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Lin CW, Lin HC. Response to "Acute or persistent mechanisms of dysphonia in COVID-19 patients". Am J Otolaryngol 2024; 45:104286. [PMID: 38636171 DOI: 10.1016/j.amjoto.2024.104286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Chung-Wei Lin
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan and Kaohsiung, Taiwan; Department of Business Management, Institute of Healthcare Management and Institute of Biomedical Science, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; Sleep Center, Robotic Surgery Center and Center for Quality Management Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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Espina González C, Núñez Batalla F, Mackers Iglesias P, Sumarroca Trouboul A, Cantón Bascuas M, García Lorenzo J. Dysphonia and other voice alterations associated with COVID-19: Systematic review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024:S2173-5735(24)00059-0. [PMID: 38797375 DOI: 10.1016/j.otoeng.2024.02.005] [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: 10/08/2023] [Accepted: 02/21/2024] [Indexed: 05/29/2024]
Abstract
Among the symptoms presented by patients with SARS-Cov-2 infection, we can find various otorhinolaryngological alterations. Dysphonia appears in up to 79% of infected patients during the acute phase. Dysphonia can also occur as a sequelae, often underestimated, possibly due to its appearance along with other symptoms, also in patients after prolonged intubation or tracheostomy. We present a systematic review of the literature with a bibliographic search in PubMed, Cochrane and Google Scholar, with MESH terms including studies in English and Spanish. The results of the studies found and the vocal manifestations in patients during COVID-19 disease and the consequences produced are analysed. Dysphonia is an acute manifestation of COVID-19 with alterations in aerodynamic and acoustic analysis and in fibrolaryngoscopy. Post-COVID dysphonia can be a persistent symptom that is often underestimated, requiring multidisciplinary management and speech therapy intervention. Laryngeal sequelae are common in post-intubation or post-tracheostomy patients and are related to intubation time, tube number, pronation and respiratory sequelae.
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Affiliation(s)
| | - Faustino Núñez Batalla
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Spain
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Bueno LM, Ramos HVL, Costa CC, Alves W, Velasco LC, De Biase NG. Voice handicap and voice-related quality of life in COVID-19 patients. Braz J Otorhinolaryngol 2024; 90:101437. [PMID: 38701618 PMCID: PMC11078625 DOI: 10.1016/j.bjorl.2024.101437] [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: 12/27/2023] [Revised: 03/11/2024] [Accepted: 03/30/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES Identifying voice handicap and voice-related quality of life in patients presenting pulmonary impairment associated with COVID-19 infection, comparing pulmonary parameters between these patients and individuals in the control group, as well as correlating pulmonary parameters to self-assessment questionnaires (IDV-10 and QVV). METHODS Thirty-five (35) patients presenting pulmonary impairment with COVID-19 infection were herein selected and compared to 35 individuals who were not affected by COVID-19 infection. Two self-assessment questionnaires were applied (vocal handicap index and voice quality of life protocol). Maximum phonation time Forced Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) were measured and videolaryngoscopy was performed. RESULTS There was statistically significant difference in scores recorded in voice self-assessment questionnaires (IDV-10 and QVV), Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) between patients with pulmonary impairment associated with COVID-19 infection and those in the control group. Correlation between PEF/PIF and scores recorded in voice self-assessment questionnaires was also observed. CONCLUSION Pulmonary impairment associated with COVID-19 infection has worsened voice handicap and voice-related quality of life in the assessed patients, as well as reduced their forced expiratory and inspiratory pressure in comparison to the control group. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Lourival Mendes Bueno
- Programa Interinstitucional de Pós-Graduação do Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil.
