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Yamaga R, Chikaishi M, Iwasaki T, Tada A, Mizutani S, Amano K, Iwase Y, Taniguchi H. Pilot study on the relationship between oral function or subjective symptoms and appetite. J Oral Rehabil 2024. [PMID: 39054906 DOI: 10.1111/joor.13811] [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: 04/02/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE This pilot study evaluated the relationships between appetite and oral function, and between appetite and the subjective symptoms of decreased oral function. METHODS Seventy-one adult dental clinic patients (22 males, 66.0 ± 14.0 years) participated in this study. A Council on Nutrition Appetite Questionnaire score of ≤28 indicated anorexia, and the Mini Nutritional Assessment Short-form, body mass index and skeletal muscle mass index were used to define subject characteristics. Seven oral function tests and seven subjective symptoms related to oral function were evaluated. The relationship between subject characteristics, oral function tests, subjective symptoms and anorexia was analysed using the chi-square test and univariate and multivariate logistic regression. RESULT There were significant differences between the normal appetite group and the anorexia group for the 10-item Eating Assessment Tool (EAT-10) survey and the question 'Food remains in the oral cavity after eating' (p < .05). Univariate logistic regression found significant differences in the items of masticatory function, the EAT-10 survey and the question 'Food remains in the oral cavity after eating'. Multivariate logistic regression revealed significant differences in masticatory function (AOR 4.35; 95% CI: 1.03-18.35; p = .045) and EAT-10 (AOR 6.27; 95% CI: 1.40-24.02; p = .016). CONCLUSION This pilot study investigated the influence of factors related to oral function on appetite. Relationships were found among poor masticatory function, poor swallowing function and anorexia.
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Affiliation(s)
- Ryosuke Yamaga
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Department of Dentistry for Persons with Disabilities, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Yamaga Dental Clinic, Kuwana, Japan
| | - Masato Chikaishi
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Department of Dentistry for Persons with Disabilities, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Department of Dentistry and Oral-Maxillofacial Surgery, Chikaishi Hospital, Medical Corporation Touhoukai, Gifu, Japan
| | - Toshihiro Iwasaki
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Akira Tada
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Department of Oral Surgery, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Saki Mizutani
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Department of Dentistry for Persons with Disabilities, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Kota Amano
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Yoko Iwase
- Department of Dentistry for Persons with Disabilities, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Hiroshige Taniguchi
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
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Cordier R, Joosten AV, Heijnen BJ, Speyer R. A Psychometric Evaluation of the Dysphagia Handicap Index Using Rasch Analysis. J Clin Med 2024; 13:2331. [PMID: 38673604 PMCID: PMC11050868 DOI: 10.3390/jcm13082331] [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: 02/29/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: The Dysphagia Handicap Index (DHI) is commonly used in oropharyngeal dysphagia (OD) research as a self-report measure of functional health status and health-related quality of life. The DHI was developed and validated using classic test theory. The aim of this study was to use item response theory (Rasch analysis) to evaluate the psychometric properties of the DHI. Methods: Prospective, consecutive patient data were collected at dysphagia or otorhinolaryngology clinics. The sample included 256 adults (53.1% male; mean age 65.2) at risk of OD. The measure's response scale, person and item fit characteristics, differential item functioning, and dimensionality were evaluated. Results: The rating scale was ordered but showed a potential gap in the rating category labels for the overall measure. The overall person (0.91) and item (0.97) reliability was excellent. The overall measure reliably separated persons into at least three distinct groups (person separation index = 3.23) based on swallowing abilities, but the subscales showed inadequate separation. All infit mean squares were in the acceptable range except for the underfitting for item 22 (F). More misfitting was evident in the Z-Standard statistics. Differential item functioning results indicated good performance at an item level for the overall measure; however, contrary to expectation, an OD diagnosis presented only with marginal DIF. The dimensionality of the DHI showed two dimensions in contrast to the three dimensions suggested by the original authors. Conclusions: The DHI failed to reproduce the original three subscales. Caution is needed using the DHI subscales; only the DHI total score should be used. A redevelopment of the DHI is needed; however, given the complexities involved in addressing these issues, the development of a new measure that ensures good content validity may be preferred.
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Affiliation(s)
- Reinie Cordier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
| | | | - Bas J. Heijnen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands;
| | - Renée Speyer
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands;
- Department Special Needs Education, University of Oslo, NO-0371 Oslo, Norway
- MILO Foundation, Centre for Augmentative and Alternative Communication, 5482 JH Schijndel, The Netherlands
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López-Fernández MD, Fernández-Lao C, Ruíz-Martínez AM, Fernández-Gualda MÁ, Lozano-Lozano M, Ortiz-Comino L, Galiano-Castillo N. Exploring predictors of dysphagia in survivors of head and neck cancer: A cross-sectional study. Support Care Cancer 2024; 32:162. [PMID: 38366091 PMCID: PMC10873441 DOI: 10.1007/s00520-024-08358-w] [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: 10/25/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE To evaluate the prevalence of dysphagia in survivors of head and neck cancer (sHNC) and to identify the predictors contributing to the development of dysphagia. METHODS We enrolled 62 sHNC in a cross-sectional study to check the prevalence of dysphagia in sHNC and to evaluate which factors were influencing the presence of this side effect. Besides dysphagia, sociodemographic and clinical characteristics, oral symptoms, maximal mouth opening (MMO), sleep quality and physical condition were evaluated, and a linear regression analysis was performed to verify which of these outcomes impact dysphagia. RESULTS Among all the sHNC, 85.5% presented dysphagia. The linear regression analysis confirmed that 44.9% of the variance in dysphagia was determined by coughing, MMO and sleep quality, being MMO the most powerful predictor, followed by coughing and sleep quality. CONCLUSION Dysphagia affected the great majority of sHNC. Moreover, symptoms as coughing, reduced MMO and sleep disorders may act as predictors contributing to the development of dysphagia. Our results emphasize the importance of an early and proper identification of the symptoms as well as an adequate treatment strategy to address the cluster of symptoms that sHNC undergo.
