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Ueha R, Miura C, Matsumoto N, Sato T, Goto T, Kondo K. Vocal Fold Motion Impairment in Neurodegenerative Diseases. J Clin Med 2024; 13:2507. [PMID: 38731036 PMCID: PMC11084971 DOI: 10.3390/jcm13092507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Vocal fold motion impairment (VFMI) is the inappropriate movement of the vocal folds during respiration, leading to vocal fold adduction and/or abduction problems and causing respiratory and vocal impairments. Neurodegenerative diseases (NDDs) are a wide range of disorders characterized by progressive loss of neurons and deposition of altered proteins in the brain and peripheral organs. VFMI may be unrecognized in patients with NDDs. VFMI in NDDs is caused by the following: laryngeal muscle weakness due to muscular atrophy, caused by brainstem and motor neuron degeneration in amyotrophic lateral sclerosis; hyperactivity of laryngeal adductors in Parkinson's disease; and varying degrees of laryngeal adductor hypertonia and abductor paralysis in multiple system atrophy. Management of VFMI depends on whether there is a presence of glottic insufficiency or insufficient glottic opening with/without severe dysphagia. VFMI treatment options for glottic insufficiency range from surgical interventions, including injection laryngoplasty and medialization thyroplasty, to behavioral therapies; for insufficient glottic opening, various options are available based on the severity and underlying cause of the condition, including continuous positive airway pressure therapy, botulinum toxin injection, tracheostomy, vocal fold surgery, or a combination of interventions. In this review, we outline the mechanisms, clinical features, and management of VFMI in NDDs and provide a guide for physicians who may encounter these clinical features in their patients. NDDs are always progressive; hence, timely evaluation, proper diagnosis, and appropriate management of the patient will greatly affect their vocal, respiratory, and swallowing functions as well as their quality of life.
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Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
| | - Cathrine Miura
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
| | - Naoyuki Matsumoto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.M.); (N.M.); (T.S.); (T.G.); (K.K.)
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Ribeiro M, Miquilussi PA, Gonçalves FM, Taveira KVM, Stechman-Neto J, Nascimento WV, de Araujo CM, Schroder AGD, Massi G, Santos RS. The Prevalence of Oropharyngeal Dysphagia in Adults: A Systematic Review and Meta-analysis. Dysphagia 2024; 39:163-176. [PMID: 37610669 DOI: 10.1007/s00455-023-10608-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
To determine the global prevalence of oropharyngeal dysphagia (OD) in adults. Six electronic databases (Embase, LILACS, LIVIVO, PubMed/Medline, Scopus, and Web of Science) were searched, in addition to gray literature (ASHA, Google Scholar, ProQuest Dissertation, and Theses). A random-effects model for meta-analysis of proportions was conducted, and heterogeneity was evaluated according to the moderator variable through subgroup analysis and meta-regression. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the certainty of the evidence was assessed using the GRADE tool. Thirty papers were included for qualitative and quantitative synthesis. The combined prevalence estimate was 60% [CI 95% = 50%-70%; I2 = 95%], accounting for different baseline conditions. However, the wide variation that exists between the different baseline conditions (underlying disease or risk factor) tended to overestimate this prevalence when considering the general population. Only one study evaluated healthy individuals, which showed a prevalence of 31% [CI95% = 27%-36%]. The risk of bias was considered low for all studies. None of the variables were considered predictors for the observed variance between the effect sizes of the included studies. For the prevalence of OD, the GRADE rating was considered very low. Despite the high prevalence observed, with over half of the individuals affected, the evidence regarding this outcome remains uncertain due to an overestimation of the generated estimates caused by the baseline condition of the sample.
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Affiliation(s)
- Marcos Ribeiro
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil.
