Barbara Ebersole

Baseline health perceptions, dysphagia, and survival in patients with head and neck cancer

In head and neck cancer patients prior to treatment, dysphagia noted by patients is more common than aspiration on formal swallow studies. The authors hypothesized that patient‐reported dysphagia impacts multiple domains of quality of life (QOL) and predicts disease recurrence and disease‐related death.

Treatment of Chronic Cough Single-Institution Experience Utilizing Behavioral Therapy

Objective Chronic cough remains a challenging condition, especially in cases where it persists despite comprehensive medical management. For these particular patients, there appears to be an emerging role for behavior modification therapy. We report a series of patients with refractory chronic cough to assess if there is any benefit of adding behavioral therapy to their treatment regimen. Study Design A case series with planned chart review of patients treated for chronic cough. Setting The review was performed with an outpatient electronic health record system at a tertiary care center. Subjects and Methods The charts of all patients treated for chronic cough by a single laryngologist over a 30-month period were analyzed. Patients’ response to treatment and rate of cough improvement were assessed for those with refractory chronic cough who underwent behavior modification therapy. Results Thirty-eight patients with chronic cough were initially treated empirically for the most common causes of cough, of which 32% experienced improvement. Nineteen patients who did not significantly improve with medical management underwent behavior modification therapy with a speech-language pathologist. Of these patients, 84% experienced resolution or marked improvement of their symptoms. Conclusion Behavioral therapy may be underutilized in practice and could lead to improvement of otherwise recalcitrant cough.

Impact of baseline patient-reported dysphagia on acute gastrostomy placement in patients with head and neck squamous cell carcinoma undergoing definitive radiation

Dysphagia‐related symptoms in patients with head and neck cancer are common before treatment. We hypothesized greater self‐reported baseline dysphagia would predict gastrostomy placement during primary radiation.

Maximizing Functional Outcomes in Head and Neck Cancer Survivors: Assessment and Rehabilitation

With increases in survivorship for patients with head and neck cancer, attention is turning to quality-of-life issues for survivors. Care for these patients is multifaceted. Dysphagia and issues of voice/speech, airway obstruction, neck and shoulder dysfunction, lymphedema, and pain control are important to address. Rehabilitation interventions are patient-specific and aim to prevent, restore, compensate, and palliate symptoms and sequelae of treatment for optimal functioning. Central to providing comprehensive interdisciplinary care are the head and neck surgeon, laryngologist, and speech-language pathologist. Routine functional assessment, long-term follow-up, and regular communication and coordination among these specialists helps maximize quality of life in this challenging patient population.

The Role of Occupational Voice Demand and Patient-Rated Impairment in Predicting Voice Therapy Adherence

OBJECTIVE Examine the relationship among the severity of patient-perceived voice impairment, perceptual dysphonia severity, occupational voice demand, and voice therapy adherence. Identify clinical predictors of increased risk for therapy nonadherence. METHODS A retrospective cohort study of patients presenting with a chief complaint of persistent dysphonia at an interdisciplinary voice center was done. The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) survey scores, clinician rating of dysphonia severity using the Grade score from the Grade, Roughness Breathiness, Asthenia, and Strain scale, occupational voice demand, and patient demographics were tested for associations with therapy adherence, defined as completion of the treatment plan. Classification and Regression Tree (CART) analysis was performed to establish thresholds for nonadherence risk. RESULTS Of 166 patients evaluated, 111 were recommended for voice therapy. The therapy nonadherence rate was 56%. Occupational voice demand category, VHI-10, and V-RQOL scores were the only factors significantly correlated with therapy adherence (P < 0.0001, P = 0.018, and P = 0.008, respectively). CART analysis found that patients with low or no occupational voice demand are significantly more likely to be nonadherent with therapy than those with high occupational voice demand (P < 0.001). Furthermore, a VHI-10 score of ≤29 or a V-RQOL score of >40 is a significant cutoff point for predicting therapy nonadherence (P < 0.011 and P < 0.004, respectively). CONCLUSION Occupational voice demand and patient perception of impairment are significantly and independently correlated with therapy adherence. A VHI-10 score of ≤9 or a V-RQOL score of >40 is a significant cutoff point for predicting nonadherence risk.