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Affiliation(s)
- María Dolores López-Fernández
- UGC Medicina Física y Rehabilitación, Hospital de Neurotraumatología y Rehabilitación, Hospital Universitario Virgen de Las Nieves, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Carolina Fernández-Lao
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Sport and Health Research Center (IMUDs), Instituto de Investigación Biosanitaria Ibs, Granada, Spain.
| | - Alba María Ruíz-Martínez
- Department of Radiation Oncology, Hospital Universitario Vírgen de Las Nieves, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Miguel Ángel Fernández-Gualda
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Mario Lozano-Lozano
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Sport and Health Research Center (IMUDs), Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Lucía Ortiz-Comino
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty (Melilla), University of Granada, Sport and Health Research Center (IMUDs), Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Noelia Galiano-Castillo
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Sport and Health Research Center (IMUDs), Instituto de Investigación Biosanitaria Ibs, Granada, Spain
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Kamei M, Nishibe M, Araki R, Kohyama K, Kusakabe Y. Effect of texture preference on food texture perception: Exploring the role of matching food texture and preference. Appetite 2024; 192:107078. [PMID: 37898406 DOI: 10.1016/j.appet.2023.107078] [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: 08/02/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/30/2023]
Abstract
This study aimed to investigate the influence of smooth texture preference on smoothness perception. An online questionnaire (Study 1, n = 464) and a sensory evaluation test (Study 2, n = 65) were administered to Japanese elderly participants (65-74 years), with common Japanese confectionery (Daifuku) as test foods. Through the online questionnaire, four distinct texture preference groups were formed based on the factors of preference for smoothness and firmness of the inner bean paste layer. Analysis of the food preference scale for imbalanced diet (FPSID) revealed that smooth-texture likers were more likely to be picky eaters than firm-texture likers. Furthermore, high (HiSm) and low smoothness preference groups (LoSm) were selected for the food sensory evaluation test to compare perceived textures (smoothness and firmness). Only the HiSm group exhibited a positive association between perceived smoothness and overall texture liking, perceiving smoothness significantly more intense than the LoSm group in situations where overall texture liking was high. This finding indicates that smooth texture preference does not act independently but rather interacts with food texture matching to affect perception. Our findings suggest that when food texture aligns with individuals' preferences, it elicits hedonic emotions and dynamically enhances food texture perception. This preference-involved perceptual process may contribute to the development of more explicit texture preferences.
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Affiliation(s)
- Mio Kamei
- Food Research Institute, National Agricultural and Food Research Organization, Japan.
| | - Misaki Nishibe
- Food Research Institute, National Agricultural and Food Research Organization, Japan
| | - Risa Araki
- Food Research Institute, National Agricultural and Food Research Organization, Japan
| | - Kaoru Kohyama
- Food Research Institute, National Agricultural and Food Research Organization, Japan
| | - Yuko Kusakabe
- Food Research Institute, National Agricultural and Food Research Organization, Japan
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Giray E, Eyigör S, Çalık Y, Albayrak Gezer İ, Sarı A, Umay E, Akaltun MS, Tıkız C, Ünlü Z, Vural M, Aydeniz B, Karahan AY. The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye. Turk J Phys Med Rehabil 2023; 69:453-468. [PMID: 38766582 PMCID: PMC11099854 DOI: 10.5606/tftrd.2023.11894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/10/2023] [Indexed: 05/22/2024] Open
Abstract
Objectives The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL. Patients and methods This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI). Results The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores. Conclusion Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.
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Affiliation(s)
- Esra Giray
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Türkiye
| | - Sibel Eyigör
- Department of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Yalkın Çalık
- Department of Physical Medicine and Rehabilitation, Bolu Izzet Baysal Physical Treatment and Rehabilitation Training and Research Hospital, Bolu, Türkiye
| | - İlknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, Selçuk University Faculty of Medicine, Konya, Türkiye
| | - Aylin Sarı
- Department of Physical Medicine and Rehabilitation, Erenköy Physical Medicine and Rehabilitation Hospital, Istanbul, Türkiye
| | - Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Dışkapı Training and Research Hospital, Ankara, Türkiye
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
| | - Canan Tıkız
- Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Zeliha Ünlü
- Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Meltem Vural
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Banu Aydeniz
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Medical Faculty of Uşak University, Uşak, Türkiye
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Blaszczyk A, Brandt N, Ashley J, Tuders N, Doles H, Stefanacci RG. Crushed Tablet Administration for Patients with Dysphagia and Enteral Feeding: Challenges and Considerations. Drugs Aging 2023; 40:895-907. [PMID: 37707775 PMCID: PMC10511598 DOI: 10.1007/s40266-023-01056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/15/2023]
Abstract
Dysphagia is increasingly common in older adults; it is especially prevalent in long-term care settings. Patients with dysphagia likely require pharmacologic treatment for multiple comorbidities but may find it difficult or impossible to swallow oral medications. Administering crushed medications mixed with a soft food or liquid vehicle, or via a feeding tube, is a common strategy to circumvent swallowing difficulties in patients with dysphagia. However, inappropriate medication use and improper crushing technique can reduce the medication dose a patient receives, alter medication pharmacokinetics and pharmacodynamics, and compromise treatment efficacy and patient safety. Clinical judgment is needed to identify medications that can and cannot be crushed, select a crushing methodology and vehicle for administering crushed medications, and create a strategy for administering multiple medications. A coordinated effort from the entire care team-including physicians, pharmacists, nurses, advanced practice providers, speech therapists, patients, and caregivers-is necessary to develop and implement an individualized plan for administering medications to patients with dysphagia. This review details the current literature regarding the administration of medications that have been altered, such as by crushing tablets or opening capsules, for patients with dysphagia or who are receiving enteral feeding and provides recommendations on best practices.