- , Avenida Diederichsen, 864. Apt: 172, Vila Guarani - South Zone, São Paulo, SP, 04310-000, Brazil.
| | - Paloma Alves Miquilussi
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
| | - Flávio Magno Gonçalves
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
| | - Karinna Veríssimo Meira Taveira
- Department of Morphology- Center of Biosciences, University of Notre Dame, 100 Galvin Life Science Center, Notre Dame, USA
- Postgraduate Program in Speech, Language and Hearing Sciences, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - José Stechman-Neto
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
| | - Weslania Viviane Nascimento
- Department of Dentistry, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Curitiba, Brazil
| | - Cristiano Miranda de Araujo
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
| | | | - Giselle Massi
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
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Glinzer J, Flynn É, Tampoukari E, Harpur I, Walshe M. Dysphagia Prevalence in Progressive Supranuclear Palsy: A Systematic Review and Meta-Analysis. Dysphagia 2024:10.1007/s00455-024-10681-7. [PMID: 38523230 DOI: 10.1007/s00455-024-10681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/02/2024] [Indexed: 03/26/2024]
Abstract
The objective of this systematic review was to determine the prevalence of dysphagia and aspiration in people with progressive supranuclear palsy (PSP). A search of six electronic databases was performed from inception to April 2022. No context restrictions were set. All primary research comprising figures to derive a prevalence rate were included. Two independent reviewers screened search results. Data were extracted by one reviewer. Conflicts were resolved by discussion with a third reviewer. The quality of included studies was assessed using the JBI Checklist for Prevalence Studies. From 877 studies, 12 were eligible for inclusion. Dysphagia had to be confirmed using instrumental assessments, clinical swallowing evaluation, screening, and patient-reported outcome measures (PROM). A random-effects meta-analysis calculated a pooled dysphagia prevalence in 78-89% (95% CI [60.6, 89.1], [78.9, 95.0]). depending on the chosen assessment method, and a pooled aspiration prevalence of 23.5% (95% CI [14.5, 33.7]). The included studies were of moderate quality, with high risk of selection and coverage bias and low to moderate risk of measurement bias. Dysphagia is highly prevalent in a sample of participants with mostly moderately severe PSP. Aspiration occurs in a quarter of this sample and is likely to increase as the disease progresses. Given the low general prevalence of PSP, studies remain at high risk for selection bias. Prospective research should focus on the development of dysphagia in the course of PSP and its subcategories using instrumental assessment and consider all phases of swallowing. REGISTRATION: The protocol of this systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) in April 2021 (registration number: CRD42021245204).
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Affiliation(s)
- Julia Glinzer
- Department of Clinical Speech and Language Studies, Trinity College Dublin, University of Dublin, Dublin 2, Ireland
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Éadaoin Flynn
- Department of Clinical Speech and Language Studies, Trinity College Dublin, University of Dublin, Dublin 2, Ireland
- Department of Speech and Language Therapy, Tallaght University Hospital, Dublin, Ireland
| | - Eleni Tampoukari
- Department of Clinical Speech and Language Studies, Trinity College Dublin, University of Dublin, Dublin 2, Ireland
| | - Isolde Harpur
- The Library of Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, University of Dublin, Dublin 2, Ireland.
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Doruk C, Curtis JA, Dakin AE, Troche MS. Cough and Swallowing Therapy and Their Effects on Vocal Fold Bowing and Laryngeal Lesions. Laryngoscope 2024; 134:1127-1132. [PMID: 37497803 DOI: 10.1002/lary.30922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Expiratory muscle strength training (EMST) and sensorimotor training of airway protection (smTAP) are two exercises intended to improve cough and swallowing in people with Parkinson's Disease (PwPD). The aims of this study were to (1) examine whether EMST or smTAP elicit changes to vocal fold bowing; and (2) describe the safety of EMST and smTAP as it relates to the development of vocal fold lesions. METHOD(S) This was a secondary analysis of data from PwPD who completed EMST or smTAP as part of a prospective randomized controlled trial. Vocal fold bowing (BI) and the presence of laryngeal lesions were blindly analyzed from flexible endoscopic evaluation of swallowing (FEES) using ImageJ software and operational definitions. Linear regression was used to examine the influence time (pre- vs. post-therapy) and therapy (EMST vs. smTAP) on vocal fold bowing. Descriptive statistics were used to describe the presence of laryngeal lesions. RESULT(S) Overall, 56 participants were included, 28 per group. The median BI scores pre- and post-therapy were 8.2% and 8.3% for the EMST group and 11.3% and 8.4% for the smTAP group, respectively. Statistical analyses revealed insufficient evidence to suggest an effect of time and treatment type on BI (p > 0.05) or on the presence of vocal fold lesions (p > 0.05). CONCLUSION Based on these and previous findings, it appears that changes in vocal fold bowing do not drive treatment effects following EMST and smTAP. Also, this study further supports the safety of smTAP and EMST despite the required forceful exhalation and repetitive coughing. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1127-1132, 2024.
