Voice changes may be the earliest signs in laryngeal cancer. We investigated whether automated voice signal analysis can be used to distinguish patients with laryngeal cancer from healthy subjects. We extracted features using the software package for speech analysis in phonetics (PRAAT) and calculated the Mel-frequency cepstral coefficients (MFCCs) from voice samples of a vowel sound of /a:/. The proposed method was tested with six algorithms: support vector machine (SVM), extreme gradient boosting (XGBoost), light gradient boosted machine (LGBM), artificial neural network (ANN), one-dimensional convolutional neural network (1D-CNN) and two-dimensional convolutional neural network (2D-CNN). Their performances were evaluated in terms of accuracy, sensitivity, and specificity. The result was compared with human performance. A total of four volunteers, two of whom were trained laryngologists, rated the same files. The 1D-CNN showed the highest accuracy of 85% and sensitivity and sensitivity and specificity levels of 78% and 93%. The two laryngologists achieved accuracy of 69.9% but sensitivity levels of 44%. Automated analysis of voice signals could differentiate subjects with laryngeal cancer from those of healthy subjects with higher diagnostic properties than those performed by the four volunteers.

Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology.Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion: This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Kim DH, et al. Ann Rehabil Med. 2012 Dec;36(6):791-796. http://dx.doi.org/10.5535/arm.2012.36.6.791

The purpose of this study was to compare the posterior superior iliac spine (PSIS) and the iliac crest as accurate anatomical landmarks for identifying spinal level. This study was conducted in 2 stages. First, 4 examiners examined 60 patients and blindly identified iliac crest and PSIS levels, and the interexaminer reliability of PSIS and iliac crest palpation were then analyzed. Second, 4 examiners attached a radio opaque marker at presumed PSIS and iliac crest levels in 72 patients, and posteroanterior lumbar radiographs were then taken. Four examiners then confirmed PSIS and iliac crest levels after radiographically identifying the marker levels and checked the spinal level at which the spinous process or interspace was crossed by drawing a horizontal line drawn between radio opaque markers. The interexaminer reliability of palpation was significantly greater for PSIS level than for the iliac crest (P < .05). Spinal levels of estimated PSISs identified by palpation ranged from the L5-S1 interspace to the S2 spinous process, and the spinal levels of estimated iliac crest ranged from the L2-3 interspace to the L5 spinous process. Although PSIS palpation showed statistically higher interexaminer reliability than iliac crest level, clinicians should be cautious when applying this method as a measurement tool because estimated spinal level by palpation can be influenced inadvertently by examiner skill and anatomical variations.