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Affiliation(s)
- Amie Blaszczyk
- Division of Geriatrics and Pediatrics, Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Dallas, TX, USA
| | - Nicole Brandt
- Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Jeremy Ashley
- Fisch College of Pharmacy, University of Texas at Tyler, Tyler, TX, USA
| | - Nancy Tuders
- National Association of Directors of Nursing Administration of Long-Term Care, Springdale, OH, USA
| | - Hannah Doles
- Division of Geriatrics and Pediatrics, Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Dallas, TX, USA
| | - Richard G Stefanacci
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut Street, 10th Floor, Philadelphia, PA, 19107, USA.
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Kang MG, Ji S, Park YK, Baek JY, Kwon YH, Seo YM, Lee SH, Lee E, Jang IY, Jung HW. The Clinical Frailty Scale as a Risk Assessment Tool for Dysphagia in Older Inpatients: A Cross-Sectional Study. Ann Geriatr Med Res 2023; 27:204-211. [PMID: 37429593 PMCID: PMC10556717 DOI: 10.4235/agmr.23.0053] [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: 04/17/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Dysphagia is a common problem with potentially serious consequences including malnutrition, dehydration, pneumonia, and death. However, there are challenges in screening for dysphagia in older adults. We assessed the feasibility of using the Clinical Frailty Scale (CFS) as a risk assessment tool for dysphagia. METHODS This cross-sectional study was conducted at a tertiary teaching hospital from November 2021 to May 2022 and included 131 older patients (age ≥65 years) admitted to acute wards. We used the Eating Assessment Tool-10 (EAT-10), which is a simple measure for identifying individuals at risk of dysphagia, to assess the relationship between EAT-10 score and frailty status as measured using the CFS. RESULTS The mean age of the participants was 74.3±6.7 years, and 44.3% were male. Twenty-nine (22.1%) participants had an EAT-10 score ≥3. The CFS was significantly associated with an EAT-10 score ≥3 after adjusting for age and sex (odds ratio=1.48; 95% confidence interval [CI], 1.09-2.02). The CFS was able to classify the presence of an EAT-10 score ≥3 (area under the receiver operating characteristic [ROC] curve=0.650; 95% CI, 0. 544-0.756). The cutoff point for predicting an EAT-10 score ≥3 was a CFS of 5 according to the highest Youden index, with a sensitivity of 82.8% and a specificity of 46.1%. The positive and negative predictive values were 30.4% and 90.4%, respectively. CONCLUSION The CFS can be used as a tool to screen for the risk of swallowing difficulty in older inpatients to determine clinical management encompassing drug administration routes, nutritional support, prevention of dehydration, and further evaluation of dysphagia.
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Affiliation(s)
- Min-gu Kang
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Sunghwan Ji
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ki Park
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hye Kwon
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Yeon mi Seo
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses. Dysphagia 2023; 38:76-121. [PMID: 35639156 PMCID: PMC9873728 DOI: 10.1007/s00455-022-10465-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/29/2022] [Indexed: 01/28/2023]
Abstract
Oropharyngeal dysphagia (OD) is prevalent in the elderly and persons with complex medical conditions, resulting in considerable medical and psychosocial consequences and reduced quality of life. Many prevalence studies regard OD in relation to age or diagnosis. Knowledge on the prevalence of OD in different healthcare settings is lacking. This systematic review aimed to estimate the prevalence of OD in adults admitted to hospitals, rehabilitation facilities, nursing homes, and palliative care facilities through meta-analyses. A systematic literature search was completed including all dates up to March 30, 2021. The methodology and reporting were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Forty-four out of 1,956 screened articles were deemed eligible. Considerable heterogeneity in definitions of OD and type and quality of selected outcome measures were observed. Overall within-group pooled prevalence estimates for OD determined by meta-analysis were 36.5% (95% CI 29.9 - 43.6) in the hospital setting, 42.5% (95% CI 35.8 - 49.5) in the rehabilitation setting, and 50.2% (95% CI 33.3-67.2) in nursing homes. No OD prevalence data were identified for palliative care facilities. Results for between-group analyses of OD prevalence estimates in the hospital setting were non-significant for type of assessment method, diagnostic group, and type of hospital ward, but indicated significantly higher prevalence estimates in nursing homes when using screening compared to patient-report. Future research should provide OD prevalence data for palliative care, achieve consensus in OD-related terminology when performing prevalence studies, and use screening and assessments with optimal diagnostic performance and psychometric properties.
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Affiliation(s)
| | - Lena Hartelius
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Skaraborgs Hospital, Skövde, Sweden
| | - Liza Bergström
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Speech Pathology, Division of Neurology, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- REMEO Stockholm, Stockholm, Sweden
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Renée Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, the Netherlands
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Ghelichi L, Hashemian M, Nakhostin Ansari N, Tarameshlu M. Cross-cultural Adaption, Validation and Factor Analysis of the Persian Version of the Eating Assessment Tool: EAT-10. Dysphagia 2022; 37:1511-1518. [PMID: 35132473 DOI: 10.1007/s00455-021-10405-1] [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: 10/02/2021] [Accepted: 12/28/2021] [Indexed: 02/05/2023]
Abstract
The eating assessment tool (EAT-10) is a self-reported questionnaire to assess the patient's perception of swallowing difficulties. The aim of this study was to cross-culturally adapt and determine validity and reliability of the Persian version of the EAT-10 (P-EAT-10) in patients with oropharyngeal dysphagia. The EAT-10 was translated into Persian language and cross-culturally adapted. One hundred patients with dysphagia (mean age ± SD = 44.44 ± 14.69 years) participated. The test-retest reliability (time interval = 7 days) was assessed in 50 patients. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were analyzed. The Persian version of functional oral intake scale (FOIS-P) was also recorded to assess construct validity. One hundred healthy subjects completed the P-EAT-10 for clinical validity. Factor analysis was performed to determine the P-EAT-10 structure. There were no missing responses and floor or ceiling effects. Internal consistency was high (Cronbach's α 0.91). Item-total correlations exceeded acceptable standard of 0.3 for the all items (0.62-0.83). The test-retest reliability was excellent [(ICC)agreement 0.96]. The SEM and SDC were 2.61 and 7.23, respectively. Construct validity was confirmed by a significant correlation between the P-EAT-10 and FOIS-P scores (r = 0.84). Clinical validity was supported by a significant discrimination between patients and healthy subjects (t = 29.97, P < 0.001). Factor analysis indicated 2 components for the P-EAT-10. The P-EAT-10 is a valid and reliable tool and can be used in clinic and research for the assessment of oropharyngeal dysphagia in Persian-speaking patients.
