Twenty-One for 2021: The Most Influential Papers in Laryngology Since 2000

Development and Rationale for the Consensus Auditory-Perceptual Evaluation of Voice-Revised (CAPE-Vr)

RATIONALE

The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) has been in circulation for more than 20 years. Over the course of time, issues have arisen that have had an impact on the intended administration and interpretation of this common clinical tool.

PURPOSE

Based on published literature, clinical experience, recent survey data, and practical considerations, and while maintaining the original purpose of the instrument, the authors developed a revised protocol, new rating form, and updated instructions for the CAPE-V, now called the CAPE-V-Revised (CAPE-Vr).

SUMMARY OF MODIFICATIONS

Revisions to the CAPE-V include the following: removal of textual labels indicating regions of severity under each visual analog scale on the rating form, instead displaying terms indicating the direction of the lines; modification of several of the stimuli; revised rating options for pitch, loudness, and resonance, and an added category for nasality; added space to describe inconsistencies according to task; modified options for vocal instabilities and other features; and added space for comments about overall impression. The form also includes sections for documenting recording and rating conditions. Updated instructions are provided to clarify the CAPE-Vr protocol and correspond closely to the rating form.

CONCLUSION

The CAPE-Vr is constructed to avoid common errors and problems identified from previous use of the original CAPE-V. This paper provides a rationale for each modification to the original CAPE-V, an updated form, and an example of a completed form. The CAPE-Vr is intended as a clear and useful assessment tool for documenting the auditory-perceptual evaluation of voice.

From practice to protocol: The CAPE-VFQ by and for Quebec French SLPs

This article presents the Quebec French adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-VFQ), a standardised protocol for evaluating voice quality. Developed through collaboration within the Quebec Voice Speech-Language Pathologist (SLP) Community of Practice, the adapted tool addresses linguistic and cultural nuances specific to Quebec French. This adaptation ensures standardised assessments and harmonises clinical and research practices across the province. The article outlines the iterative development process, including clinician feedback, and describes ongoing efforts to validate and support the use of the Quebec French CAPE-V in clinical settings. The adapted protocol serves as both a clinical tool and a reference point for future research, promoting reliable and culturally relevant voice assessments.

Survey of Voice-Focused Speech-Language Pathologists' Usage of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V)

PURPOSE

As part of the process of developing specific recommendations for modifying certain elements of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) to promote end-user fidelity, the authors sought input from voice clinicians who regularly use the CAPE-V to assess voice quality.

METHOD

At an academic meeting focusing on voice disorders, we presented a poster briefly reviewing the CAPE-V protocol and describing several sources of variability that have been reported in its current use. Interested viewers were directed to a QR code linking to a brief, anonymous survey on how individuals currently use the CAPE-V and how they might improve it. A link to the survey was also distributed on the conference discussion board.

RESULTS

Fifty-nine participants responded to the survey: 49 completed it. The median respondent reported 8years of experience conducting voice evaluations, with 50% of their current practice in voice, and about eight voice evaluations per week. Key findings from this survey were that fewer than half of respondents reported audio recording any components of in-person or virtual voice evaluations, and that most respondents reported changing some aspect of the CAPE-V tasks and stimuli in practice.

CONCLUSION

This exploratory study revealed a wide range of idiosyncratic practices by clinicians when administering and scoring the CAPE-V. The findings support planned revisions to the CAPE-V protocol and form involving the tasks, stimuli, and rating procedures.

Disruption Index in Otolaryngology: Uncovering a Bibliometric History of a Rapidly Evolving Field

OBJECTIVES

As the volume of research publications in the field of otolaryngology has increased, so has the need to qualify articles through bibliometric analyses to identify the most important and impactful work in the field. Herein, we aim to identify the 100 most disruptive articles in ENT over a 60-year period and examine how disruption index (DI) compares with other bibliometrics in identifying impactful works in the field.

