A pre- and post-operative protocol for assessment of voice and swallowing function in patients undergoing heart or lung transplantation.

Background: Oropharyngeal dysphagia and laryngeal dysfunction are complications of lung and heart transplantation. However, there is a lack of understanding around pre-operative function and an absence of standardized assessment protocols. We aimed to trial a pre- and post-operative protocol for assessing voice and swallowing function. Method: A prospective, longitudinal study of 14 adults undergoing investigation for lung or heart transplantation was conducted at a tertiary referral hospital. Patients were assessed pre-surgery and up to 6 months afterwards. The protocol involved phonation tasks with auditory-perceptual and acoustic analysis, videolaryngostroboscopy, a flexible endoscopic examination of swallowing and patient reported quality of life measures. Risk factors and clinical outcomes were extracted from patient records. Results: Patient self-reports of swallowing and voice difficulties were elevated pre-operatively. No evidence of swallowing difficulty was observed under endoscopic examination pre-transplant (Penetration-Aspiration Scale score <2; no accumulated secretions) and only one patient presented with incomplete glottic closure. Auditory perceptual ratings revealed voices were largely within the healthy range at baseline. One out of five patients presented with severe dysphonia post-operatively. Completion of evaluation measures prior to transplantation was 79% but post- operative rates were low due to feasibility challenges with follow up in this complex population. Conclusion: Novel evidence of self-reported pre-transplant voice and swallowing changes indicate value in baseline screening. Discrepancies between patient-report and instrumental assessment results highlight the need for multi-faceted evaluation. Large cohort studies are needed to determine the salient evaluation measures and time points for voice and swallowing assessment in this population.