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Affiliation(s)
- Leila Ghelichi
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Hashemian
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tarameshlu
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
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10
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Kilinc HE, Ünver B. Effects of Craniocervical Flexion on Suprahyoid and Sternocleidomastoid Muscle Activation in Different Exercises. Dysphagia 2022; 37:1851-1857. [PMID: 35471669 DOI: 10.1007/s00455-022-10453-1] [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: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022]
Abstract
This study aims to investigate the effects of craniocervical flexion (CCF) on the activation of suprahyoid and sternocleidomastoid (SCM) muscles in Shaker and Resistant Jaw Opening (RJO) exercises, and to compare the effects of these two exercises on the same muscles with the Chin Tuck Against Resistance (CTAR) exercise. The study recruited a total of 37 healthy participants (20 female and 17 male, mean age: 27.45 ± 7.32 years). All participants received craniocervical flexion training with the biofeedback pressure unit (Stabilizer™, Chattanooga Group Inc. USA). Shaker, Shaker with CCF, RJO, RJO with CCF and CTAR exercises were performed and surface electromyographic (sEMG) activations of the suprahyoid and SCM muscles were recorded. In addition, the maximum sEMG activations of suprahyoid and SCM muscles were recorded for the normalization procedure. CCF increased the effect of Shaker exercise on the suprahyoid muscle activation (p < 0.001); but this effect was not seen in RJO exercise (p > 0.05). Suprahyoid muscle activation was lower in Shaker exercise compared to RJO and CTAR exercises (p < 0.016). SCM muscle activation was greater in CTAR exercise compared to Shaker and RJO exercises (p < 0.016). The addition of CCF to the Shaker and RJOE exercises did not affect the ranking among the three exercises for both the suprahyoid and SCM muscles. The result of this study suggest that integration of CCF movement to the Shaker exercise would have a greater therapeutic effect. In addition, RJO exercise can be included in the rehabilitation program as an alternate to CTAR exercise.
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Affiliation(s)
- Hasan Erkan Kilinc
- Physical Therapy and Rehabilitation Faculty, Hacettepe University, Samanpazarı/Altındağ, 06230, Ankara, Turkey.
| | - Banu Ünver
- Health Science Faculty, Physiotherapy and Rehabilitation Department, Lokman Hekim University, Ankara, Turkey
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11
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Hazelwood RJ, Armeson KE, Hill EG, Bonilha HS, Martin-Harris B. Relating Physiologic Swallowing Impairment, Functional Swallowing Ability, and Swallow-Specific Quality of Life. Dysphagia 2022:10.1007/s00455-022-10532-3. [PMID: 36229718 PMCID: PMC10097835 DOI: 10.1007/s00455-022-10532-3] [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: 05/22/2021] [Accepted: 10/03/2022] [Indexed: 11/24/2022]
Abstract
Many studies include functional swallowing ability and quality of life information to indicate a response to a specific swallowing intervention or to describe the natural history of dysphagia across diseases and conditions. Study results are difficult to interpret because the association between these factors and actual swallowing impairment is not understood. We set out to test the associations between components of physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life using standardized and validated measurement tools: Modified Barium Swallow Impairment Profile (MBSImP), Functional Oral Intake Scale (FOIS), Eating Assessment Tool (EAT-10), and Dysphagia Handicap Index (DHI). We specifically aimed to understand which factors may contribute to the overall relationships between these measurement tools when analyzed using total scores and item-level scores. This study included a heterogeneous cohort of 273 outpatients who underwent a modified barium swallow study (MBSS). We found significant correlations between MBSImP total scores and FOIS scores and DHI total scores, but not between MBSImP total scores and EAT-10 total scores. Significant correlations were also found between MBSImP item-level component scores and FOIS scores, EAT-10 total scores, and DHI total scores. Detailed item-level analyses revealed the MBSImP components of bolus transport/lingual motion, oral residue, and tongue base retraction were correlated with EAT-10 item-level scores and DHI item-level scores. The clinically modest associations between physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life reveal different factors that uniquely contribute to patients' overall dysphagic profile, emphasizing the clinical impact of a comprehensive swallowing assessment.
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Affiliation(s)
- R Jordan Hazelwood
- Department of Rehabilitation Sciences, Beaver College of Health Sciences, Appalachian State University, Boone, NC, USA.
| | - Kent E Armeson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Heather Shaw Bonilha
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA.,Department of Otolaryngology-Head and Neck Surgery and Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Edward Hines, Jr. VA Hospital, Hines, IL, USA
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12
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A simplified method for evaluating swallowing ability and estimating malnutrition risk: A pilot study in older adults. PLoS One 2022; 17:e0263896. [PMID: 35171950 PMCID: PMC8849596 DOI: 10.1371/journal.pone.0263896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/29/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The aim of this pilot study was to develop a Thai-version of a simple swallowing questionnaire, called the T-SSQ, and to evaluate the association between malnutrition risk and swallowing ability, determined objectively by tongue strength and subjectively by the T-SSQ. Sensitivity analysis was also performed to determine which swallowing indices better estimate malnutrition in older adults. Methods This cross-sectional study comprised two phases: Phase I, development and cross-cultural translation of the T-SSQ; and Phase II, application of the T-SSQ in 60 older adults. In Phase I, content and face validity of the T-SSQ was evaluated by 10 experts and 15 older adults. In Phase II, the convergent validity of the T-SSQ was evaluated by determining its association with objective tongue strength. Nutritional status was evaluated using the Thai-version of the Mini-Nutritional Assessment. Covariates included sociodemographic characteristics, and oral and health-related status. Adjusting for covariates, the associations between the two swallowing indices and malnutrition risk were determined using multivariable regression analyses. A cut-off value for low tongue strength was determined using a receiver operating characteristic (ROC) curve, and sensitivity analysis between the swallowing indices and malnutrition risk was performed. Results The T-SSQ comprised 4-items of common signs and symptoms of a swallowing problem. Its content and face validity were verified. Older adults were considered as having a swallowing problem when at least one item was reported. Convergent validity of the subjective index was shown by significantly different tongue strength values between the participants with and without a swallowing problem (p for independent t-test = 0.014). Based on the highest area under the ROC curve, an 18-kPa cut-off value was chosen to classify low tongue strength. Having a swallowing problem and low tongue strength was significantly associated with malnutrition risk. The positive predictive value of the subjective swallowing index was 1.8-fold higher than objective tongue strength. Conclusions Self-reported swallowing problems determined by the T-SSQ can be used as a subjective index for evaluating swallowing ability in older adults. Subjective swallowing problems and objective tongue strength were associated with malnutrition risk. However, the T-SSQ estimated malnutrition risk better than the objective index.
