1. Validation of a patient based survey to evaluate post-operative dysphagia, odynophagia, and voice disability in patients undergoing anterior cervical neck surgery
Joseph A. Sclafani MD1, Deborah I. Ross CCC-SLP2, Brian H. Weeks MD3, Choll W Kim MD,PhD1
11Spine Institute of San Diego, Minimally Invasive Spine Surgery Center of Excellence
2 San Diego Speech Therapy, San Diego, CA
3. Senta Clinic, San Diego, CA
INTRODUCTION
Common morbidities associated with the anterior approach to cervical reconstruction are post- operative dysphagia, odynophagia, and/or voice disability (Figure 1).
Existing evaluative instruments such as the American Speech and Hearing Association’s National Outcomes Measurement System (NOMS) are cumbersome and require administration by a highly trained practitioner.
A novel patient reported survey that quantifies the severity of post-operative dysphagia, odynophagia, and voice disabilities (DOV) was previously determined sufficiently sensitive to detect post-operative disabilities after an anterior cervical approach (Figure 2).
This study was conducted to utilize the widely-accepted practitioner-administered NOMS scale to validate the dysphagia and voice components of the patient-reported DOV survey.
MATERIALS AND METHODS
DOV questionnaires were comprised of 3 distinct categories of disability: dysphagia (4 points), odynophagia (3 points), and voice (3 points).
DOV questionnaires were completed on post-operative day 1 by patients that had undergone anterior cervical discectomy and fusion.
A NOMS evaluation and swallow VAS pain scale was performed on the patient by a certified Speech Language Pathologist within the same therapy session.
DOV dysphagia and voice scores were converted to an equivalent NOMS score and DOV odynophagia scores were converted to VAS scores based on comparable disability (Table)
Statistical analysis was performed using paired t-tests to compare converted swallow pain VAS, NOMS swallow and voice disability scores to DOV odynophagia, dysphagia and voice scores, respectively (p<0.05 represents non-equivalence between the two instruments).
Chronbach’s alpha was utilized to test internal consistency of the DOV survey.
Figure 1. An example of prevertebral soft tissue swelling (*) after an anterior approach to cervical fusion. Such swelling can lead to dysphagia, odynophagia, or voice changes.
Figure 2. The patient administered Dysphagia, Odynophagia, and Voice (DOV) survey.
Converted Survey Parameters: No Significant Difference Between DOV, NOMS, and VAS
RESULTS
A total of 20 patients completed the post-operative DOV and NOMS instruments.
There was not a significant difference between converted NOMS swallow (1.1 ± 1.2, n=20) and DOV dysphagia (1.0 ± 1.3, n=20, p= 0.61) scores, converted NOMS voice (1.0 ± 0.6, n=20) and DOV voice (1.1 ± 0.8, n=20, p= 0.6) disability scores, or VAS odynophagia (0.67 ± 0.5, n=15) and DOV odynophagia scores (0.8 ± 0.8, n=15, p= 0.34).
Internal consistency of the DOV was an acceptable Chronbach’s alpha of 0.74.
Odynophagia Conversion
VAS
DOV
7 to 10
Severe pain 3
4 to 7
Moderate Pain 2
1 to 3
Mild pain 1
No pain
Dysphagia Conversion
NOMS
NPO + PEG 4
NPO + PEG, trials with therapy only
Peg + Chopped & Honey thick
Thick liquids + Chopped or soft & nectar 5
Either soft or nectar thick 6
extra time to eat but regular and thins 7
normal, regular and thins
Voice Conversion
No Voice
Cannot functionally communicate
Functional but severely limited
Moderate Limitation
Min-Mod limitation
Minimal limitation
Normal
CONCLUSIONS
The DOV is a patient-based outcome measure that can rapidly and reliably detect disabilities in swallow and voice function.
There are no significant differences between voice and swallow components of the patient-reported DOV and practitioner-administered NOMS surveys.
Therefore, the DOV survey can be clinically utilized to screen post-operative patients for voice and swallow dysfunctions that require a formal evaluation by a Speech Language Pathologist.