| | - Hugo Valter Lisboa Ramos
- Programa Interinstitucional de Pós-Graduação do Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil
| | - Claudiney Cândido Costa
- Programa Interinstitucional de Pós-Graduação do Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil
| | - Wilder Alves
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo Dr. Henrique Santillo (CRER), Goiânia, GO, Brazil
| | - Leandro Castro Velasco
- Programa Interinstitucional de Pós-Graduação do Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil
| | - Noemi Grigoleto De Biase
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil; Pontifícia Universidade Católica de São Paulo (PUC-SP), São Paulo, SP, Brazil
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Clayton NA, Freeman-Sanderson A, Walker E. Dysphagia Prevalence and Outcomes Associated with the Evolution of COVID-19 and Its Variants in Critically Ill Patients. Dysphagia 2024; 39:109-118. [PMID: 37347254 PMCID: PMC10781836 DOI: 10.1007/s00455-023-10598-7] [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: 12/18/2022] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
Data collected during the 2020-21 COVID-19 alpha wave indicated dysphagia prevalence rates up to 93%. Whilst many patients recovered during hospital admission, some experienced persistent dysphagia with protracted recovery. To explore (1) prevalence, (2) treatment, and (3) recovery patterns and outcomes for swallowing, in the ICU patient with Delta and subsequent variants of COVID-19. Prospective observational study. Patients admitted to 26 Intensive Care Units (ICUs) over 12 months, diagnosed with COVID-19, treated for survival and seen by Speech-Language Pathology (SLP) for clinical swallowing assessment were included. Demographic, medical, SLP treatment, and swallowing outcome data were collected. 235 participants (63% male, median age = 58 years) were recruited. Median mechanical ventilation was 16 days, and ICU and hospital length of stay (LOS) were 20 and 42 days, respectively. ICU-Acquired Weakness (54%) and delirium (49%) were frequently observed. Prevalence of dysphagia was 94% with the majority (45%) exhibiting profound dysphagia (Functional Oral Intake Scale = 1) at initial assessment. Median duration to initiate oral feeding was 19 days (IQR = 11-44 days) from ICU admission, and 24% received dysphagia rehabilitation. Dysphagia recovery by hospital discharge was observed in 71% (median duration = 30 days [IQR = 17-56 days]). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU LOS, and duration to SLP assessment (p = 0.000), dysphagia severity (p = 0.000), commencing oral intake (p = 0.000), dysphagia recovery (p < 0.01), and enteral feeding (p = 0.000). Whilst older participants had more severe dysphagia (p = 0.028), younger participants took longer to commence oral feeding (p = 0.047). Dysphagia remains highly prevalent in ICU COVID-19 patients. Whilst invasive ventilation duration is associated with swallowing outcomes, more evidence on dysphagia pathophysiology is required to guide rehabilitation.
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Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department & Intensive Care Unit, Concord Repatriation General Hospital, Building 42, Hospital Rd, Concord, Sydney, NSW, 2139, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Amy Freeman-Sanderson
- Speech Pathology Department & Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
- Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Walker
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Clayton NA, Freeman-Sanderson A, Walker E. Prevalence and recovery of dysphonia in COVID-19 patients requiring intensive care treatment. Aust Crit Care 2024; 37:151-157. [PMID: 37709656 DOI: 10.1016/j.aucc.2023.07.043] [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: 02/07/2023] [Revised: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Dysphonia and laryngeal pathology are considerable issues in patients hospitalised with COVID-19 with prevalence rates cited between 29% and 79%. Most studies currently are limited to reporting single-institution data with many retrospective. OBJECTIVES The aims of this study were to prospectively explore the following: (i) prevalence; (ii) treatment; and (iii) recovery pattern and outcomes for dysphonia, in patients with COVID-19 requiring intensive care unit (ICU) treatment. METHODS Patients admitted to 26 ICUs over 12 months, diagnosed with COVID-19, treated for survival, and seen by speech-language pathology for clinical voice assessment were considered. Demographic, medical, speech-language pathology treatment, and voice outcome data (grade, roughness, breathiness, asthenia, strain [GRBAS]) were collected on initial consultation and continuously monitored throughout the hospital admission. FINDINGS Two-hundred and thirty five participants (63% male, median age = 58 yrs) were recruited. Median mechanical ventilation duration and ICU and hospital lengths of stay (LOSs) were 16, 20, and 42 days, respectively. Dysphonia prevalence was 72% (170/235), with 22% (38/170) exhibiting profound impairment (GRBAS score = 3). Of those with dysphonia, rehabilitation was provided in 32% (54/170) cases, with dysphonia recovery by hospital discharge observed in 66% (112/170, median duration = 35 days [interquartile range = 21-61 days]). Twenty-five percent (n = 42) of patients underwent nasendoscopy: oedema (40%, 17/42), granuloma (31%, 13/42), and vocal fold palsy/paresis (26%, 11/42). Presence of dysphonia was inversely associated with the number of intubations (p = 0.002), intubation duration (p = 0.037), ICU LOS (p = 0.003), and hospital LOS (p = 0.009). Conversely, duration of dysphonia was positively associated with the number of intubations (p = 0.012), durations of intubation (p = 0.000), tracheostomy (p = 0.004), mechanical ventilation (p = 0.000), ICU LOS (p = 0.000), and hospital LOS (p = 0.000). More severe dysphonia was associated with younger age (p = 0.045). Proning was not associated with presence (p = 0.075), severity (p = 0.164), or duration (p = 0.738) of dysphonia. CONCLUSIONS Dysphonia and laryngeal pathology are common in critically ill patients with COVID-19 and are associated with younger age and protracted recovery in those with longer critical care interventions.