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13
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Hum S, Fellows LK, Lourenco C, Mayo NE. Are the Items of the Starkstein Apathy Scale Fit for the Purpose of Measuring Apathy Post-stroke? Front Psychol 2021; 12:754103. [PMID: 34950086 PMCID: PMC8688540 DOI: 10.3389/fpsyg.2021.754103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Importance: Given the importance of apathy for stroke, we felt it was time to scrutinize the psychometric properties of the commonly used Starkstein Apathy Scale (SAS) for this purpose. Objectives: The objectives were to: (i) estimate the extent to which the SAS items fit a hierarchical continuum of the Rasch Model; and (ii) estimate the strength of the relationships between the Rasch analyzed SAS and converging constructs related to stroke outcomes. Methods: Data was from a clinical trial of a community-based intervention targeting participation. A total of 857 SAS questionnaires were completed by 238 people with stroke from up to 5 time points. SAS has 14 items, rated on a 4-point scale with higher values indicating more apathy. Psychometric properties were tested using Rasch partial-credit model, correlation, and regression. Items were rescored so higher scores are interpreted as lower apathy levels. Results: Rasch analysis indicated that the response options were disordered for 8/14 items, pointing to unreliability in the interpretation of the response options; they were consequently reduced from 4 to 3. Only 9/14 items fit the Rasch model and therefore suitable for creating a total score. The new rSAS was deemed unidimensional (residual correlations: < 0.3), reasonably reliable (person separation index: 0.74), with item-locations uniform across time, age, sex, and education. However, 30% of scores were > 2 SD above the standardized mean but only 2/9 items covered this range (construct mistargeting). Apathy (rSAS/SAS) was correlated weakly with anxiety/depression and uncorrelated with physical capacity. Regression showed that the effect of apathy on participation and health perception was similar for rSAS/SAS versions: R2 participation measures ranged from 0.11 to 0.29; R2 for health perception was ∼0.25. When placed on the same scale (0–42), rSAS value was 6.5 units lower than SAS value with minimal floor/ceiling effects. Estimated change over time was identical (0.12 units/month) which was not substantial (1.44 units/year) but greater than expected assuming no change (t: 3.6 and 2.4). Conclusion: The retained items of the rSAS targeted domains of behaviors more than beliefs and results support the rSAS as a robust measure of apathy in people with chronic stroke.
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Affiliation(s)
- Stanley Hum
- McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, Montreal, QC, Canada
| | - Lesley K Fellows
- McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, Montreal, QC, Canada
| | - Christiane Lourenco
- Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, Brazil
| | - Nancy E Mayo
- McGill University, Montreal, QC, Canada.,McGill University Health Centre (MUHC), Montreal, QC, Canada.,McGill University Health Centre-Research Institute (MUHC-RI), Montreal, QC, Canada
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14
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Declau F, Pingnet L, Verkest V, Hansen T. Cross-Cultural Evaluation of the Dutch FACE-Q Rhinoplasty Questionnaires Using Rasch Analysis. Aesthet Surg J 2021; 41:NP1916-NP1930. [PMID: 33945612 DOI: 10.1093/asj/sjab217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The English version of the FACE-Q rhinoplasty module, developed according to Rasch measurement theory, has recently been translated into Dutch. Before conclusions can be drawn from the Dutch version, this translation must also fit the item analysis by the Rasch model. OBJECTIVES The primary aim of this study was to evaluate cross-cultural equivalence between the Dutch and English versions of the FACE-Q rhinoplasty module by applying Rasch methodology. METHODS Rasch analysis performed with Winsteps (Beaverton, OR) was used to evaluate the Dutch version of the FACE-Q nose and nostrils scales with data from a prospective consecutive cohort of 100 Dutch-speaking septorhinoplasty patients. New Dutch-related conversion tables were constructed for the FACE-Q nose and nostrils scales and compared to the original ones. Psychometric cross-validation was performed by receiver operating characteristics (ROC) analysis. RESULTS Both questionnaires adequately met the requirement of invariance. Within an acceptable range, some issues with item and person fit were found, as well as some local item dependency and differential item functioning. However, comparison of the Dutch- and English-related conversion tables by ROC analysis demonstrated identical results for the FACE-Q nose and nostrils scales. CONCLUSIONS Item analysis by the Rasch model on the data of a Dutch-speaking population proved the conceptual correspondence with the original English version.
