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Associations between voice quality and swallowing function in patients treated for oral or oropharyngeal cancer

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Abstract

Purpose

The purpose of this study was to investigate associations between voice quality and swallowing function in patients treated for oral or oropharyngeal cancer.

Methods

Recordings of speech and videofluoroscopy of 51 patients after treatment for oral or oropharyngeal cancer were analysed. Acoustic voice parameters (fundamental frequency (F0), perturbation (jitter %, shimmer %), harmonics-to-noise ratio (HNR), and intensity (extracted from the vowels /a/, /i/, and /u/)) were compared to swallowing function parameters as assessed via videofluoroscopy (oral, oropharyngeal, and total transit time; estimated percent of oral, oropharyngeal, and total residue; oropharyngeal swallowing efficiency (OPSE), and the penetration/aspiration (PA-) scale).

Results

Stepwise multivariate regression analyses revealed that jitter, shimmer, and HNR were not associated with swallowing function. Higher voice intensity in all three vowels /a/, /i/, and /u/ was significantly associated with a higher score on the PA-scale (more penetration and aspiration). Higher voice intensity and F0 were significantly associated with lower OPSE.

Conclusion

Higher voice intensity was significantly associated with higher amount of penetration/aspiration, and higher voice intensity and fundamental frequency were significantly associated with swallowing inefficiency. Possible explanations may be found in overcompensation by increased laryngeal muscular strength resulting in increased intensity and pitch during phonation. However, the physiology of associated voice and swallowing function is yet unclear, and more research is recommended.

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Reference

  1. Pauloski BR, Rademaker AW, Logemann J et al (2004) Surgical variables affecting swallowing in patients treated for oral/oropharyngeal cancer. Head Neck 26:625–636

    Article  PubMed  Google Scholar 

  2. Mittal BB, Pauloski BR, Haraf DJ et al (2003) Swallowing dysfunction–preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: a critical review. Int J Radiat Oncol Biol Phys 57(5):1219–1230

    Article  PubMed  Google Scholar 

  3. Lazarus CL (2009) Effects of chemoradiotherapy on voice and swallowing. Curr Opin Otolaryngol Head Neck Surg 17(3):172–178

    Article  PubMed  Google Scholar 

  4. Robbins J, Coyle J, Rosenbek J et al (1999) Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale. Dysphagia 14(4):228–232

    Article  PubMed  CAS  Google Scholar 

  5. J.Logemann. Slikstoornissen. / Evaluation and Treatment of Swallowing Disorders (PRO-ED, Austin, Texas). Amsterdam: Harcourt Assessment; 2000

  6. Logemann J (1993) Manual for the videofluoroscopic study of swallowing, 2nd edn. PRO-ED, Austin, Texas

    Google Scholar 

  7. Aviv JE, Kim T, Thomson JE et al (1998) Fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) in healthy controls. Dysphagia 13(2):87–92

    Article  PubMed  CAS  Google Scholar 

  8. Verdonck-de Leeuw I, Rinkel RN, Leemans CR (2007) Evaluating the impact of cancer of the head and neck. In: Ward EJ, van As-Brooks CJ (eds) Head and neck cancer: treatment, rehabilitation and outcomes. Plural Publishing, San Diego, pp 27–56

    Google Scholar 

  9. Splaingard ML, Hutchins B, Sulton LD et al (1988) Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment. Arch Phys Med Rehabil 69(8):637–640

    PubMed  CAS  Google Scholar 

  10. Groves-Wright KJ, Boyce S, Kelchner L (2010) Perception of wet vocal quality in identifying penetration/aspiration during swallowing. J Speech Lang Hear Res 53(3):620–632

    Article  PubMed  Google Scholar 

  11. Groves-Wright KJ (2007) Acoustics and perception of wet vocal quality in identifying penetration/aspiration during swallowing. Communication sciences and disorders. University of Cincinnati, Ohio

    Google Scholar 

  12. Ryu JS, Park SR, Choi KH (2004) Prediction of laryngeal aspiration using voice analysis. Am J Phys Med Rehabil 83(10):753–757

    Article  PubMed  Google Scholar 

  13. Warms T, Richards J (2000) "Wet Voice" as a predictor of penetration and aspiration in oropharyngeal dysphagia. Dysphagia 15(2):84–88

    PubMed  CAS  Google Scholar 

  14. Waito A, Bailey GL, Molfenter SM et al (2011) Voice-quality abnormalities as a sign of dysphagia: validation against acoustic and videofluoroscopic data. Dysphagia 26(2):125–134

