Validity and Reliability of the Malay Questionnaire for Olfactory Disorders

Background

Olfactory disorders (OD) are an umbrella term for a diverse group of smell problems. Numerous tests and questionnaires have been formulated to identify and test the severity of smell impairment, which is not readily available or translated for the Malaysian population. This study aimed to translate the Questionnaire for Olfactory Disorders (QOD) and validate and test the reliability of the Malay Questionnaire for Olfactory Disorders (mQOD).

Methods

This cross-sectional study was conducted in two tertiary centres. A forward and backward translation was conducted for the QOD. The translated questionnaire was distributed to subjects with self-reported smell disorders on days 1 and 7. Internal consistency was analysed using Cronbach's alpha and test-retest reliability was tested with an intraclass correlation coefficient. Confirmatory factor analysis was performed to test construct validity.

Results

A total of 375 participants were recruited, 52 dropped out and 323 completed the questionnaire a second time. The Cronbach's alpha coefficient was 0.537 for parosmia (P), 0.892 for life quality (LQ), 0.637 for sincerity (S) and 0.865 for visual analogue score (VAS). The intraclass correlation coefficient (ICC) for domain scores was > 0.9, while the ICC for all items was good to excellent. A three-factor model for mQOD showed an acceptable fit with indices chi-square value (CMIN)/degree of freedom (DF) = 3.332, Tucker-Lewis fit index (TLI) = 0.923, comparative fit index (CFI) = 0.939, root mean square error of approximation (RMSEA) = 0.079 and standardised root mean square residual (SRMR) = 0.0574.

Conclusion

The mQOD is a valid and reliable tool for assessing OD in patients.

A Missed Diagnosis of Laryngotracheal Injury Secondary to Emergency Intubation: Lessons Learned

Iatrogenic laryngotracheal trauma is a potentially fatal complication of endotracheal intubation, especially in an emergency setting. Symptoms are almost always related to speech, breathing, and swallowing. Hoarseness being the commonest symptom, while shortness of breath and stridor always signify more devastating injury. We present a case of iatrogenic subglottic and tracheal stenosis, which was misdiagnosed in the emergency department during the first visit. This case report highlights the importance of salient history and thorough examination with a high index of suspicion in a stridorous case with a recent history of intubation. Early detection and management are vital to avoid a life-threatening event.

Quality of life in stroke patients with dysphagia: a systematic review

INTRODUCTION

Dysphagia is a common disorder among stroke patients. Dysphagia can lead to consequences that can negatively impact the quality of life (QoL) in stroke patients.

AIM

To investigate the impact of dysphagia on the QoL in stroke patients.

METHODS

Relevant types of literature were searched from PubMed, Scopus, ProQuest, and Google Scholar databases from inception to July 2022. Peerreviewed studies that aimed to determine the impact of dysphagia on the QoL in stroke patients were included regardless of the year of publication. The National Institutes of Health tool for observational cohort and cross-sectional studies was used to assess the methodological quality of the selected studies. In addition, data analysis was conducted using qualitative methodology with narrative synthesis.

RESULTS

A total of 6 studies met the inclusion criteria with a total number of 381 participants. Only one study has good methodological quality while other studies have fair methodological quality. Dysphagia negatively impacts the QoL in stroke patients, especially those with severe dysphagia. However, after treatment, changes were evident through improved QoL and decreased severity of dysphagia. Moreover, the research found that patients with a higher educational level have a better QoL.

CONCLUSION

Dysphagia has a negative impact on the QoL in stroke patients, so dysphagia in stroke patients should be diagnosed and treated as soon as possible to avoid poor QoL.

Assessment of perception, attitude, and practice of primary care practitioners towards allergic rhinitis practice guidelines: Development and validation of a new questionnaire

BACKGROUND

Primary care practitioners (PCPs), being the front liners, play an important role in treating allergic rhinitis (AR). As there is no proper tool to assess their perception, attitude, and practice in utilizing the guidelines, we aimed to develop and validate a new questionnaire for such purpose.

METHODS

The development phase consists of both literature and expert panel review. The validation phase consists of content validity, face validity, and construct validity. Cronbach's alpha was used to verify internal consistency. The development phase produced a questionnaire with 3 domains: perception, attitude, and practice consisting of 60 items (PAP-PCP questionnaire). Item response theory analysis for perception demonstrated the difficulty and discrimination values were acceptable except for 3 items. Exploratory factor analysis for attitude and practice domains showed the psychometric properties were good except for 3 items in practice domain. Experts judgement was used to decide on the final selection of questionnaire which consists of 59 items.

