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Purpose: In the present study, the authors investigated the association between wet vocal quality (WVQ) and prandial material in the larynx during phonation. The presence of such material is indicative of oropharyngeal dysphagia and results from entry of material into the laryngeal vestibule during swallowing. The primary aim of the study was to determine whether clinicians reliably perceive WVQ during phonation when prandial material is in the larynx.
Method: Seventy-eight subjects underwent videofluoroscopic swallow study, and simultaneous recording of time-linked videofluoroscopic and acoustic data was conducted during postswallow phonation. Experienced dysphagia clinicians then rated randomized audio samples for presence or absence of WVQ.
Results: WVQ is not reliably perceived by clinicians when material is present in the larynx in the region of the glottis during phonation, and there is a high degree of interrater variability for perceptual judgments of wetness.
Conclusions: Material in the larynx during phonation may result in multiple voice quality percepts, and even experienced clinicians may not be adept at identifying the perceptual consequences of this. Observation of laryngeal physiology during voicing when material is in the larynx using vocal tract imaging can improve reliability in the identification of wet vocal quality.
Wet vocal quality (WVQ) is a widely used term describing a type of voice abnormality that is considered an important clinical sign of dysphagia. It is presumed to be perceptually and physiologically distinct from other voice disturbances (e.g., dysphonia due to vocal fold pathology or paralysis) and has been anecdotally characterized as a wet, gurgly, or liquid sound during phonation (Logemann, 1998; Murray, Langmore, Ginsberg, & Dostie, 1996; Warms & Richards, 2000). Physiologically, WVQ is thought to be a consequence of a person's voice being produced through liquid or viscous material that has been misdirected into the larynx before, during, or after a swallow (Logemann, 1998;Murray et al., 1996). This can result in penetration-defined as passage of material into the laryngeal vestibule that does not pass below the vocal folds (Friedman & Frazier, 2000; Rosenbek, Robbins, Roecker, Coyle, &Wood, 1996)-as well as aspiration, or passage of material below the vocal folds and into the respiratory tract (Marik, 2001). When WVQ occurs after swallowing, it is thought to be suggestive of prandial material in the larynx during phonation, posing a...