    Article  PubMed  Google Scholar 

  15. Chang H-Y, Torng P-C, Wang T-G et al (2012) Acoustic voice analysis does not identify presence of penetration/aspiration as confirmed by videofluoroscopic swallowing study. Arch Phys Med Rehabil 93(11):1991–1994

    Article  PubMed  Google Scholar 

  16. Linden P, Kuhlemeier KV, Patterson C (1993) The probability of correctly predicting subglottic penetration from clinical observations. Dysphagia 8(3):170–179

    Article  PubMed  CAS  Google Scholar 

  17. Stemple JC, Glaze LE, Gerdeman BK (2000) Clinical voice pathology: theory and management, third editionth edn. Singular Publishing Group, San Diego, CA, USA

    Google Scholar 

  18. Robert D, Pouget J, Giovanni A et al (1999) Quantitative voice analysis in the assessment of bulbar involvement in amyotrophic lateral sclerosis. Acta Otolaryngol 119(6):724–731

    Article  PubMed  CAS  Google Scholar 

  19. Pribuisiene R, Uloza V, Kardisiene V (2011) Voice characteristics of children aged between 6 and 13 years: impact of age, gender, and vocal training. Logoped Phoniatr Vocol 36(4):150–155

    Article  PubMed  Google Scholar 

  20. Fung K, Yoo J, Leeper HA et al (2001) Vocal function following radiation for non-laryngeal versus laryngeal tumors of the head and neck. Laryngoscope 111(11 Pt 1):1920–1924

    Article  PubMed  CAS  Google Scholar 

  21. de Swart BJ, Willemse SC, Maassen BA et al (2003) Improvement of voicing in patients with Parkinson's disease by speech therapy. Neurology 60(3):498–500

    Article  PubMed  Google Scholar 

  22. Praat: doing phonetics by computer [Computer program]. Version 5.2.35. University of Amsterdam: 2007

  23. Logemann JA, Pauloski BR, Colangelo L (1998) Light digital occlusion of the tracheostomy tube: a pilot study of effects on aspiration and biomechanics of the swallow. Head Neck 20(1):52–57

    Article  PubMed  CAS  Google Scholar 

  24. Borggreven PA, Verdonck-de Leeuw I, Rinkel RN et al (2007) Swallowing after major surgery of the oral cavity or oropharynx: a prospective and longitudinal assessment of patients treated by microvascular soft tissue reconstruction. Head Neck 29(7):638–647

    Article  PubMed  Google Scholar 

  25. Campbell BH, Spinelli K, Marbella AM et al (2004) Aspiration, weight loss, and quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg 130:1100–1103

    Article  PubMed  Google Scholar 

  26. Pauloski BR, Rademaker AW, Logemann JA et al (2002) Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck 24(6):555–565

    Article  PubMed  Google Scholar 

  27. Rademaker AW, Pauloski BR, Logemann JA et al (1994) Oropharyngeal swallow efficiency as a representative measure of swallowing function. J Speech Hear Res 37(2):314–325

    PubMed  CAS  Google Scholar 

  28. Rosenbek JC, Robbins JA, Roecker E et al (1996) A penetration-aspiration scale. Dysphagia 11:93–98

    Article  PubMed  CAS  Google Scholar 

  29. Van Houtte E, Van Lierde KM, Claeys S (2011) Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. Journal of Voice 25(2):202–207

    Article  PubMed  Google Scholar 

  30. Fox C, Ebersbach G, Ramig L et al. LSVT LOUD and LSVT BIG: Behavioral treatment programs for speech and body movement in Parkinson disease. Parkinson's Disease 2012

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Conflict of interest

The authors report no conflict of interests.

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Authors and Affiliations

  1. Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, Amsterdam, 1007 MB, The Netherlands

    Marieke J. de Bruijn, Rico N. P. M. Rinkel, Ingrid C. Cnossen, C. René Leemans & Irma M. Verdonck-de Leeuw

  2. Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

    Birgit I. Witte

  3. Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Johannes A. Langendijk

Authors
  1. Marieke J. de Bruijn
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  2. Rico N. P. M. Rinkel
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  3. Ingrid C. Cnossen
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  4. Birgit I. Witte
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  5. Johannes A. Langendijk
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  6. C. René Leemans
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  7. Irma M. Verdonck-de Leeuw
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Corresponding author

Correspondence to Irma M. Verdonck-de Leeuw.

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de Bruijn, M.J., Rinkel, R.N.P.M., Cnossen, I.C. et al. Associations between voice quality and swallowing function in patients treated for oral or oropharyngeal cancer. Support Care Cancer 21, 2025–2032 (2013). https://doi.org/10.1007/s00520-013-1761-3

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  • DOI: https://doi.org/10.1007/s00520-013-1761-3

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