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Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department & Intensive Care Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Amy Freeman-Sanderson
- Speech Pathology Department & Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Walker
- Speech Pathology Department & Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Linquest L, Ackerman K, Dewan K. Implications of COVID-19 in Airway and Swallowing Function. OTO Open 2023; 7:e74. [PMID: 37693827 PMCID: PMC10487325 DOI: 10.1002/oto2.74] [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: 04/20/2023] [Revised: 07/18/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Objective The acute treatment and complications of the novel COVID-19 virus have been well studied, but the implications of this novel virus for swallowing function continue to be investigated. The goal of this study is to retrospectively assess airway and swallowing outcomes for those patients who required intensive care unit(ICU)-level care for COVID-19 infection. Study Design Comparison of swallowing outcomes through diet change in COVID-19 patients in the Ochsner-Louisiana State University (LSU) Hospital ICU. Setting Ochsner-LSU Hospital (Shreveport, Louisiana). Methods A retrospective chart review was performed from March 2020 to May 2022 to identify patients with a primary diagnosis of COVID-19. Variables analyzed include age, gender, length of intubation, length of ventilation, airway interventions, use of extracorporeal membrane oxygenation, and diet prior to, during, and after hospitalization for COVID-19 infection. Results Two hundred and seven patients fit the inclusion criteria. There was a significant difference in discharge diet between those patients who were intubated and those who were not (P = .007). Thirty percent of patients were discharged on a different diet than their baseline with patients on a nonregular diet significantly more likely to discharge to a facility (P = .043). Negative vaccine status was associated with prolonged ICU stay, prolonged duration of intubation, and prolonged duration of ventilation. Conclusion COVID-19 continues to present novel challenges with new implications and outcomes being discovered in the third year of the pandemic. Further research is necessary to determine the most effective treatment approaches with respect to optimized speech and swallow outcomes.
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Affiliation(s)
- Lauren Linquest
- Department of Otolaryngology–Head and Neck SurgeryLSU‐Health Sciences CenterShreveportLouisianaUSA
| | - Kayla Ackerman
- Department of Otolaryngology–Head and Neck SurgeryLSU‐Health Sciences CenterShreveportLouisianaUSA
| | - Karuna Dewan
- Department of Otolaryngology–Head and Neck SurgeryLSU‐Health Sciences CenterShreveportLouisianaUSA
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Khoddami SM, Aghadoost S, Aghajanzadeh M, Molazeinal Y. The Health-related Quality of Life and Voice Handicap Index in Recovered COVID-19 Patients in Comparison to Healthy Subjects. J Voice 2023:S0892-1997(23)00155-8. [PMID: 37400351 DOI: 10.1016/j.jvoice.2023.05.003] [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: 03/16/2023] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION COVID-19 has various long-lasting effects on different aspects of health and life. This study aimed to evaluate the general health and voice-related quality of life (QOL) and assess their correlation in patients with COVID-19 compared to healthy people. STUDY DESIGN This was a cross-sectional study. METHODS Sixty-eight subjects (with a mean age of 40.07 ± 5.62 years) participated in two groups including 34 recovered-COVID-19 patients and 34 healthy subjects. All participants completed the Persian version of Short Form 36 (SF-36) and Voice Handicap Index (VHI). The patients were assessed two months after recovery when they were discharged from the hospital. RESULTS The results showed the COVID-19 patients got significantly lower scores in all subcategories and two main components of SF-36 compared to the healthy group (P < 0.005). Also, the patients held significantly higher results in VHI and its subscales (P < 0.005). A significant correlation was observed between the physical and mental component summary (PCS and MCS) of SF-36 with a total score of VHI in the COVID-19 patients. CONCLUSION COVID-19 has negative consequences on various aspects of general health and voice-related QOL. Two months after recovery from COVID-19, the patients had the worst scores in all subscales of SF-36 and also, decreased physical, emotional, and functional voice-related QOL which reveals the persistent effect of COVID-19 even after recovery. The general health and voice-related QOL had a noticeable correlation in recovered COVID-19 patients that demonstrates the effect of voice quality in different aspects of life.