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Affiliation(s)
- Can Doruk
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - James A Curtis
- Aerodigestive Innovations Research lab (AIR), Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
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Mir MJ, Childers JT, Wheeler-Hegland K. Cough Correlates of Functional Swallow Outcomes in Atypical Parkinsonism. Mov Disord Clin Pract 2024; 11:265-275. [PMID: 38229245 DOI: 10.1002/mdc3.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Swallow and cough impairments lead to aspiration and reduced clearance of aspirate material. Both behaviors are impaired in Parkinson's disease, but it is unknown whether a similar relationship of dysfunction exists in forms of atypical Parkinsonism (APD). Elucidating this association in APD may lead to early, comprehensive airway protection treatment. OBJECTIVES We tested the hypotheses that swallow deficits in APD are associated with impaired cough and that airway protective dysfunction is associated with longer disease duration. METHODS Swallowing difficulty was described by 11 participants with APD. Penetration-Aspiration Scale (PAS) and DIGEST scores for thin liquid trials were extracted from medical records of videofluoroscopic swallow study reports. Voluntary and capsaicin induced-reflex cough measures of flow, volume, and timing were analyzed. RESULTS While most participants did not have post-swallow residue, ~80% received abnormal PAS scores and reported swallowing difficulty. Those with abnormal PAS scores had lower voluntary cough expired volume (P = 0.037; mean rank difference = 5.0); lower reflex inspiratory flow rate (P = 0.034; mean rank difference = 5.5); and longer reflex expiratory flow rise time (P = 0.034; mean rank difference = 5.5). Higher PAS scores and reduced reflex cough volume acceleration were significantly correlated (r = -0.63; P = 0.04) and longer disease duration predicted larger voluntary cough expired volume (R2 = 0.72) and longer flow rise times (R2 = 0.47). CONCLUSIONS As swallow safety worsens, so might the ability to clear the airways with effective cough in in APD; particularly with longer disease duration. Assessing cough in conjunction with swallowing is important for informing airway protection treatment plans in APD.