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Affiliation(s)
- Frank Declau
- ENT Department, Sint-Vincentius Hospital, Antwerp, Belgium
| | - Laura Pingnet
- ENT Department, Sint-Vincentius Hospital, Antwerp, Belgium
| | | | - Tina Hansen
- Department of Physical and Occupational Therapy, University Hospital Hvidovre-Amager, Hvidovre, Denmark
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15
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Schimmel M, Domioni T, Bukvic H, Arakawa I, Seifert E, Abou-Ayash S. Oral diadochokinesis and associated oro-facial function in young and old German mother-tongue speakers: A cross-sectional study. Gerodontology 2021; 39:33-40. [PMID: 34741348 PMCID: PMC9298062 DOI: 10.1111/ger.12602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
Objectives The aims of this study were to compare oral diadochokinesis and to test associations with oro‐facial functional parameters in healthy young and old German speakers. Background Oral diadochokinesis is a key component in the concept of oro‐facial hypofunction and relates to tongue and lip motor function but may depend on the linguistic background. Materials and methods Healthy German speakers with a minimum of 20 teeth were recruited to form a young (<60 years) and an older group (≥60 years). Oral diadochokinesis was assessed as the number of repetitions/s for the monosyllables /pa/, /ta/ and /ka/ to evaluate movement capacity of the lip, the anterior region of the tongue and the posterior region of the tongue, respectively. Maximum voluntary lip force, maximum voluntary bite force, masticatory performance, maximum voluntary tongue pressure, xerostomia and swallowing function were assessed with validated instruments. Results are presented as median (IQR). Results Sixty participants formed the younger group (n = 35, 30.0 years [24.0‐49.0]) and the older group (n = 25, 64.0 years [62.0‐72.0]). Counts/s of /ta/ were different between age groups (younger group: 6.0 vs older group: 5.4) but not for syllables /pa/ (younger group: 6.0 vs older group: 5.8) and /ka/ (younger group: 5.6 vs older group: 5.0). The oral diadochokinesis with /pa/ was overall associated with maximum voluntary lip force; oral diadochokinesis performed with /ta/ was associated with tongue pressure, and oral diadochokinesis with /ka/ with swallowing function. Masticatory performance was not associated with oral diadochokinesis but with maximum voluntary bite force, xerostomia and with maximum voluntary tongue pressure. Conclusions The published thresholds for oral diadochokinesis should be reconsidered in non‐Japanese mother‐tongue speakers. However, they still play an important role in the overall concept of oro‐facial functional assessment.
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Affiliation(s)
- Martin Schimmel
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Tania Domioni
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Hristina Bukvic
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Itsuka Arakawa
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Comprehensive Dental Care Unit, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Eberhard Seifert
- Division of Phoniatrics, Department of Otorhinolaryngology, Head Neck Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Samir Abou-Ayash
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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16
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Focht Garand KL, Suiter DM, Reyes S, York JD, Chen IHA. Aspiration Screening in Motor Neuron Disease: Preliminary Results From Utilization of the Yale Swallow Protocol. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2693-2699. [PMID: 34670101 DOI: 10.1044/2021_ajslp-21-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Dysphagia is a common symptom experienced by patients with motor neuron disease (MND). The Yale Swallow Protocol (YSP) is a validated screening instrument for identifying patients at risk for aspiration. The purpose of this exploratory cross-sectional, multicenter study was to investigate how the YSP results in identifying aspiration risk in patients with MND in comparison with aspiration observed during a videofluoroscopic swallow study (VFSS). Method Participants referred for VFSS as part of clinical management were recruited from four specialized MND clinics. All participants were administered the YSP immediately prior to the VFSS by a speech-language pathologist, with results recorded as pass or fail. Aspiration on VFSS was determined using the Penetration-Aspiration Scale (scores 6-8). A 2 × 2 contingency table was constructed to compare results of YSP with those on VFSS. Results Thirty-one patients with MND (13 males, 18 females; M age = 64 ± 12 years) referred for VFSS participated in this study. Of the 22 patients who failed the YSP, interrupted drinking was the most frequent reason (65%). Compared to the VFSS, the YSP yielded a sensitivity of 80%, a specificity of 33%, positive predictive value of 36%, and negative predictive value of 78%. Conclusions The YSP is a simple tool and easy to utilize and has a high sensitivity in identifying aspiration risk in amyotrophic lateral sclerosis. A future investigation with a larger sample size is needed to better investigate the utility of YSP as a screening tool for this population.
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Affiliation(s)
| | - Debra M Suiter
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | | | | | - I-Hweii Amy Chen
- Department of Neurology, Medical University of South Carolina, Charleston
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17
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Yalcin O, Marais I, Lee C, Correia H. Revisions to the Young Schema Questionnaire using Rasch analysis: the YSQ-R. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1979885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ozgur Yalcin
- Department of Psychology, Murdoch University, Perth, Australia
| | - Ida Marais
- Medical School, University of Western Australia, Perth, Australia
| | - Christopher Lee
- Medical School, University of Western Australia, Perth, Australia
| | - Helen Correia
- Department of Psychology, Murdoch University, Perth, Australia
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18
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Schimmel M, Leuchter I, Héritier Barras AC, Leles CR, Abou-Ayash S, Viatte V, Esteve F, Janssens JP, Mueller F, Genton L. Oral function in amyotrophic lateral sclerosis patients: A matched case-control study. Clin Nutr 2021; 40:4904-4911. [PMID: 34358835 DOI: 10.1016/j.clnu.2021.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/31/2021] [Accepted: 06/19/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Patients with amyotrophic lateral sclerosis (ALS) develop swallowing difficulties with the progression of the disease. The present study aimed at comparing oral function and body composition between ALS patients and healthy controls, and at evaluating which parameters are the most discriminant between both groups. METHODS We included ALS patients at the start of their multidisciplinary follow-up at the Geneva University Hospitals and healthy age-, gender-, and dental status-matched adults. We assessed the severity of the disease through the ALS Functional Rating Scale and the swallowing difficulties through the EAT-10 score. We performed an intraoral examination of the dental status, and measured chewing performance, bite, lip and tongue force, saliva weight, and body composition. Group comparisons were performed with t-tests or Mann-Whitney tests as appropriate. Linear discriminant analysis was used to determine the most discriminant parameters between groups. RESULTS Twenty-six ALS patients (bulbar onset: n = 7, median (IQR) ALS Functional Rating Scale: 37 (11)) were included. The ALS patients had a significantly lower chewing performance (p < 0.001), lip force (p < 0.001), tongue force (p = 0.002), saliva weight (p < 0.004) and fat-free mass index (p < 0.001) as compared to the healthy individuals, and a higher EAT-10 score (p < 0.001). In ALS patients, a low chewing performance was correlated with a low bite (r = -0.45, p < 0.05)) and tongue force (r = -0.59, p < 0.05). The most discriminant parameters between both groups, by order of importance, were chewing performance, fat-free mass index and saliva weight and allowed the calculation of a discriminant function. CONCLUSION Compared to healthy controls, ALS patients have significant alterations of oral function and body composition. The most discriminant parameters between both groups were chewing performance, fat-free mass index and saliva volume. It remains to be demonstrated whether oral parameters predict outcome. CLINICAL TRIAL REGISTRY: clinicaltrials.gov, identifier: NCT01772888.