METHODS

In this cross-sectional bibliometric analysis, articles published between 1954 and 2014 in commonly referenced otolaryngology-head and neck surgery (OHNS) journals were queried in PubMed. Publications were characterized by DI, journal, subspecialty discipline, and status as an impactful article in the field as determined by other bibliometrics such as citation count, the "Sleeping Beauty Index," and those derived by the modified Delphi process.

RESULTS

Of the 122,094 articles queried, 67,561 (55.3%) had available citation count as well as disruption score data, meeting inclusion criteria. The most represented subspecialty disciplines within the top 100 most disruptive articles were Otology/Neurotology (28%), General (Comprehensive) (27%), Head and Neck Surgery (12%), and Laryngology (11%). Fifty percent of articles identified as Sleeping Beauties and impactful via modified Delphi approach had scores in the top 86th percentile.

CONCLUSION

DI in otolaryngology can be appreciated as an added dimension to existing indices and can unearth seminal research, which serve as early foundations of evidence-based management in the field of OHNS today.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:629-636, 2024.

Fidelity to the Consensus Auditory-Perceptual Analysis of Voice (CAPE-V): A Pilot Study

OBJECTIVES

Auditory-perceptual measurements of voice are among the most common diagnostic tools used during a voice evaluation and are considered a gold standard for documenting voice disorders. The goal of this pilot study was to examine the fidelity of clinicians in the administration of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and its published protocol. This investigation aimed to determine how the CAPE-V is being used by clinicians and researchers and the extent to which users deviate from the published procedure.

STUDY DESIGN

Survey METHODS: Data were collected by surveying a group (N = l7) of speech-language pathologists who regularly evaluate and treat patients with voice disorders. Survey results revealed that few of the sampled speech-language pathologists follow exactly the standardized instructions for administering the CAPE-V. Considerable variability in CAPE-V administration, including tasks and stimuli examined, was found across respondents.

CONCLUSIONS

This exploratory project may be used to develop a larger national survey study investigating fidelity to the CAPE-V and to motivate recommendations for possible revisions to the instrument and its protocol for administration.

An epidemiological survey of gastroesophageal reflux disease at the digestive endoscopy center in Guangzhou

OBJECTIVE

This study aims to investigate the detection rates, common symptoms and risk factors of gastroesophageal reflux disease (GERD), and laryngopharyngeal reflux disease (LPRD) at the digestive endoscopy center.

METHODS

A multicenter cross-sectional survey conducted at three hospitals and a total of 565 eligible participants were enrolled. All the patients completed routine ENT examination, gastroscopy, gastroesophageal reflux questionnaire (GerdQ), reflux symptom index (RSI) and a self-designed 25-item symptoms table survey.

RESULTS

Among the 565 eligible participants, the detection rates of GERD and LPRD were 18.41% (104/565) and 9.91% (56/565), respectively. The detection rate of GERD combined with LPRD was 3.19% (18/565). Among GERD and LPRD patients, males (vs. females), middle-aged and elderly patients (vs. young people), BMI ≥ 24.0 kg/m² (vs. BMI < 24.0 kg/m²), with current smoking history (vs. no smoking), and current drinking history (vs. no drinking), lying down immediately after meal (vs. no lying down immediately after meal) were significantly higher (all p < 0.05). The most common extraesophageal symptoms in patients with GERD were dry mouth (66.35%), globus sensation (56.73%), dry throat and pharyngeal itching (55.77%). The most common extraesophageal symptoms in patients with LPRD were globus sensation (91.07%), dry throat and pharyngeal itching (83.93%), and dry mouth (82.14%).

CONCLUSION

GERD and LPRD had a high detection rate at the digestive endoscopy center in Guangzhou, China. Older age, BMI ≥ 24.0 kg/m², smoking and drinking history were risk factors for both GERD and LPRD. Neither GerdQ nor RSI scores included common extraesophageal symptoms.