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Affiliation(s)
- Michela J Mir
- Breathing Research and Therapeutics Center, Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
- Brooks Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida, USA
| | - Justin T Childers
- College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Karen Wheeler-Hegland
- Norman Fixel Institute for Neurological Diseases, UF Health, Gainesville, Florida, USA
- Upper Airway Dysfunction Lab, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA
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Doruk C, Çaytemel B, Şahin E, Kara H, Samancı B, Abay SN, Bilgiç B, Hanağası H, Başaran B, Enver N, Rameau A. Evaluation of Post-Swallow Residue with Visual Analysis of Swallowing Efficiency and Safety in Patients with Idiopathic Parkinson's Disease. EAR, NOSE & THROAT JOURNAL 2023:1455613231210976. [PMID: 38050868 DOI: 10.1177/01455613231210976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Objectives: Dysphagia is common in idiopathic Parkinson's disease (IPD) and is associated with impairments in both swallowing safety and swallowing efficiency. The goals of this study were to define post-swallow residue patterns in people with IPD and describe pathophysiological endoscopic findings affecting residue accumulation. Methods: This was a prospective single-blinded cross-sectional cohort study of patients with the diagnosis of IPD recruited from a Movement Disorder Clinic. Clinical variables included patient age, cognitive function, and measures of disease severity, and laryngoscopic examinations with a flexible endoscopic evaluation of swallowing (FEES) were completed for each patient. Visual Analysis of Swallowing Efficiency and Safety (VASES) was used to analyze FEES. Post-swallow residue outcomes and non-residue endoscopic outcomes including the Bowing index, Penetration Aspiration Scale (PAS) score, premature leakage, and build-up phenomenon were evaluated. Multiple regression models were used to evaluate factors affecting the residue at different anatomic levels. Results: Overall 53 patients completed the study. The multiple regression analyses showed a relation between (1) the presence of residue at the level of oropharynx and epiglottis with premature leakage, (2) the presence of residue at the level of the laryngeal vestibule and vocal folds with build-up phenomenon, and (3) the presence of residue at the level of the hypopharynx, laryngeal vestibule, and subglottis with airway invasion. Conclusion: Residue pattern during FEES is associated with specific swallow dysfunctions in IPD. Using residue localization and quantification may be a helpful tool in assessing the impact of targeted swallowing interventions in patients with IPD and dysphagia.
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Affiliation(s)
- Can Doruk
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
- Division of Laryngology, Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical School, New York, NY, USA
| | - Berkay Çaytemel
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Erdi Şahin
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Hakan Kara
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Bedia Samancı
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Sevinç Nisa Abay
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
- Işık University, Istanbul, Turkey
| | - Başar Bilgiç
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Haşmet Hanağası
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Bora Başaran
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Necati Enver
- Department of Otolaryngology, Head and Neck Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Anais Rameau
- Department of Otolaryngology-Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, NY, USA
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Wodwaski N. Progressive Supranuclear Palsy: Challenges and Considerations for Care Transitions. Crit Care Nurs Clin North Am 2023; 35:393-401. [PMID: 37838414 DOI: 10.1016/j.cnc.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Progressive supranuclear palsy (PSP) is a fatal neurodegenerative disorder. Care requires a patient-centered approach encompassing compassion, communication, and empathy. Despite concerted actions to streamline PSP patient transitions, the care is multifaceted and cause of concern. Patients with PSP undergoing transitional care are at an increased risk of undesirable outcomes, frequently endure poor communication, and encounter inconsistent care. Therefore, patients with PSP and families worry about the uncertainty in care, including who is accountable for the care and available resources. Through the three spheres of impact, Clinical Nurse Specialists can educate and assist intensive care unit nurses caring for patients with PSP /families, aiding in the successful care transition.
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Affiliation(s)
- Nadine Wodwaski
- University of Detroit Mercy, 4001 West McNichols Road, Detroit, MI 48221, USA.
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Baertsch H, Cvancara DJ, Paniello RC, Hillel AD, Bhatt NK. Recurrent laryngeal motor nerve conduction studies in a rat model: Establishing an objective measure for investigating laryngeal innervation. Muscle Nerve 2023; 68:471-475. [PMID: 37575043 DOI: 10.1002/mus.27932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION/AIMS Disease or injury can cause neuromuscular changes to the larynx that can affect voice, breathing, and swallowing. Motor nerve conduction studies have had limited use in the study of laryngeal neurophysiology, despite their importance in other anatomic sites. The aim of this study was to explore the feasibility of performing recurrent laryngeal motor nerve conduction studies (rlMNCS) in a rat model. METHODS rlMNCS were performed in 15 rats under anesthesia. A bipolar stimulating electrode was placed on the recurrent laryngeal nerve (RLN) 5 mm below the cricoid cartilage. Via direct laryngoscopy, a recording electrode was placed transorally into the thyroarytenoid muscle. The RLN was maximally stimulated to determine the compound muscle action potential (CMAP). Three consecutive trials were averaged. RESULTS The mean stimulating threshold to the RLN to achieve a CMAP from the thyroarytenoid was 1.7 ± 0.6 mA. RLN stimulation caused a visible adductor twitch of the vocal fold in all animals. The mean negative amplitude was 2.0 ± 0.8 mV, and the total area was 1.0 ± 0.4 mV ms. The CMAP latency and negative duration were 1.0 ± 0.1 ms and 0.9 ± 0.2 ms, respectively. DISCUSSION rlMNCS are feasible and may be useful in understanding laryngeal neurophysiology with disease or injury. This work could provide a tractable animal model for studying and monitoring treatment of neuromuscular conditions affecting voice, breathing, and swallowing.
