An MDADI score below about 74 identifies the head and neck cancer patients who need a swallow study

The edition in brief

In 208 head and neck cancer patients contributing 470 paired MD Anderson Dysphagia Inventory and videofluoroscopic swallow observations, the composite score correlated inversely with DIGEST grade (r = -0.63) and the Penetration-Aspiration Scale (r = -0.50), with area under the curve 0.78 to 0.88 for detecting impairment. Optimal thresholds ran from 74 to 78, with about 74 best identifying DIGEST grade 2 or above. A four-item short form agreed closely with the full composite (r = 0.96) and retained good discrimination (AUC 0.85). A separate audit of 528 dysphonia referrals to one academic department found adherence to the 2018 hoarseness guideline did not improve after publication and fell for three recommendations: timely referral (71.3% after vs 80.9% before), avoiding pre-laryngoscopy imaging (96.6% vs 100%) and avoiding antibiotics (89.7% vs 95.7%). Overall adherence was 52.5% after against 61.7% before. In 461 children with obstructive sleep apnoea, of whom 195 were obese, class II and III obesity were associated with shorter total sleep time, lower sleep efficiency and more wake after sleep onset, while apnoea severity was associated only with the proportion of N1 sleep. And a series of 12 workplace-injury patients showed seemingly minor head trauma, usually a fall with temporal impact, converting anatomically predisposed superior semicircular canal dehiscence into symptomatic syndrome, with immediate hearing loss in all and autophony in 10.