RESULTS

The final validated questionnaire has 3 domains with 59 items. All domains had Cronbach's alpha above 0.65 which was reliable. 302 physicians completed the questionnaire. 98% PCPs diagnosed AR based on clinical history. Although, majority agree AR guidelines is useful (67%), they had difficulty in using it to classify AR (54.9%) and determine AR severity (73.9%). Oral anti-histamines (first and second generation) were the most prescribed (>75%) followed by intranasal corticosteroids (59%) and combined intranasal corticosteroid and oral anti-histamine (51%). Majority agreed that treatment efficacy (81.8%), adverse effects (83.8%), fear of adverse effects (73.5%), route of administration (69.4%), dosing frequency (72.5%), taste (64.6%) and cost (73.5%) affect treatment compliance.

CONCLUSIONS

The newly developed and validated questionnaire is a promising instrument in understanding the treatment gap in AR. Although further testing and refinement are needed, it provides an initial means for evaluating knowledge and understanding of PCPs in treating AR.

Bilateral Vocal Cord Immobility After Chemoradiotherapy For Nasopharyngeal Carcinoma

Post chemoradiation vocal cord immobility is a rare complication and this maybe life threatening when patients present with severe aspiration and recurrent pneumonia or even worse if they have an upper airway obstruction. We report a case of nasopharyngeal carcinoma patient whom after receiving curative concurrent chemoradiotherapy, presented with episodes of shortness of breath and aspiration pneumonia finally diagnosed with bilateral vocal cord immobility. She had no evidence of tumour recurrence.

Ni endoscopic classification for Storz Professional Image Enhancement System (SPIES) endoscopy in the detection of upper aerodigestive tract (UADT) tumours

The diagnostic procedure for upper aerodigestive tract (UADT) tumours is by white light endoscopy (WLE) combined with biopsy. However, WLE has difficulty identifying minute epithelial changes which hinders early diagnosis. Storz Professional Image Enhancement System (SPIES) is designed to enhance the visualization of microvasculature on the mucosal surface and detect any epithelial changes. In this study, we aimed to evaluate the use of Ni endoscopic classification with SPIES endoscopy in the detection of UADT tumours. Fifty-nine patients with suspected UADT tumours underwent WLE followed by SPIES endoscopy. All the tumours were biopsied and sent for histopathological examination (HPE). The kappa index (κ) was used to evaluate the agreement between the methods. The level of agreement between SPIES using Ni classification and HPE showed almost perfect agreement as compared to moderate agreement between WLE and HPE. The sensitivity and specificity for WLE and HPE were 77.5% and 84.2% respectively with positive predictive value (PPV) of 91.2% and negative predictive value (NPV) of 64%. The sensitivity and specificity for SPIES endoscopy using Ni classification and HPE were 97.5% and 94.7% respectively with PPV of 97.5% and NPV of 94.7%. SPIES endoscopy using Ni classification is a valid tool for earlier tumour detection.

Cervical Aerocele: A Rare Delayed Complication of Tracheostomy

Acquired cervical aerocele in adults is a rare condition and its delay development after tracheostomy decannulation is reported rarely. Our patient presented eight years after tracheostomy decannulation with a compressible anterior neck mass that only appeared when she coughed and could be deflated using manual compression. The mass was situated suprasternal at the previous tracheostomy scar. Computed tomography scan showed a paratracheal air sac without significant defect at the tracheal wall. Surgical intervention is the best treatment for symptomatic patients. As in this patient, we advise direct laryngoscopy and bronchoscopy for diagnostic and therapeutic purposes in such cases. However, our patient refused any surgical intervention.

Clinical Validity and Reliability of the Malay Language Translations of Gastroesophageal Reflux Disease Questionnaire and Quality of Life in Reflux and Dyspepsia Questionnaire in a Primary Care Setting

BACKGROUND

Gastroesophageal Reflux Disease Questionnaire (GERDQ) and Quality of Life in Reflux and Dyspepsia Questionnaire (QOLRAD) are reliable tools for evaluation of GERD.

AIM

We aimed to test validity and reliability of Malay language translations of GERDQ and QOLRAD in a primary care setting.

METHODS

The questionnaires were first translated into the Malay language (GERDQ-M and QOLRAD-M). Patients from primary care clinics with suspected GERD were recruited to complete GERDQ-M, QOLRAD-M, and Malay-translated 36-item short-form health survey (SF-36 or SF-36-M), and underwent endoscopy and 24-h pH-impedance test.