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Affiliation(s)
- Hans Baertsch
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David J Cvancara
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Randal C Paniello
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Allen D Hillel
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Neel K Bhatt
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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Rameau A, Andreadis K, German A, Lachs MS, Rosen TE, Pitzrick MS, Symes LB, Klinck H. Changes in Cough Airflow and Acoustics After Injection Laryngoplasty. Laryngoscope 2023; 133 Suppl 3:S1-S14. [PMID: 35723533 PMCID: PMC9763552 DOI: 10.1002/lary.30255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE/HYPOTHESIS We explored the following hypotheses in a cohort of patients undergoing injection laryngoplasty: (1) glottic insufficiency affects voluntary cough airflow dynamics and restoring glottic competence may improve parameters of cough strength, (2) cough strength can be inferred from cough acoustic signal, and (3) glottic competence changes cough sounds and correlates with spectrogram morphology. STUDY TYPE/DESIGN Prospective interventional study. METHODS Subjects with glottic insufficiency secondary to unilateral vocal fold paresis, paralysis, or atrophy, and scheduled for injection laryngoplasty completed an instrumental assessment of voluntary cough airflow using a pneumotachometer and a protocolized voluntary cough sound recording. A Wilcoxon signed-rank test was used to compare the differences between pre- and post-injection laryngoplasty in airflow and acoustic measures. A Spearman rank-order correlation was used to evaluate the association between airflow and acoustic cough measures. RESULTS Twenty-five patients (13F:12M, mean age 68.8) completed voluntary cough airflow measurements and 22 completed cough sound recordings. Following injection laryngoplasty, patients had a statistically significant decreased peak expiratory flow rise time (PEFRT) (mean change: -0.03 s, SD: 0.06, p = 0.04) and increased cough volume acceleration (mean change: 13.1 L/s2 , SD: 33.9, p = 0.03), suggesting improved cough effectiveness. Correlation of cough acoustic measures with airflow measures showed a weak relationship between PEFRT and acoustic energy (coefficient: -0.31, p = 0.04) and peak power density (coefficient: -0.35, p = 0.02). CONCLUSIONS Our study thus indicates that injection laryngoplasty may help avert aspiration in patients with glottic insufficiency by improving cough effectiveness and that improved cough airflow measures may be tracked with cough sounds. LEVEL OF EVIDENCE 3 Laryngoscope, 133:S1-S14, 2023.
