Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Date of Graduation


Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Communication Sciences and Disorders


Erin Kamarunas

Cynthia O'Donoghue

Christina Kuo


The clinical swallowing evaluation (CSE) is a non-instrumental exam that informs speech-language pathologists about a patient’s cognition, readiness for instrumental evaluation, and swallowing symptoms. Because of the common neuroanatomy and physiology of the larynx during voicing and swallowing tasks, coughing or throat clearing after food and drink may indicate swallowing impairment. Also because of the shared mechanisms of the larynx, some clinicians also attribute voice changes after swallowing to dysphagia although many studies to date demonstrate conflicting results on the effectiveness of post-prandial voice assessment. The aim of this study was to assess if dysphonia and/or voice change after swallowing is indicative of a swallowing disorder. Thirty-nine adults between the ages of 49-97 years were audio recorded completing a sustained vowel and sentence prior to a videofluoroscopic swallowing study (VFSS) and again after swallowing each bolus. Swallowing function was categorized with a revised Penetration-Aspiration Scale, and pharyngeal residue was measured with the Normalized Residue Ratio Scale (NRRS). Two hundred and fifty voice samples were measured acoustically and perceptually. Acoustic measures of interest included mean fundamental frequency, relative average perturbation, and noise-to-harmonic ratio. Following listener training, perceptual analysis of the voice samples was completed by three speech-language pathologists using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

Results indicated that baseline dysphonia was associated with greater instances of penetration and/or aspiration. Speech-language pathologists perceptually identified a change in the voice when there was a change in the acoustic signal; however, perceptually-identified voice change after swallowing was not related to dysphagia. Based on these results, dysphonia during a CSE should alert speech-language pathologists of a possible comorbid dysphagia; however, voice change after swallowing appears unrelated to airway invasion.

Available for download on Thursday, July 01, 2021