AUTHOR=Rajappa Akila Theyyar , Soriano Kristie R. , Ziemer Courtney , Troche Michelle S. , Malandraki Jaime Bauer , Malandraki Georgia A. 

TITLE=Reduced Maximum Pitch Elevation Predicts Silent Aspiration of Small Liquid Volumes in Stroke Patients

JOURNAL=Frontiers in Neurology

VOLUME=8

YEAR=2017

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00436

DOI=10.3389/fneur.2017.00436

ISSN=1664-2295

ABSTRACT=<sec id="ST1"><title>Background and purpose</title><p>Preliminary evidence has shown that reduced ability to maximally raise vocal pitch correlates with the occurrence of aspiration (i.e., airway invasion by food or liquid). However, it is unclear if this simple task can be used as a reliable predictor of aspiration in stroke patients. Our aim was to examine whether maximum vocal pitch elevation predicted airway invasion and dysphagia in stroke.</p></sec><sec id="ST2"><title>Methods</title><p>Forty-five consecutive stroke patients (&lt;1 month poststroke) at a rehabilitation setting participated in a videofluoroscopic swallow study and two maximum vocal pitch elevation tasks. Maximum pitch was evaluated acoustically [maximum fundamental frequency (max <italic>F</italic><sub>0</sub>)] and perceptually. Swallowing safety was rated using the Penetration/Aspiration Scale and swallowing performance was assessed using components of the Modified Barium Swallow Impairment Profile (MBSImPTM©). Data were analyzed using simple regression and receiver operating characteristics curves to test the sensitivity and specificity of max <italic>F</italic><sub>0</sub> in predicting aspiration. Correlations between max <italic>F</italic><sub>0</sub> and MBSImP variables were also examined.</p></sec><sec id="ST3"><title>Results</title><p>Max <italic>F</italic><sub>0</sub> predicted silent aspiration of small liquid volumes with 80% sensitivity and 65% specificity (<italic>p</italic> = 0.023; area under the curve: 0.815; cutoff value of 359.03 Hz). Max <italic>F</italic><sub>0</sub> did not predict non-silent aspiration or penetration in this sample and did not significantly correlate with MBSImP variables. Furthermore, all participants who aspirated silently on small liquid volumes (11% of sample) had suffered cortical or subcortical lesions.</p></sec><sec id="ST4"><title>Conclusion</title><p>In stroke patients (&lt;1 month poststroke), reduced maximum pitch elevation predicts silent aspiration of small liquid volumes with high sensitivity and moderate specificity. Future large-scale studies focusing on further validating this finding and exploring the value of this simple and non-invasive tool as part of a dysphagia screening are warranted.</p></sec>