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Affiliation(s)
- Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Alexander German
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Mark S Lachs
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Tony E Rosen
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Michael S. Pitzrick
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
| | - Laurel Braden Symes
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
| | - Holger Klinck
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
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Bluett B, Pantelyat AY, Litvan I, Ali F, Apetauerova D, Bega D, Bloom L, Bower J, Boxer AL, Dale ML, Dhall R, Duquette A, Fernandez HH, Fleisher JE, Grossman M, Howell M, Kerwin DR, Leegwater-Kim J, Lepage C, Ljubenkov PA, Mancini M, McFarland NR, Moretti P, Myrick E, Patel P, Plummer LS, Rodriguez-Porcel F, Rojas J, Sidiropoulos C, Sklerov M, Sokol LL, Tuite PJ, VandeVrede L, Wilhelm J, Wills AMA, Xie T, Golbe LI. Best Practices in the Clinical Management of Progressive Supranuclear Palsy and Corticobasal Syndrome: A Consensus Statement of the CurePSP Centers of Care. Front Neurol 2021; 12:694872. [PMID: 34276544 PMCID: PMC8284317 DOI: 10.3389/fneur.2021.694872] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS; the most common phenotype of corticobasal degeneration) are tauopathies with a relentless course, usually starting in the mid-60s and leading to death after an average of 7 years. There is as yet no specific or disease-modifying treatment. Clinical deficits in PSP are numerous, involve the entire neuraxis, and present as several discrete phenotypes. They center on rigidity, bradykinesia, postural instability, gait freezing, supranuclear ocular motor impairment, dysarthria, dysphagia, incontinence, sleep disorders, frontal cognitive dysfunction, and a variety of behavioral changes. CBS presents with prominent and usually asymmetric dystonia, apraxia, myoclonus, pyramidal signs, and cortical sensory loss. The symptoms and deficits of PSP and CBS are amenable to a variety of treatment strategies but most physicians, including many neurologists, are reluctant to care for patients with these conditions because of unfamiliarity with their multiplicity of interacting symptoms and deficits. CurePSP, the organization devoted to support, research, and education for PSP and CBS, created its CurePSP Centers of Care network in North America in 2017 to improve patient access to clinical expertise and develop collaborations. The directors of the 25 centers have created this consensus document outlining best practices in the management of PSP and CBS. They formed a writing committee for each of 12 sub-topics. A 4-member Steering Committee collated and edited the contributions. The result was returned to the entire cohort of authors for further comments, which were considered for incorporation by the Steering Committee. The authors hope that this publication will serve as a convenient guide for all clinicians caring for patients with PSP and CBS and that it will improve care for patients with these devastating but manageable disorders.
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Affiliation(s)
- Brent Bluett
- Neurology, Pacific Central Coast Health Center, Dignity Health, San Luis Obispo, CA, United States
- Neurology, Stanford University, Stanford, CA, United States
| | - Alexander Y. Pantelyat
- Neurology, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Irene Litvan
- Neurology, University of California, San Diego, San Diego, CA, United States
| | - Farwa Ali
- Neurology, Mayo Clinic, Rochester, MN, United States
| | - Diana Apetauerova
- Neurology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Danny Bega
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lisa Bloom
- Neurology, Surgery, University of Chicago, Chicago, IL, United States
| | - James Bower
- Neurology, Mayo Clinic, Rochester, MN, United States
| | - Adam L. Boxer
- Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Marian L. Dale
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Rohit Dhall
- Neurology, University of Arkansas for Medical Sciences, Little Rock, AK, United States
| | - Antoine Duquette
- Service de Neurologie, Département de Médecine, Unité de Troubles du Mouvement André-Barbeau, Centre Hospitalier de l'Université de Service de Neurologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Hubert H. Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jori E. Fleisher
- Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Murray Grossman
- Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael Howell
- Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Diana R. Kerwin
- Geriatrics, Presbyterian Hospital of Dallas, Dallas, TX, United States
| | | | - Christiane Lepage
- Service de Neurologie, Département de Médecine, Unité de Troubles du Mouvement André-Barbeau, Centre Hospitalier de l'Université de Service de Neurologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | | | - Martina Mancini
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Nikolaus R. McFarland
- Neurology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Paolo Moretti
- Neurology, The University of Utah, Salt Lake City, UT, United States
| | - Erica Myrick
- Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Pritika Patel
- Neurology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Laura S. Plummer
- Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Julio Rojas
- Neurology, University of California, San Francisco, San Francisco, CA, United States
| | | | - Miriam Sklerov
- Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Leonard L. Sokol
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Paul J. Tuite
- Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Lawren VandeVrede
- Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Wilhelm
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Anne-Marie A. Wills
- Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Tao Xie
- Neurology, Surgery, University of Chicago, Chicago, IL, United States
| | - Lawrence I. Golbe
- Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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