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Affiliation(s)
- Martin Schimmel
- Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Igor Leuchter
- Otorhinolaryngology, University Hospitals, Geneva, Switzerland
| | | | - Claudio R Leles
- Prevention and Oral Rehabilitation, School of Dentistry, Federal University of Goias, Goiania, Brazil
| | - Samir Abou-Ayash
- Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Valérie Viatte
- Clinical Nutrition, University Hospitals, Geneva, Switzerland
| | | | | | - Frauke Mueller
- Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, Geneva, Switzerland
| | - Laurence Genton
- Clinical Nutrition, University Hospitals, Geneva, Switzerland.
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19
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Hansen T, Nielsen RL, Houlind MB, Tavenier J, Rasmussen LJH, Jørgensen LM, Treldal C, Beck AM, Pedersen MM, Andersen O, Petersen J, Andersen AL. Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data. Geriatrics (Basel) 2021; 6:geriatrics6020046. [PMID: 33926079 PMCID: PMC8167602 DOI: 10.3390/geriatrics6020046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 01/18/2023] Open
Abstract
There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.
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Affiliation(s)
- Tina Hansen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Correspondence: ; Tel.: +45-29243586
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Psychology and Neuroscience, Duke University, 2020 W Main St, Durham, NC 27705, USA
| | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650 Hvidovre, Denmark
| | - Charlotte Treldal
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730 Herlev, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650 Hvidovre, Denmark
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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White Paper by the European Society for Swallowing Disorders: Screening and Non-instrumental Assessment for Dysphagia in Adults. Dysphagia 2021; 37:333-349. [PMID: 33787994 PMCID: PMC8009935 DOI: 10.1007/s00455-021-10283-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023]
Abstract
This White Paper by the European Society for Swallowing Disorders (ESSD) reports on the current state of screening and non-instrumental assessment for dysphagia in adults. An overview is provided on the measures that are available, and how to select screening tools and assessments. Emphasis is placed on different types of screening, patient-reported measures, assessment of anatomy and physiology of the swallowing act, and clinical swallowing evaluation. Many screening and non-instrumental assessments are available for evaluating dysphagia in adults; however, their use may not be warranted due to poor diagnostic performance or lacking robust psychometric properties. This white paper provides recommendations on how to select best evidence-based screening tools and non-instrumental assessments for use in clinical practice targeting different constructs, target populations and respondents, based on criteria for diagnostic performance, psychometric properties (reliability, validity, and responsiveness), and feasibility. In addition, gaps in research that need to be addressed in future studies are discussed. The following recommendations are made: (1) discontinue the use of non-validated dysphagia screening tools and assessments; (2) implement screening using tools that have optimal diagnostic performance in selected populations that are at risk of dysphagia, such as stroke patients, frail older persons, patients with progressive neurological diseases, persons with cerebral palsy, and patients with head and neck cancer; (3) implement measures that demonstrate robust psychometric properties; and (4) provide quality training in dysphagia screening and assessment to all clinicians involved in the care and management of persons with dysphagia.
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Speyer R, Cordier R, Bouix C, Gallois Y, Woisard V. Using Classical Test Theory to Determine the Psychometric Properties of the Deglutition Handicap Index. Dysphagia 2021; 37:65-73. [PMID: 33515311 PMCID: PMC8844159 DOI: 10.1007/s00455-021-10250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/13/2021] [Indexed: 11/06/2022]
Abstract
The Deglutition Handicap Index (DHI) is a self-report measure for patients at risk of oropharyngeal dysphagia on deglutition-related aspects of functional health status (FHS) and health-related quality of life (HR-QoL). The DHI consists of 30 items which are subsumed within the Symptom, Functional and Emotional subscales. The purpose of this study was to evaluate the psychometric properties of the DHI using Classic Test Theory according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. A total of 453 patients with dysphagia with different aetiologies were recruited concurrently at two academic hospitals. Dysphagia was confirmed by fiberoptic endoscopic and/or videofluoroscopic evaluation of swallowing. In addition, a healthy control group of 132 participants were recruited. Structural validity was determined using exploratory and confirmatory factor analyses and internal consistency by calculating Cronbach’s alpha coefficients. Hypothesis testing was evaluated using Mann–Whitney U-tests, linear regression analysis and correlations analysis. Diagnostic performance and receiver operating characteristic curves analysis were calculated. Factor analyses indicated that the DHI is a unidimensional measure. The DHI has good internal consistency with some indication of item redundancy, weak to moderate structural validity and strong hypothesis testing for construct validity. The DHI shows high diagnostic performance as part of criterion validity. These findings support that the DHI is an appropriate choice as a patient self-report measure to evaluate FHS and HR-QoL in dysphagia. Ongoing validation to assess the measure for possible item redundancy and to examine the dimensionality of the DHI using item response theory is recommended.