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Affiliation(s)
- Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Aghadoost
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahshid Aghajanzadeh
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasamin Molazeinal
- MSc at School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Xiao Y, Lin Y, Chen Q, Wang R, Li Z, Chen D, Huang Y, Peng G. Acupuncture for swallowing disorder after recovery from COVID-19: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2023; 102:e32491. [PMID: 37000050 PMCID: PMC10063305 DOI: 10.1097/md.0000000000032491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Swallowing disorder is a common sequela after recovery from COVID-19. Acupuncture is an important traditional therapy for treating swallowing disorder. However, the efficacy of acupuncture for swallowing disorder after recovery from COVID-19 lacks evidence-based medicine. METHODS All randomized controlled trials of acupuncture for swallowing disorder after recovery from COVID-19 will be retrieved and collected from December 2019 to November 2022 with no language restrictions. PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database, Chinese Biomedical Database, Chinese Science and Technology Journal Database (VIP), and the Wanfang Database will be searched. Two researchers will independently select studies, extract data, and evaluate study quality. The Cochrane risk of bias tool for randomized trials will be used to assess the risk of bias in the included studies. Statistical analyses will be performed using Review Manager version 5.3. RESULTS This study will provide a high-quality and convincing assessment of the efficacy and safety of acupuncture for swallowing disorder after recovery from COVID-19 and will be published in peer-reviewed journals. CONCLUSION Our findings will provide a reference for future clinical decisions and guidance development.
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Affiliation(s)
- Yao Xiao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yueqi Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiqi Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Runyi Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zuming Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Daman Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuxin Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guiyuan Peng
- Department of Otolaryngology-Head and Neck, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China
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Bouldin E, Sandeep S, Gillespie A, Tkaczuk A. Otolaryngologic Symptom Severity Post SARS-CoV-2 Infection. J Voice 2023:S0892-1997(23)00080-2. [PMID: 37068983 PMCID: PMC9977624 DOI: 10.1016/j.jvoice.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023]
Abstract
Objective(s) To assess laryngologic symptomatology following SARS-CoV-2 infection and determine whether symptom severity correlates with disease severity. Methods Single-institution survey study in participants with documented SARS-CoV-2 infection between March 2020 and February 2021. Data acquired included demographic, infection severity characteristics, comorbidities, and current upper aerodigestive symptoms via validated patient reported outcome measures. Primary outcomes of interest were scores of symptom severity questionnaires. COVID-19 severity was defined by hospitalization status. Descriptive subgroup analyses were performed to investigate differences in demographics, comorbidities, and symptom severity in hospitalized participants stratified by ICU status. Multivariate logistical regression was used to evaluate significant differences in symptom severity scores by hospitalization status. Results Surveys were distributed to 5300 individuals with upper respiratory infections. Ultimately, 470 participants with COVID-19 were included where 352 were hospitalized and 118 were not hospitalized. Those not hospitalized were younger (45.87 vs. 56.28 years), more likely female (74.17 vs. 58.92%), and less likely white (44.17 vs. 52.41%). Severity of dysphonia, dyspnea, cough, and dysphagia was significantly worse in hospitalized patients overall and remained worse at all time points. Cough severity paradoxically worsened in hospitalized respondents over time. Dyspnea scores remained abnormally elevated in respondents even 12 months after resolution of infection. Conclusion Results indicate that laryngologic symptoms are expected to be worse in patients hospitalized with COVID-19. Dyspnea and cough symptoms can be expected to persist or even worsen by one-year post infection in those who were hospitalized. Dysphagia and dysphonia symptoms were mild. Non-hospitalized participants tended to have minimal residual symptoms by one year after infection.
