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This study investigated the relationships between the perceptual evaluation of “wetness” of both pre-swallow voice and expiratory sound and video uoroscopic swallowing study (VFSS) ndings. Pre-swallow phonation of the vowel “a” and expiratory sounds were recorded immediately before VFSS in 51 patients with head and neck cancer. During VFSS, subjects were requested to swallow 3 ml of a jelly-like, radiopaque test food. A total of 61 samples of “a” phonations and expiratory sounds were investigated in this study. These sound samples were randomized and presented to 12 examiners with various years of experience in dysphagia management. The examiners perceptually evaluated the wetness of sound samples using a 5-point “wetness” grade. VFSS findings were evaluated using the 8-point penetration aspiration (PA) scale. The relationships between the wetness of sound samples and VFSS findings were analyzed. Penetration / aspiration without materials ejected out of the airway can be predicted by the wetness of sound samples. In this study, both the pre-swallow wet voice and wet expiratory sounds were suitable for predicting penetration / aspiration after swallowing. High inter-rater and intra-rater reliabilities were verified in the highand low-experience examiners, with no signi cant difference evident between these groups. These ndings suggest that clinicians could predict penetration / aspiration in head and neck cancer patients by perceptually evaluating the wetness of pre-swallow voice and expiratory sounds regardless of clinical experience.

Prediction of Aspiration by Perceptual Evaluation of Pre-swallow Wet Voice and Wet Expiratory Sounds in Adults Diagnosed with Head and Neck Cancer