SUMMARY
Background
Outcome assessment in laryngeal dystonia is hindered by lack of consensus on a core
set of outcome measures to quantify treatment effect and disease severity on quality
of life. Potential outcome measure domains include objective voice, clinician reported,
and patient reported outcome measures (PROMs) for determining treatment success and
longitudinal disease tracking. We aim to determine correlations between a selections
of outcome measure tools following Botulinum toxin injection.
Methods
A selection of instruments were administered to assess adductor laryngeal dystonia
patient outcomes before and after Botulinum toxin injection. Voice samples recorded
using a cellular telephone application were used for objective acoustic measures (CPPS,
acoustic voice quality index) and speech language pathologist perceptual analysis
(CAPE-V). Additionally, patients completed a PROMs battery consisting of the Voice
Handicap Index-10, Communicative Participation Item Bank-10, OMNI-Vocal Effort Scale,
3 visual analog scale (VAS) questions. Changes in these outcome measures pre-post
treatment were compared between each other and with a global rating of change questionnaire
(GRCQ) using Spearman's rank correlation coefficients.
Results
Twenty six patients (20 female, mean age 57.7 years) participated. Using an anchor
based GRCQ, patients reported Botox efficacy was the only outcome measure found to
have significant correlation (r = 0.54, P = 0.022); all other outcome measures did not meet statistically significant correlation.
Amongst the selected outcome tools, several moderate-strong correlations were identified,
largely for outcome measures within the same domain. Most notable were correlations
between the patient reported OMNI-VES and VAS questions (r > 0.68, P < 0.05), clinician CAPE-V strain and overall severity (r = 0.900, P < 0.001), and acoustic voice quality index with sustained vowel CPPs (r = -0.797, P = 0.002).
Conclusion
Correlation between outcome measures instruments used for patients with adductor laryngeal
dystonia requires further attention. Weak correlations with an anchor based GRCQ were
found for this study's selected outcome instruments. A select number of correlations
were found between outcome instruments within each of the individual outcome measure
domains (patient perception, clinical perception, objective acoustics), but there
was largely a lack of correlation found for instruments between these three separate
domains.
Key Words
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Article info
Publication history
Published online: April 29, 2023
Accepted:
March 29,
2023
Publication stage
In Press Corrected ProofFootnotes
Financial Support: None.
Conflicts of Interest: Clark A. Rosen, MD disclosures and financial relationships: Olympus America Inc. Consultant; Instrumentarium: Royalties; Freudenberg Medical: Consultant; Reflux Gourmet LCC: ShareholderSarah L. Schneider disclosures and financial relationships: Medbridge: RoyaltiesThe other authors have no financial relationships or conflicts of interest to disclose.
Scientific Meetings: Accepted for presentation at the following scientific meetings:(a) Canadian Society of Otolaryngology-Head & Neck Surgery Annual Meeting, Vancouver, BC, Canada, October 2022 (Podium Presentation)(b) Fall Voice Conference, San Francisco, CA, USA, October 2022 (Poster Presentation)
Identification
Copyright
© 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