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Affiliation(s)
- Emerson Bouldin
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322
| | - Shelly Sandeep
- Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308
| | - Amanda Gillespie
- Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308
| | - Andrew Tkaczuk
- Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308,Corresponding Author: Andrew T. Tkaczuk, Emory University School of Medicine, Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308, Tell: 404-778-3381, Fax: 404-686-4699
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Lin CW, Chiang TY, Chen WC, Chiu LW, Su YC, Lin HC, Chang CT. Is Postextubation Dysphagia Underestimated in the Era of COVID-19? A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:935-943. [PMID: 36842159 DOI: 10.1002/ohn.168] [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: 07/21/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To investigate the incidence rate of postextubation dysphagia (PED) in patients with COVID-19, as well as relative factors potentially influencing the clinical course of dysphagia. DATA SOURCES Six databases including PubMed, MEDLINE, Embase, ScienceDirect, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched with no restriction on the language. REVIEW METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were extracted and cross-examined among 3 of the authors. The random-effects model was adopted for the statistical synthesis. The percentage and 95% confidence interval (CI) were adopted as the effect measurements of the PED incidence rate. Subgroup analyses, sensitivity analyses, and metaregression were also performed to identify the heterogeneity among the studies. RESULTS A total of 594 patients were enrolled and analyzed from the 10 eligible studies. The weighted incidence of PED in patients with COVID-19 was 66.5% (95% CI: 49.7%-79.9%). Age was the potential factor influencing the incidence rate after heterogeneity was adjusted by the metaregression analysis. CONCLUSION Compared to the current evidence reporting only 41% of the non-COVID patients experienced PED, our study further disclosed that a higher 66.5% of COVID-19 patients suffered from PED, which deserves global physicians' attention. With the association between COVID-19 and dysphagia having been more clearly understood, future clinicians are suggested to identify intubated patients' risk factors earlier to strengthen PED care programs in the era of COVID-19.
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Affiliation(s)
- Chung-Wei Lin
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ting-Yi Chiang
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Ching Chen
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Wen Chiu
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yung-Chung Su
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Division of Laryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Business Management and Institute of Biomedical Science, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan.,Sleep Center, Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chun-Tuan Chang
- Department of Business Management and Institute of Biomedical Science, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan
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Lee CL, Huang G, Banda KJ, Chu YH, Jen HJ, Chu H, Liu D, Pien LC, Chen R, Chou KR. Prevalence of oropharyngeal dysphagia and risk of mortality among hospitalized COVID-19 patients: A meta-analysis. J Glob Health 2022; 12:05058. [PMID: 36579715 PMCID: PMC9798345 DOI: 10.7189/jogh.12.05058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Post-extubation and neurologic complications in COVID-19 patients have been shown to cause oropharyngeal dysphagia (OD). We performed the first meta-analysis to explore and estimate the pooled prevalence of OD, risk of mortality, and associated factors among hospitalized COVID-19 patients. Methods We searched Scopus, PubMed, Embase, CINAHL, WHO COVID-19 database, and Web of Science for literature on dysphagia in COVID-19 patients. We used the generalized linear mixed model (GLMM) to determine the prevalence estimates of OD in the R software and the DerSimonian-Lard random-effects model in the Comprehensive Meta-Analysis software to explore the risk of mortality and associated factors of OD, presented as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). We used Cochran's Q, τ2, and the I2 statistic to assess heterogeneity and conducted a moderator analysis to identify moderator variables. Results We included eighteen studies with a total of 2055 participants from the 910 studies retrieved from electronic databases. The prevalence of OD among hospitalized COVID-19 patients was estimated at 35% (95% CI = 21-52; low certainty of evidence) associated with a high risk of mortality (OR = 6.41; 95% CI = 1.48-27.7; moderate certainty of evidence). Intubation (OR = 16.3; 95% CI = 7.10-37.3; high certainty of evidence), use of tracheostomies (OR = 8.09; 95% CI = 3.05-21.5; high certainty of evidence), and proning (OR = 4.97; 95% CI = 1.34-18.5; high certainty of evidence) among hospitalized COVID-19 patients were highly associated with developing OD. The prevalence of OD was higher among hospitalized COVID-19 patients who were admitted in intensive care units (ICU), intubated, and mechanically ventilated. Conclusions The prevalence of OD among hospitalized COVID-19 patients is estimated at 35% associated with a high risk of mortality. OD assessment among hospitalized COVID-19 patients who are managed in an ICU, prone position, intubated, and mechanical ventilated deserves more attention. Registration PROSPERO CRD42022337597.
