2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

AE Vertigan et al .

Table 2 Summary of tests and outcome measures Function Test

Outcome

Ml/sec 12

Swallowing Vocalization

Timed Swallow Test

CAPE-V, Percentage severity 18 Maximum phonation time 19 Dysphonia severity index 20

Auditory Perceptual Analysis Acoustic Voice Assessment

Voice Stress Test

Change in percentage severity in CAPE-V Change in Urge to Cough Scores Worst Urge to Cough Scores Change in Modified Borg Scores Worse Borg Scores Change in Borg Laryngeal Paraesthesia Worst Laryngeal Paraesthesia

FIF50 22 Log dose response slope

Vocal fold closure

4.5% saline provocation

LogC5 dose described 23 Log cough/hour Change in percentage severity CAPE-V

Cough sensitivity

Capsaicin cough reflex testing

CAPE-V, Consensus Auditory Perceptual Evaluation-Voice; FIF, forced inspiratory flow.

( n = 9) and by word of mouth ( n = 4). They had no history of voice disorder, chronic cough or extratho- racic airway hyper-responsiveness asthma, rhinosi- nusitis, gastro-oesophageal reflux, or symptoms of breathing, cough or dypshonia and/or swallowing difficulty. The study was approved by the Hunter New England Research Ethics Committee. Procedure Assessments were conducted by a qualified speech pathologist with post-graduate training in respiratory function testing. The assessment included self-report questionnaires, voice testing, swallow examination, hypertonic (4.5%) saline bronchial provocation chal- lenge, capsaicin cough sensitivity test, Leicester Cough Frequency Monitor 10 and a Voice Stress Test. A summary of the tests and outcome measures are reported in Table 2. The questionnaires included the Symptom Fre- quency and Severity Questionnaire, 1 the Reflux Symptom Index, 17 the Hospital Anxiety and Depres- sion Scale, 11 the Voice Handicap Index 18 and the Laryngeal Paraesthesia Questionnaire (Vertigan A, & Gibson P, unpublished data). Swallowing TheTimed SwallowTest was conducted as described. 12 The speed of swallowing (mL/s) was calculated for each participant. Any abnormality of swallowing during the test was recorded and a clinical swallowing assessment conducted if abnormal features were noted. 13 Phonation Voice testing included auditory perceptual ratings using the Consensus Auditory Perceptual Evaluation: Voice (CAPE-V), 18 and acoustic assessment. 19,20 The Voice Stress Test was adapted from Awan. 21 Baseline

spirometry and symptom ratings were made. Partici- pants then held 1 kg hand weights with arms raised in a lateral position at shoulder height while reading the second line of ‘The Rainbow Passage’ 14 followed by maximum sustained phonation on vowel /a/. This sequence was continued for two 1-min periods with a 30-s break in between. Spirometry and symptom ratings were repeated and results compared to baseline. Respiration Participants had baseline inspiratory/expiratory flow volume curves followed by an airway provocation test with hypertonic (4.5%) saline. The pulmonary func- tion test was performed in the respiratory laboratory, according to the standards established by the Ameri- canThoracic Society, 15 and the hypertonic saline chal- lenge was performed using the protocol of Anderson and Gibson. 22 A drop in FIF50 from baseline of 20% or more was considered to be an abnormal result. The hypertonic saline challenge was not performed on 11 participants due to low baseline spirometry (FEV 1 < 60% predicted), or inability to obtain repro- ducible flow volume loops. Cough Cough Reflex Sensitivity testing was conducted as previously described. 23 Participants were also asked to rate their urge to cough 24 after each dose inhalation, the modified Borg scale for breathing 25 and the Borg laryngeal paraesthesia scale. Perceptual voice quality was also rated after each dose. 18 Data analysis Normally distributed and continuous data were ana- lysed using a one-way ANOVA with post-hoc testing using a Tukey test. Skewed and ordinal data were ana- lysed using a Kruskal–Wallis test with post-hoc analy- sis using a Mann–Whitney U -test. Nominal data were © 2013 The Authors Respirology © 2013 Asian Pacific Society of Respirology

Respirology (2013) 18 , 948–956

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