• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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• 제60권9호
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• pp.454-462
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• 2017

Background and Objectives The present study aimed to investigate the effects of penetration/aspiration (P/A) on voice acoustic parameters. Subjects and Method Twenty-seven patients were analyzed with the videofluoroscopic swallowing study (VFSS) and then divided into two groups based on the modified Penetration and Aspiration Scale results. Ten patients (5 males and 5 females) were included in the Non-P/A group, and 17 patients (12 males and 5 females) in the P/A group. Stroke was the major cause of swallowing disorders. Three sustained /a/ vowels recorded in pre- and post-VFSS were analyzed. Mann-Whitney U-test was used to compare acoustic values before and after VFSS, and the receiver operating characteristics (ROC) curve with combination of significant parameters was also conducted. Results Among acoustic parameters, the length of analyzed sample (p=0.010), number of segments computed (p=0.018), total number detected pitch periods (p=0.017), and second formant (p=0.013) in pre- and post-VFSS were significantly different between Non-P/A and P/A groups. In the P/A group after VFSS, the means of these significant parameters decreased. According to ROC combined with four significant parameters, the probability of predicting P/A condition was 84% (p=0.005), the sensitivity was 80%, and the specificity was 80%. Conclusion Voice acoustic analysis can reflect voice changes by penetration/aspiration and the combination of significant parameters can also detect swallowing disorders. Therefore, voice analysis can be a reliable screening tool for patients with swallowing disorders.

• 대한구순구개열학회지
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• 제6권1호
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• pp.35-42
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• 2003

PAP (Palatal Augmentation Prosthesis) may be given to the patients with dysphagia; especially, who cannot achieve tongue-palate contact. PAP fills hard palate area where the tongue cannot make contact and then the distance of tongue elevation is shortened. 1bat may be expected to improve swallowing and to prevent from aspiration. The purpose of this report is to show the effects of PAP in patients with dysphagia through the videofluoroscopic study. Oral-pharyngeal swallowing post PAP is analyzed in 2 cases; one is a person who had subarachnoid hemorrhage due to aneurysmal rupture, right hemiparesis, hydrocephalus and aphamia. And the other is a person who had squamous cell carcinoma on mouth floor and he had radical neck dissection and marginal mandibulectomy. In this report, the rate of aspiration, the transit time and length measurements of anatomical structure are examined in the each frame of videofluoroscopy. The results are as follows; 1) PAP decreased the aspiration in both cases. 2) In the cases of patients with PAP, the pharyngeal transit time was decreased.

• 말소리와 음성과학
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• 제10권4호
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• pp.147-154
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• 2018

Wet voice quality (WVQ) is a characteristic that appears after swallowing. Although the concept is accepted by many clinicians worldwide, it is nevertheless ambiguous. In this study, we investigated WVQ in patients with swallowing disorders using acoustic analysis. A total of 106 patients diagnosed with penetration-aspiration by the videofluoroscopic swallowing study (VFSS) were recruited. A voice recording of vowel /a/ was conducted before and after the VFSS, and an acoustic analysis was then performed using PRAAT. Voice after VFSS was used for a perceptual judgment and divided into two groups: the Wet group (48 patients) and the Non-wet group (58 patients). At the post-VFSS stage, the two groups displayed significant differences in many acoustic parameters including F0_SD, Jitter, RAP, Shimmer, APQ, HNR, NHR, FUF, DVB, and CPP. The parameter affecting judging wetness resulted into Jitter and NHR by the logistic regression test. At the pre-VFSS stage, the two groups differed significantly in many acoustic parameters including Intensity, Jitter, RAP, Shimmer, NHR, FUF, DVB, and CPP. Both pre-and post-VFSS, the mean values of all significant parameters, except Intensity, HNR, and CPP, were higher in the Wet group. According to pre-and post-VFSS, the two groups displayed interactions in many parameters (Intensity, F0_SD, Jitter, RAP, Shimmer, APQ, HNR, NHR, FUF, DVB, and CPP). In particular, Intensity increased in both groups after the VFSS, although the increase in the Non-wet group was greater. Based on these results, it was conjectured that the WVQ after swallowing resulted from the secretion effect of the mucous membrane due to the dry laryngeal characteristic of elderly patients, rather than aspiration resulting in food on the vocal cords.

• Annals of Rehabilitation Medicine
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• 제42권6호
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• pp.798-803
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• 2018

Objective To investigate the relationship between peak cough flow (PCF), pulmonary function tests (PFT), and severity of dysphagia in patients with ischemic stroke. Methods This study included patients diagnosed with ischemic stroke, who underwent videofluoroscopic swallowing study (VFSS), PCF and PFT from March 2016 to February 2017. The dysphagia severity was assessed using the videofluoroscopic dysphagia scale (VDS). Correlation analysis of VDS, PFT and PCF was performed. Patients were divided into three groups based on VDS score. One-way ANOVA of VDS was performed to analyze PCF, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and age among the different groups. Results The correlation coefficients of VDS and PCF, VDS and FVC, and VDS and FEV1 were -0.836, -0.508, and -0.430, respectively, all of which were statistically significant at the level of p<0.001. The one-way ANOVA indicated statistically significant differences in PCF, FVC, FEV1, and age among the VDS groups. Statistically significant differences in VDS and age were observed between aspiration pneumoia and non-aspiration pneumonia groups. Conclusion Coughing is a useful factor in evaluating the risk of aspiration in dysphagia patients. Evaluation of respiratory and coughing function should be conducted during the swallowing assessment of patients with ischemic stroke.