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Affiliation(s)
- Chi-Li Lee
- Division of Intensive Care Medicine, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Garry Huang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan,Australasian College of Paramedicine, Australia,Australian Institute of Project Management, Australia
| | - Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Yu-Hao Chu
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan,Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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12
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Aghadoost S, Molazeinal Y, Khoddami SM, Shokuhifar G, Dabirmoghaddam P, Saffari M. Dysphonia Severity Index and Consensus Auditory-Perceptual Evaluation of Voice Outcomes, and Their Relation in Hospitalized Patients with COVID-19. J Voice 2022:S0892-1997(22)00384-8. [PMID: 36642593 PMCID: PMC9712076 DOI: 10.1016/j.jvoice.2022.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES This study aimed to compare the results of the Dysphonia Severity Index (DSI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) between patients hospitalized with COVID-19 and healthy subjects, as well as to investigate the correlation between DSI and CAPE-V. STUDY DESIGN Cross-sectional survey. MATERIAL AND METHODS Eighty subjects, 40 COVID-19 patients (with a mean age of 41.2± 5.41) and 40 healthy subjects (with a mean age of 44.50± 3.50) participated in this study. Assessments included the DSI for aerodynamic-acoustic measurement and the Persian version of Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) for evaluating auditory-perceptual voice quality. Data were analyzed by means of the independent t-test and Pearson correlation at the 5% significance level. RESULTS The results showed COVID-19 patients got significantly lower score in DSI compared to healthy subjects (P < 0.05). Moreover, the patients with COVID-19 had higher scores in all categories of voice production (severity, roughness, loudness, pitch, strain and breathiness) than the healthy group (P < 0.05). Comparing the result of the two voice assessments in each group revealed that there was a greater negative significant correlation in the diseased group (r p: -0.68, P: 0.001) than in the healthy group (r p: -0.37,P: 0.049). CONCLUSIONS Hospitalized COVID-19 patients experience deviations in the voice quality and acoustic-aerodynamic features of their voice. Also, the results of this study showed the patient group had higher perceptual dysphonia and lower voice quality compared to the healthy group. Further studies are recommended to determine the relationship between objective and subjective voice evaluation in patients with COVID-19 after recovery.
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Affiliation(s)
- Samira Aghadoost
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Tehran, Iran.
| | - Yasamin Molazeinal
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Ghazaal Shokuhifar
- Department of audiology, University of Social Welfare and Rehabilitation, Tehran, Tehran, Iran
| | - Payman Dabirmoghaddam
- Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Maryam Saffari
- Department of radiology, faculty of medicine, Kashan University of Medical Sciences, Tehran, Tehran, Iran
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13
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Cordani C, Battel I, Del Furia MJ, Lazzarini SG, Negrini S, Arienti C. Dysphagia, dysphonia and olfactory disease: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition. Eur J Phys Rehabil Med 2022; 58:875-879. [PMID: 36534007 PMCID: PMC10153549 DOI: 10.23736/s1973-9087.22.07811-x] [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: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Currently, no evidence exists on specific treatments for post COVID-19 condition (PCC). However, rehabilitation interventions that proved effective for similar symptoms in other health conditions could be applied to people with PCC. With this overview of systematic reviews with mapping, we aimed to describe the Cochrane evidence on rehabilitation interventions proposed for dysphagia, dysphonia and olfactory dysfunction in different health conditions that can be relevant for PCC. EVIDENCE ACQUISITION We searched the last five years' Cochrane Systematic Review (CSRs) using the terms "dysphagia," "swallowing disorder," "dysphonia," "voice disorder," "olfactory dysfunction," "smell changes" and "rehabilitation" in the Cochrane Library. We extracted and summarized the available evidence using a map. We grouped the included CSRs for health conditions and interventions, indicating the effect and the quality of evidence. EVIDENCE SYNTHESIS We found 170 CSRs published between 2016 and 2021 and 1 was included. It provided data on dysphagia in acute and subacute stroke. Interventions included were acupuncture, neuromuscular electrical stimulation, transcranial magnetic stimulation and behavioral interventions, and swallowing therapy, with very low- to moderate-quality evidence. We did not find any CSR on dysphonia and olfactory disease. CONCLUSIONS These results are the first step of indirect evidence able to generate helpful hypotheses for clinical practice and future research. They served as the basis for the three recommendations on treatments for these PCC symptoms published in the current WHO Guidelines for clinical practice.
