Cough and swallowing dysfunction

Voice Meets Swallowing: A Scoping Review of Therapeutic Connections

PURPOSE

This scoping review aimed to explore the use of volitional voice tasks in assessing swallowing-related outcomes and to evaluate their therapeutic impact on swallowing disorders, including their effects on swallowing biomechanics.

METHOD

This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A literature search was performed across multiple databases (PubMed, Web of Science, and Scopus), and additional records were identified through manual searches. After screening and eligibility assessment, 36 studies were included for data extraction and analysis. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was employed to evaluate the quality of the included studies.

RESULTS

The review identified various volitional voice tasks, such as maximum phonation time and pitch glides, as potential assessment tools for predicting swallowing-related outcomes. Additionally, voice tasks targeting pitch modulation, increased vocal loudness, and squeezed voice quality showed promising therapeutic benefits for swallowing disorders across different populations, especially individuals with neurological conditions and head and neck cancer.

CONCLUSIONS

While methodological limitations were found in current literature, volitional voice tasks demonstrate potential as complementary tools for assessing and treating swallowing disorders, leveraging their interconnected neurological and biomechanical mechanisms underlying functions. Further research with more robust methodologies is needed to establish the efficacy of these integrated interventions, facilitate their translation into clinical practice, and test new possibilities.

Clinical validation of the nursing outcome "Swallowing status: pharyngeal phase" in patients with laryngeal cancer

AIMS AND OBJECTIVES

This study aimed to clinically validate the nursing outcome "Swallowing status: pharyngeal phase" (1013).

METHODS

A two-stage study was designed: (1) Chinese translation and cultural adaptation and (2) clinical validation. Internal consistency and interrater reliability tests were performed on 285 patients with laryngeal cancer, and an additional 130 patients were randomly selected from the 285 patients as an independent sample. Criterion-related validity tests were performed using the standardized swallowing assessment (SSA). Nursing outcome sensitivity was detected by scoring two time points.

RESULTS

The Cronbach's alpha coefficients were 0.951 for the nursing outcome and 0.942-0.965 for each indicator. The interclass correlation coefficient (ICC) values for each indicator ranged from 0.73 to 0.929. The scores of the nursing outcome were negatively correlated with the SSA scores (r = -0.555, p < 0.01). With the exception of two indicators, there was a significant difference (p < 0.05) between the total scores of the scale and its 11 indicator scores for the two time points. The results indicated that the nursing outcome "Swallowing status: pharyngeal phase" (1013) exhibited satisfactory psychometric properties and high sensitivity to change.

CONCLUSIONS

The nursing outcome "Swallowing status: pharyngeal phase" (1013) demonstrated good reliability, validity, and sensitivity in patients with laryngeal cancer.

IMPLICATIONS FOR NURSING PRACTICE

The nursing outcome "Swallowing status: pharyngeal phase" (1013) can be used to assess swallowing function in patients with laryngeal cancer and provide guidance for the development of rehabilitation intervention plans and nursing care.

The American Broncho-Esophagological Association Position Statement on Swallowing Fluoroscopy

OBJECTIVES

To develop an expert consensus statement on the clinical use of swallowing fluoroscopy in adults that reduces practice variation and identifies opportunities for quality improvement in the care of patients suffering from swallowing impairment.

METHODOLOGY

A search strategist reviewed data sources (PubMed, Embase, Cochrane, Web of Science, Scopus) to use as evidence for an expert development group to compose statements focusing on areas of controversy regarding swallowing fluoroscopy. Candidate statements underwent two iterations of a modified Delphi protocol to reach consensus.

RESULTS

A total of 2184 publications were identified for title and abstract review with 211 publications meeting the criteria for full text review. Of these, 148 articles were included for review. An additional 116 publications were also included after reviewing the references of the full text publications from the initial search. These 264 references guided the authors to develop 41 candidate statements in various categories. Forty statements encompassing patient selection, fluoroscopic study choice, radiation safety, clinical team dynamics, training requirements, videofluoroscopic swallow study and esophagram techniques, and interpretation of swallowing fluoroscopy met criteria for consensus. One statement on esophagram technique reached near-consensus.

CONCLUSIONS

These 40 statements pertaining to the comprehensive use of swallowing fluoroscopy in adults can guide the development of best practices, improve quality and safety of care, and influence policy in both the outpatient and inpatient settings. The lack of consensus on some aspects of esophagram technique likely reflects gaps in knowledge and clinical practice variation and should be a target for future research. Laryngoscope, 133:255-268, 2023.

Effects of transcranial direct current stimulation on cough reflex and urge-to-cough in healthy young adults

Background

Chronic cough is prevalent in the clinic. The existing therapies are mostly limited to medical treatment, with poor curative effects and serious side effects. Studies have suggested that the right dorsolateral prefrontal cortex (rDLPFC) may play an active role in the inhibitory pathway of cough elicitation. Thus, this study explored the effect of transcranial direct current stimulation (tDCS) on the rDLPFC activation in relation to cough reflex and urge-to-cough sensitivity.

Methods

Twenty-three healthy young adults completed the experiment. Participants randomly received tDCS anodal stimulation, cathodal stimulation, and sham stimulation, and the interval between every two stimuli was at least one week. The tDCS (2 mA, 30 min) stimulated brain rDLPFC region. After tDCS intervention, cough reflex threshold and urge-to-cough were evaluated immediately by inhalation of citric acid-saline solution.

Results

Compared with sham stimulation, the cough reflex thresholds logC₂ and logC₅ have increased under tDCS anodal stimulation (1.78 ± 0.55 g/L vs. 1.57 ± 0.57 g/L, p < 0.05; 1.92 ± 0.53 g/L vs. 1.67 ± 0.56 g/L, p < 0.05), accompanied by the increase of the urge-to-cough threshold LogC_u (0.76 ± 0.53 g/L vs. 0.47 ± 0.44 g/L, p < 0.05). In contrast, the urge-to-cough sensitivity expressed as UTC slope was not significantly changed (1.21 ± 0.86 point·L/g vs. 1.00 ± 0.37 point·L/g, p > 0.05), and there were no apparent changes in cough reflex thresholds Log C₂ and logC₅, urge-to-cough threshold LogC_u, and urge-to-cough sensitivity UTC slope under tDCS cathodal stimulation, compared with sham stimulation.

Conclusions

This study found that anodal tDCS stimulation of rDLPFC could significantly decrease cough reflex sensitivity, accompanied by the increase of urge-to-cough threshold. Further investigations targeting different brain regions using multiple central intervention techniques to explore the underlying mechanisms are warranted.

Trial registration The study protocol was registered for the clinical trial in China (registration number: ChiCTR2100045618)