RESULTS

A total of 104 (mean age 47.1 years, women 51.9%) participants were enrolled. The sensitivity and specificity for GERDQ-M cut-off score ≥8 were 90.2 and 77.4%, respectively. Based on this cut-off score, 54.7% had a high probability of GERD diagnosis. GERD-M score ≥8 vs. < 8 was associated with erosive esophagitis (p < 0.001), hiatus hernia (p = 0.03), greater DeMeester score (p = 0.001), and Zerbib scores for acid refluxes (p < 0.001) but not non-acid refluxes (p = 0.1). Mean total scores of QOLRAD-M and SF-36-M were correlated (r = 0.74, p < 0.001). GERDQ-M ≥8, erosive esophagitis, and DeMeester ≥14.72 were associated with impaired QOLRAD-M in all domains (all p < 0.02) but this was not seen with SF-36.

CONCLUSIONS

GERDQ-M and QOLRAD-M are valid and reliable tools applicable in a primary care setting.

Acoustic analysis of voice in post-tonsillectomy patients

Introduction: Tonsillectomy is a common surgical procedure performed in otolaryngology setting worldwide. It is a procedure to remove the palatine tonsils, which are one of the major structures in the oropharynx which constitute part of the vocal tract. The study aimed to determine acoustic changes in post-tonsillectomy patients.Methodology: Voice sampling was collected using Praat software before and after operation, which was one day before operation and within 2-3 weeks after the operation respectively. Acoustic parameters including fundamental frequency, jitter, shimmer, harmonic to noise ratio and first formant frequency were analyzed by using paired t-test.Results: A total of 27 participants that underwent tonsillectomy or adenotonsillectomy were involved in this study. The age range of participants was 3-56 years old. The mean age of study was 18.57. There was no significant difference for all the acoustic parameters between pretonsillectomy and post tonsillectomy. However, there were noticeable voice changes through auditory as perceived by participants or caregiver.Conclusion: Although patient and care givers do notice a significant voice changes, but objectively this finding is not reveals during objective voice assessment.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.382-387

Validity and Reliability Study of Bahasa Malaysia Version of Voice Handicap Index-10

OBJECTIVES

This study aimed to determine the validity and reliability of Bahasa Malaysia version of Voice Handicap Index-10 (mVHI-10).

MATERIALS AND METHODS

This cross-sectional study was carried out in the Otorhinolaryngology, Head and Neck Surgery Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from June 2015 to May 2016. The mVHI-10 was produced following a rigorous forward and backward translation. One hundred participants, including 50 healthy volunteers (17 male, 33 female) and 50 patients with voice disorders (26 male, 24 female), were recruited to complete the mVHI-10 before flexible laryngoscopic examinations and acoustic analysis. The mVHI-10 was repeated in 2 weeks via telephone interview or clinic visit. Its reliability and validity were assessed using interclass correlation.

RESULTS

The test-retest reliability for total mVHI-10 and each item score was high, with the Cronbach alpha of >0.90. The total mVHI-10 score and domain scores were significantly higher (P < 0.001) in the pathology groups (20.92 ± 8.74) than healthy volunteers (1.54 ± 1.97), depicting excellent discriminant validity. The Kaiser-Meyer-Olkin measure was 0.92, which depicted excellent construct validity. There was a significant positive correlation between the mVHI-10 score and jitter and shimmer result (P < 0.001).

CONCLUSIONS

The present study showed good reliability and validity of the mVHI-10 when applied to both healthy volunteers and patients with voice disorders. We recommend the use of the mVHI-10 in daily clinical practice among Bahasa Malaysia-speaking population.

Bilateral vocal cord palsy post thyroidectomy: lessons learnt

Bilateral vocal cord paralysis is a known possible complication following thyroid surgery. It owes to the close relationship between the recurrent laryngeal nerve and the thyroid gland. The most feared complication of bilateral vocal cord paralysis is airway compromise. We report the case of a 39-year-old woman who underwent total thyroidectomy for multinodular goitre. The surgery was uneventful. However she developed stridor in the recovery bay needing intubation. We postulate that the cause was attributed to bilateral vocal cord paresis due to the use of the intraoperative nerve monitoring (IONM) whose high setting throughout the surgery was overlooked. She made a complete recovery without the need of a tracheostomy. We share our lessons learnt from this case.