory of Arabic-speaking young children.