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Voice-quality Abnormalities as a Sign of Dysphagia: Validation against Acoustic and Videofluoroscopic Data

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Abstract

In this study we explored the validity of clinician judgments of voice abnormalities as indicators of penetration-aspiration or other swallowing abnormalities. Voice samples were collected using a high-quality microphone from 40 adults during videofluoroscopy (VFSS), at baseline and following each of four thin liquid swallows. Blinded speech-language pathologists (SLPs) rated the audio recordings for voice quality using the GRBAS scale and the VFSS recordings for abnormal swallow onset, penetration-aspiration, airway closure, and pharyngeal residues. Acoustic measures of % jitter, % shimmer, and signal-to-noise ratio were calculated using two /a/ vowel segments spliced from each voice recording. Preswallow to postswallow measures of voice-quality change were derived and the data were compared to determine the correspondence between perceived voice abnormalities, acoustic voice parameters, and radiographically confirmed swallowing abnormalities. The sensitivity of perceived postswallow changes in voice quality to dysphagia and penetration-aspiration was poor, ranging from 8 to 29%. Specificity was stronger for both penetration-aspiration (75–94%) and dysphagia (59–86%). Acoustic measures of voice quality had moderate sensitivity and specificity for both dysphagia and penetration-aspiration. Overall, perceptual judgments of postswallow wet voice showed the strongest potential for detecting penetration-aspiration (relative risk = 3.24). We conclude that a clear postswallow voice quality provides reasonable evidence that penetration-aspiration and dysphagia are absent. However, observations of abnormal postswallow voice quality can be misleading and are not a valid indication that penetration-aspiration or dysphagia exists.

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Acknowledgments

Funding for this study was provided by an Ontario Ministry of Research and Innovation Ontario Centres of Excellence grant. The authors acknowledge the assistance of Annemarie Weeda, Janice Bennett, Nicole Buesselberg, KaLun Tam, and Becky Cliffe with data collection for this study. The authors acknowledge the support of the Toronto Rehabilitation Institute which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-term Care in Ontario. The views expressed do not necessarily reflect those of the ministry.

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Authors and Affiliations

  1. Toronto Rehabilitation Institute, 550 University Avenue, #12030, Toronto, ON, M5G 2A2, Canada

    Ashley Waito, Sonja M. Molfenter, Dana C. Zoratto & Catriona M. Steele

  2. Hamilton Health Sciences Centre, Hamilton, ON, Canada

    Gemma L. Bailey

  3. Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada

    Sonja M. Molfenter & Catriona M. Steele

  4. Institute of Biomaterials & Biomedical Engineering, University of Toronto, Toronto, ON, Canada

    Dana C. Zoratto & Catriona M. Steele

  5. Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada

    Catriona M. Steele

  6. Bloorview Kids Rehab, Toronto, Canada

    Catriona M. Steele

Authors
  1. Ashley Waito
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  2. Gemma L. Bailey
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  3. Sonja M. Molfenter
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  4. Dana C. Zoratto
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  5. Catriona M. Steele
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Correspondence to Catriona M. Steele.

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Waito, A., Bailey, G.L., Molfenter, S.M. et al. Voice-quality Abnormalities as a Sign of Dysphagia: Validation against Acoustic and Videofluoroscopic Data. Dysphagia 26, 125–134 (2011). https://doi.org/10.1007/s00455-010-9282-4

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  • DOI: https://doi.org/10.1007/s00455-010-9282-4

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