• 대한임상전기생리학회지
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• 제7권1호
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• pp.17-21
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• 2009

Purpose : The purpose of this study was to analysis the effect of electrical stimulation for dysphagia caused by cerebral infarction. Methods : We recruited nineteen adults after cerebral infarction(14 male, 5 female; mean age, 69y) for our study. Electrical stimulation was used for participants with electrical stimulator connected to two pair of electrodes positioned on the neck for one hour a day and 5 times a week for 4 weeks. Maximum tolerated stimulation levels were applied at rest while participants held their mouth closed. Videofluoroscopic recordings, physical examination of swallowing, and swallow function score were used to evaluate swallowing state of participants. All evaluate items were evaluated before and after treatment. Results : There was no significance difference of swallowing stage. The swallow function score significantly increased from 1.8 to 5.3(p<0.001). Also, cough reflex(p<0.001), laryngeal excursion(p<0.01) were significantly reduced compared to before electrical stimulation. Conclusion : Therefore, electrical stimulation for dysphasia is proved effective as it activates the function of swallowing muscle.

• 말소리와 음성과학
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• 제9권3호
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• pp.85-91
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• 2017

The present study aimed to investigate the changes of acoustic parameters of the aspirated voice in stroke patients. The eighty-eight subjects diagnosed with cerebro-vascular accident were divided into 32 penetration/aspiration (P/A) and 56 Non-P/A groups according to the videofluroscopic swallowing study (VFSS) results, and 26 control subjects participated. All subjects preformed VFSS and vowel /a/ was recorded three times pre- and post VFSS. Since the variation in the acoustic parameters within a single phonation has been observed, we proposed a delta formula for the acoustic parameters which can reflect the temporal changes of the each parameter in an utterance. We measured from the voice data eight acoustic parameters: fundamental frequency (F0), standard deviation of F0 (F0_SD), Jitter, relative average perturbation (RAP), Shimmer, amplitude perturbation quotient (APQ), harmonic to noise ration (HNR), noise to harmonic ratio (NHR). Then we found parameters which show the meaningful biggest temporal change in an utterance using the suggested delta parameter. Among them, the deltas of shimmer and APQ were significantly different pre- and post VFSS. These deltas of the P/A and the control group were increased after VFSS, while those of the Non-P/A group was descended. The variation patterns of the P/A and the control group were similar but the change width of the P/A group was larger. The large variations in an aspirated phonation of the P/A group are thought to be caused by irregular changes in air resistance due to residual food on the vocal cords.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권2호
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• pp.116-121
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• 2008

목 적: 윤상인두 협조불능은 원인 불명의 드문 질환으로 윤상인두의 이완과 연관된 인두의 수축 지연이 특징이다. 출생 초기에 연하곤란을 일으키는 타 질환과의 감별과 임상 경과에 대한 이해가 조기 진단과 적절한 치료를 위해 필요하나 이에 대한 연구가 많지 않다. 방 법: 2000년 1월부터 2006년 12월까지 부산대학교 병원 소아과에서 임상 소견과 비디오 식도 촬영 또는 식도 조영술에서 윤상인두 협조불능으로 진단받은 17예를 대상으로 병록지와 검사 소견을 후향적으로 분석하였다. 결 과: 남녀 비는 1:1.1 (남자 8예, 여자 9예)이었다. 평균 나이는 12.5${\pm}$17.5일로 7일 이내 10예(58.8%), 7~30일 5예(29.4%), 30일 이상 2예(11.7%)였다. 체중은 3백분위수 미만 8예(47.1%), 10백분위수 이하 11예(64.7%)였다. 미숙아 6예(35.3%), 저출생 체중아 7예(41.2%), 부당경량아 2예(11.8%)였다. 동반 질환은 심장기형 3예, 염색체 이상 2예, 후두연하증 1예였다. 주요증상은 재발성 흡인성 폐렴 10예(58.8%), 수유곤란 9예(52.9%), 수유 시 호흡곤란 4예(23.5%), 구토와 목맴 4예(23.5%), 기침 3예(17.6%)였다. 흡인 정도는 경도 흡인 12예(70.5%), 중증도 흡인 3예(17.6%), 중증 흡인 2예(11.8%)였다. 15예(88.2%)에서 비위관 식이를 하였다. 추적관찰이 가능했던 10예 중 9예에서 경구 식이가 가능하였다. 그 시기는 1개월까지 3예(30.0%), 6개월까지 3예(30.0%), 12개월까지 2예(20.0%), 24개월까지 1예(10.0%)였다. 하지만 흡인의 정도가 심할수록 비위관식이의 기간이 의미 있게 길었다(상관 계수 0.73, p<0.05). 결 론: 출생 직후 또는 영아 초기에 연하곤란과 반복되는 흡인성 폐렴이 있으면 비디오 식도 조영술을 이용하여 윤상인두 협조불능의 감별이 필요하다. 윤상인두 협조불능은 예후가 양호한 질환이지만 조기 진단과 관급식이 합병증의 예방과 질환의 관리에 중요하며, 흡인의 정도가 심할수록 비위관 영양 기간이 길어지므로 완전 호전될 때까지 철저한 추적관리가 중요하다.