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Affiliation(s)
- Claudio Cordani
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Irene Battel
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy -
| | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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14
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Yang X, Shi L, Ran D, Li M, Qin C, An Z. The treatment of post-stroke dysarthria with a combination of different acupuncture types and language rehabilitation training: a systematic review and network meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1281. [PMID: 36618810 PMCID: PMC9816828 DOI: 10.21037/atm-22-5583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
Background This study used a network meta-analysis to evaluate the efficacy of various different acupuncture types and language rehabilitation training on post-stroke dysarthria (PSD), and examined the possible mechanisms involved. There are often clinical studies comparing the effects of different acupuncture methods on dysarthria after stroke. The efficacy of these methods can be ranked by network meta-analysis. This is necessary for clinical acupoints selection. The results of this study illustrated the comparison of the therapeutic effects of 6 different acupuncture types, which can provide some reference for clinical acupoints selection and research. Methods A comprehensive search for clinical studies related to the use of acupuncture to treat PSD was conducted in eight English and Chinese databases. Patients were divided into six groups based on the acupoints selected, namely, tongue, neck, scalp, body, combination, and traditional acupuncture. The recovery of neurological function in the patients was assessed based on the curative impact and the National Institutes of Health Stroke Scale (NIHSS) score. The quality of the included studies was evaluated using the Cochrane risk bias assessment tool and the STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) criteria. A network meta-analysis was performed using the network-meta package of Stata 15.1 software based on frequency. The heterogeneity test, consistency test, head-to-head mixed comparison, efficacy ranking, and publication bias study were all performed. Results A total of 47 studies were finally included. There was a total of 4,197 patients in the eligible studies. The model for network meta-analysis proved robust, with minimal heterogeneity and high consistency. Combined acupuncture combined with language rehabilitation training was the most effective in treating dysarthria symptoms, followed by tongue acupuncture (TA) and nape acupuncture (NA). In addition, the combined effect of acupuncture and language training was superior to that of acupuncture alone. In terms of recovery of nerve function, traditional acupuncture and body acupuncture were more effective. To facilitate the recovery of nerve function, increasing the frequency of acupoints is necessary. Conclusions Combined acupuncture may have the most beneficial healing effect on PSD, followed by acupuncture of the tongue and the nape of the neck. In terms of recovery of nerve function, traditional acupuncture and body acupuncture may have more effective.
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Affiliation(s)
- Xinming Yang
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Lei Shi
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Dawei Ran
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Menghan Li
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chenyang Qin
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zimeng An
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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15
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Plementas M, Trapl-Grundschober M. Reoralisierung nach Intubation bei Intensivaufenthalt. PSYCHOPRAXIS. NEUROPRAXIS 2022. [PMCID: PMC9395934 DOI: 10.1007/s00739-022-00833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Die Schluckfunktion kann durch eine Intubation stark beeinträchtigt werden. Essen und Trinken, aber auch Speichelschlucken können dadurch massiv gestört werden. In diesem Fall konnten einer jungen, multimorbiden Frau durch die Zusammenarbeit des gesamten medizinischen Personals die Nahrungsaufnahme wieder ermöglicht und die Lebensqualität gesteigert werden.
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