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Hyoid and laryngeal movements contribute to laryngeal vestibule closure and upper oesophageal sphincter opening during swallowing. Evidence of an internal sensorimotor scaling system allowing individuals to achieve these functional goals is lacking. In speech, speakers adjust their articulatory movement magnitude according to the movement distance required to reach an articulatory target for intelligible speech. We investigated if swallowing is similar in that movement amplitude may be scaled by the functional goal for airway protection during swallowing, rather than by head and neck size. We hypothesized that healthy individuals adapt to their own anatomy by adjusting hyo-laryngeal movements to achieve closure of the upper airway. We also investigated if individuals would automatically compensate for changes in their initial hyo-laryngeal positions and area when head position was changed prior to swallowing. Videofluoroscopy was performed in 31 healthy adults. Using frame-by-frame motion analysis, anterior and superior hyoid and laryngeal displacement, and hyo-laryngeal area were measured prior to and during swallowing. Kinematic measurements during swallowing were examined for relationships with pharyngeal neck length, and initial hyo-laryngeal positions, length and area before swallowing. During swallowing, individuals altered laryngeal elevation magnitude to exceed hyoid elevation based on hyo-laryngeal length before swallowing. Anterior laryngeal displacement was related to initial larynx distance from the spine, while hyoid elevation was predicted by pharyngeal neck length and initial hyoid distance from the mandible prior to the swallow. In conclusion, individuals automatically adapt hyo-laryngeal movement during swallowing based on targets required for closing the hyo-laryngeal area for safe swallowing.

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Voice handicap index correlates best with glottic closed phase, suggesting duration of vocal fold closure during the glottic cycle best represents patients' subjective outcome post-procedure. Progressive improvement in voice handicap index beyond six months may relate to gradual reduction in compensatory supraglottic compression, with moderate correlation.

Aims: Patient-reported outcome measures are important in assessing the impact of dysphagia on quality of life. Our aim was to adapt and examine the cultural validity and reliability of a swallowing-related quality of life measure, the MD Anderson Dysphagia Inventory (MDADI), in English and Chinese, with head and neck cancer patients. Methods: We adapted the MDADI to Chinese through formal forward-backward translation. Sixty-six head and neck cancer survivors completed the MDADI, Swallowing Quality of Life (SWAL-QOL) questionnaire and Hospital Anxiety and Depression Scale (HADS) in English or Chinese. Swallowing status was scored on the Functional Oral Intake Scale (FOIS). Seventy-four percent (n = 49) of participants completed a repeat administration of the MDADI for test-retest reliability analysis. Results: The MDADI showed high internal consistency reliability (Cronbach's α , 0.82 ≤ α ≤ 0.94), and test-retest reliability in both English (intraclass correlation coefficient, ICC = 0.81) and Chinese (ICC = 0.72). Criterion validity was established through moderate to strong correlations with relevant SWAL-QOL domains. Convergent validity was determined by significant correlations to the HADS and FOIS. Divergent validity was determined by nonsignificant association to the SWAL-QOL Sleep domain. The MDADI also presented as hypothesised to most known-group theoretical constructs. Conclusions: The MDADI showed good psychometric properties in English and Chinese. This avails a reliable and psychometrically valid MDADI for Chinese speakers.

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preoperative values) and VLS measurements were: GOAϭ0.465 (pϽ0.001), GCPϭϪ0.733 (pϽ0.001), SGCϭ0.172 (pϭns), AMPϭ0.131 (pϭns), DURϭϪ0.404 (pϽ0.001). A subset of 25 recordings from 8 patients with progressive VHI improvement beyond 6 months showed highest correlation with SGC following IL (rϭ0.504, pϽ0.05). CONCLUSIONS: VHI correlates best with GCP, suggesting that duration of vocal-fold closure during the glottic cycle best represents patients subjective outcome following IL. Progressive improvement in VHI beyond six months in some patients may relate to gradual reduction in compensatory supraglottic compression, with moderate correlation.

Objectives To determine if particle size affects durability of medialisation in patients undergoing injection laryngoplasty (IL) with hyaluronic acid (HA) for unilateral vocal cord paralysis (UVCP). Hypothesis: Larger particle-size HA persists longer after injection to produce a more durable vocal result. Methods Study Design: Prospective randomized controlled single-blind trial. Years conducted: 2005–2007. Condition studied: UVCP. Subjects: Patients over the age of 18 requiring medialisation for UVCP. Setting: Outpatient clinic setting. Intervention: Patients underwent transcutaneous IL with Restylane (small particle-size HA) or Perlane (large particle-size HA). Outcome measurement: The Voice Handicap Index (VHI) at 6 months post-injection was the primary outcome measure. Secondary outcomes included videostroboscopic findings, and objective acoustic and aerodynamic measures. Statistical methods: Differences between groups were compared using the Mann Whitney U test and adjusted for age & gender using ANCOVA. Results 17 patients (8 Restylane, 9 Perlane) were available for follow-up at 6 months. Normalised VHI scores at 6 months after IL were significantly lower in the Perlane group compared to the Restylane group when not adjusted for age and sex (p=0.027). After adjustment the difference was not significant (p=0.053) but the Perlane group trended towards lower normalised VHI scores. Conclusions The findings support the hypothesis that the larger particle size of Perlane makes this material more durable than Restylane for IL. This material may be considered for temporary medialisation in patients with UVCP in whom medium-term improvement of at least 6 months is desirable. The trans-cutaneous route can be used safely in the office setting in non-anti-coagulated patients.