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Affiliation(s)
- Renée Speyer
- Department Special Needs Education, University of Oslo, Oslo, Norway. .,School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia. .,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Reinie Cordier
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia.,Department Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Clara Bouix
- Logopedics Training Center, Medical Department, Paul Sabatier University Toulouse III, Toulouse, France
| | - Yohan Gallois
- Department of Otoneurology and Pediatric ENT, Pierre Paul Riquet Hospital, University Hospital of Toulouse, Toulouse, France
| | - Virginie Woisard
- Logopedics Training Center, Medical Department, Paul Sabatier University Toulouse III, Toulouse, France.,Voice and Deglutition Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Larrey Hospital, University Hospital of Toulouse, Toulouse, France.,Oncorehabilitation Unit, Toulouse Universitary Cancer Institute, Oncopole Hospital, Toulouse, France
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Is Dysphagia Under Diagnosed or is Normal Swallowing More Variable than We Think? Reported Swallowing Problems in People Aged 18-65 Years. Dysphagia 2020; 36:910-918. [PMID: 33226473 PMCID: PMC7680995 DOI: 10.1007/s00455-020-10213-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
Purpose Dysphagia prevalence in younger community dwelling adults and across nations is sparse. We investigated the prevalence of swallowing problems in an unselected cohort of people aged 18–65 years. Methods The EAT-10 Assessment Tool was converted into an anonymized online survey. Invitations were e-mailed to author contacts and onwards dispersal encouraged. Analysis was performed using non-parametric test for group comparison (Mann–Whitney U) and Spearman’s rho correlation. Results From March 2014 to October 2017: 2054 responses (32 reported ages outside of 18–65 or undeclared) from Africa, Asia, Australasia/Oceania, Europe, and North and South America. Responses: 1,648 female, 364 male, (10 reported as both), median age 34, (range 18–65, mean 37.12, SD 12.40) years. Total EAT-10 scores: median 0 (range 0–36, mean 1.57, SD 3.49). EAT-10 score ≥ 3 (337) median 5 (range 3–36, mean 7.02 SD 5.91). Median age 36 (range 19–65, mean 37.81, SD 13.21) years. Declared sex was not statistically significantly associated with non-pathological vs. pathological EAT-10 score (p = 0.665). Female scores (median 0.00, mean 1.56, SD 3.338) were significantly higher than for males (median 0.00, mean 1.62, SD 4.161): U (Nfemale = 1648, Nmale = 364) = 275,420.000, z = − 2.677, p = 0.007. Age and EAT-10 score were not associated: females rs = − 0.043, p = 0.079, N = 1648, males rs = − 0.003, p = 0.952, N = 364. Considerable impact on people: “I take ages to eat a main course … This is embarrassing and I often leave food even though I am still hungry.” (no diagnosis, EAT-10 = 17). Conclusion Concerns regarding swallowing exist in people undiagnosed with dysphagia, who may feel uncomfortable seeking professional help. Dysphagia may be under reported resulting in a hidden population. Subtle changes are currently seen as subtle markers of COVID-19. Further work is required to ensure that what is an essentially normal swallow does not become medicalized.
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Systematic Dysphagia Screening of Elderly Persons in the Emergency Department-A Feasibility Study. Geriatrics (Basel) 2020; 5:geriatrics5040075. [PMID: 33053743 PMCID: PMC7709572 DOI: 10.3390/geriatrics5040075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 01/01/2023] Open
Abstract
Identification of elderly patients in risk of dysphagia as early as possible upon hospital admission seems warranted due to the risk of aspiration pneumonia, dehydration, length of stay, and increased mortality. This study aimed to evaluate the feasibility and outcome of dysphagia screening of elderly persons admitted to the emergency department (ED). Inclusion criteria were age ≥ 60 years. A nurse applied the Simple Water Swallow test within one hour of admission. Subsequent assessment was performed by an occupational therapist (OT) using Volume Viscosity Swallow Test and Minimal Eating Observation Form. Of 113 eligible participants (median age 78 years), 75 (66%) were screened in the ED by the nurse, and among those, 12 (16%) were detected with dysphagia. Twenty of the patients not screened in the ED due to critical illness were tested by the OT in the ward after clinical stabilization and 15 patients (75%) were identified with dysphagia. This study demonstrated that it is feasible to perform dysphagia screening of elderly persons by a nurse in the ED, but there are severe limitations according to screening patients with critical illness and patients fasting before surgery in the ED. These patients have a high prevalence of dysphagia and should be screened as early as possible after hospitalization, as it will rarely be possible in the ED.
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Applebaum J, Lee E, Harun A, Davis A, Hillel AT, Best SR, Akst LM. Characterization of Geriatric Dysphagia Diagnoses in Age-Based Cohorts. OTO Open 2020; 4:2473974X20939543. [PMID: 32685871 PMCID: PMC7346702 DOI: 10.1177/2473974x20939543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE An aging population requires increased focus on geriatric otolaryngology. Patients aged ≥65 years are not a homogenous population, and important physiologic differences have been documented among the young-old (65-74 years), middle-old (75-84), and old-old (≥85). We aim to analyze differences in dysphagia diagnoses and swallowing-related quality-of-life among these age subgroups. STUDY DESIGN Retrospective chart review. SETTING Tertiary care laryngology clinic. SUBJECTS AND METHODS We identified chief complaint, diagnosis, and self-reported swallowing handicap (Eating Assessment Tool [EAT-10] score) of all new patients aged ≥65 years presenting to the Johns Hopkins Voice Center between April 2015 and March 2017. Dysphagia diagnoses were classified by physiologic etiology and anatomic source. Diagnostic categories and EAT-10 score were evaluated as functions of patient age and sex. RESULTS Of 839 new patients aged ≥65 years, 109 (13.0%) reported a chief complaint of dysphagia and were included in this study. The most common dysphagia etiologies were neurologic and esophageal. Most common diagnoses were diverticula (15.6%), reflux (13.8%), and radiation induced (8.3%). Diverticula, cricopharyngeal hypertonicity, and radiation-induced changes were associated with higher EAT-10 score (P < .001). Significant differences by sex were found in anatomic source of dysphagia, as men and women were more likely to present with oropharyngeal and esophageal disease, respectively (P = .023). Dysphagia etiology and EAT-10 score were similar across age subgroups. CONCLUSION Important differences among dysphagia diagnosis and EAT-10 score exist among patients aged ≥65 years. Knowledge of these differences may inform diagnostic workup, management, and further investigations in geriatric otolaryngology.
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Affiliation(s)
- Jeremy Applebaum
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emerson Lee
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aisha Harun
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Ashley Davis
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alexander T. Hillel
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Simon R. Best
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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