Inpatient injection laryngoplasty for vocal fold immobility: When is it really necessary?☆

PURPOSE To compare pulmonary and swallow outcomes of injection laryngoplasty when performed in the acute versus subacute setting in head & neck and thoracic cancer patients presenting with new onset unilateral vocal fold immobility. MATERIALS AND METHODS Case series with chart review at an academic cancer center over a 2year period. Based on swallow evaluation, patients diagnosed with vocal fold immobility were grouped into an unsafe swallow group, injected as inpatients, and a safe swallow group, for whom injection laryngoplasty was delayed to the outpatient setting or not performed. Rates of pneumonia, diet recommendations, and swallow outcomes were compared between groups. RESULTS 24 patients with new-onset vocal fold immobility were evaluated. 7 underwent injection in the inpatient setting, 12 in the outpatient setting, and 5 did not undergo injection. There was no perceived difference in speech and swallow outcomes between the inpatient and outpatient injection groups. CONCLUSIONS Injection laryngoplasty shows promise as an effective intervention for reducing aspiration risk and improving diet normalcy in patients with dysphagia as a result of unilateral vocal fold immobility. In patients determined to have a safe swallow, delay of injection laryngoplasty is not detrimental to swallow outcomes.

Utility of Eating Assessment Tool–10 in Predicting Aspiration in Patients with Unilateral Vocal Fold Paralysis

Objective Examine the incidence of penetration/aspiration in patients with unilateral vocal fold immobility and investigate the relationship with self-reported perception of dysphagia. Study Design Case series with chart review. Setting Academic cancer center. Subjects and Methods Adult patients with unilateral vocal fold immobility diagnosed between 2014 and 2016 were reviewed. Patients were stratified into an aspiration group and a nonaspiration group using objective findings on flexible endoscopic evaluation of swallowing, as scored using Rosenbek’s Penetration Aspiration Scale. Objective findings were compared to patient perception of dysphagia. Bivariate linear correlation analysis was performed to evaluate correlation between Eating Assessment Tool–10 scores and presence of aspiration. Tests of diagnostic accuracy were calculated to investigate the predictive value of Eating Assessment Tool–10 scores >9 on aspiration risk. Results Of the 35 patients with new-onset unilateral vocal fold immobility were evaluated, 25.7% (9/35) demonstrated tracheal aspiration. Mean ± SD Eating Assessment Tool–10 scores were 19.2 ± 13.7 for aspirators and 7.0 ± 7.8 for nonaspirators (P = .016). A statistically significant correlation was demonstrated between increasing Eating Assessment Tool–10 scores and Penetration Aspiration Scale scores (r = 0.511, P = .002). Diagnostic accuracy analysis for aspiration risk in patients with an Eating Assessment Tool–10 score >9 revealed a sensitivity of 77.8% and a specificity of 73.1%. Conclusion Patient perception of swallowing difficulty may have utility in predicting aspiration risk. An EAT–10 of >9 in patients with unilateral vocal fold immobility may portend up to a 5 times greater risk of aspiration. Routine swallow testing to assess for penetration/aspiration may be indicated in patients with unilateral vocal fold immobility.

Does Even Low-Grade Dysphonia Warrant Voice Center Referral?

OBJECTIVE Data regarding the referral of dysphonic patients to specialty voice clinics are limited. The objective of this study is to examine the relationship between low perceptual dysphonia severity and subtle laryngeal findings to discern if this can help guide referral. STUDY DESIGN This is a retrospective chart review. METHODS The charts of 94 patients presenting with a primary complaint of hoarseness to a single laryngologist over a 1-year period at a tertiary care, interdisciplinary voice center were analyzed. Patients were stratified by clinician perceptual rating of dysphonia severity using the overall Grade score from the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and this was compared to their laryngeal findings on stroboscopy. RESULTS Forty-one patients had a Grade score of 0 or 1, of whom 85% had relatively subtle findings on stroboscopy, including vocal fold paresis, muscle tension dysphonia, and spasmodic dysphonia. CONCLUSION Patients with a primary complaint of hoarseness but absent or only mild perceptual dysphonia may have subtle or occult laryngeal findings that may be easily missed. These patients may benefit from early referral to a specialty voice center.

Baseline health perceptions, dysphagia, and survival in patients with head and neck cancer: Health Perceptions in Dysphagia

In head and neck cancer patients prior to treatment, dysphagia noted by patients is more common than aspiration on formal swallow studies. The authors hypothesized that patient‐reported dysphagia impacts multiple domains of quality of life (QOL) and predicts disease recurrence and disease‐related death.

Baseline health perceptions, dysphagia and survival in head and neck cancer

In head and neck cancer patients prior to treatment, dysphagia noted by patients is more common than aspiration on formal swallow studies. The authors hypothesized that patient‐reported dysphagia impacts multiple domains of quality of life (QOL) and predicts disease recurrence and disease‐related death.