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CompletedNCT04584658DYADSUpdated Jun 29, 2025

Dysphagia and Dysphonia Outcomes in SARS CoV-2 (COVID-19) Infection (DYADS Study)

An observational study in Dysphagia, Dysphonia and Subglottic Stenosis, sponsored by Cambridge University Hospitals NHS Foundation Trust. Completed at 1 site in United Kingdom. Open to participants aged 18 Years to 85 Years. Per ClinicalTrials.gov, last updated 2025-06-29.

Sponsored by Cambridge University Hospitals NHS Foundation Trust · Observational

Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
50
Ages
18 Years to 85 Years
Sex
All
01

Study summary

This study examines the presence, severity and natural history of dysphagia and dysphonia in the post-extubation and severely unwell COVID-19 patient.

02

Conditions studied

  • Dysphagia
  • Dysphonia
  • Subglottic Stenosis
  • Voice Disorders
  • Swallowing Disorder
  • Covid19
  • SARS (Severe Acute Respiratory Syndrome)
  • SARS Pneumonia
  • Quality of Life
  • SARS-CoV-2 Infection
03

Who can participate

Ages eligible
18 Years to 85 Years
Sexes eligible
All
Sampling method
Non-probability sample

Study population

Patients identified with dysphagia and dysphonia secondary to COVID19 infection. Specifically severely unwell patients and post-extubation patients.

Inclusion criteria

  • Patients who have been diagnosed with a positive SARS CoV-2 test.
  • Patients who have been diagnosed with dysphonia and/or dysphagia following COVID 19 treatment.
  • Patients who require investigation and management for dysphonia and/or dysphagia following COVID 19 treatment.
  • Adult patients aged 18 years - 85 years.
  • Patients that meet threshold for referral to the joint MDT clinic following screening

Exclusion criteria

Exclusion Criteria:

  • Patients who cannot undertake the assessment for dysphonia and/or dysphagia.
  • Patients who are being managed with palliative intent.
  • Patients with pre-existing dysphonia and/or dysphagia not previously responding to therapy (pre-existing prior to COVID-19 diagnosis).
04

Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
50 participants (actual)
Patient registry
No

Interventions

  • Diagnostic testFibreoptic Endoscopic Evaluation of Swallowing (FEES)

    This is the use of endoscopy during feeding trials. The patient is fed different consistencies of food and drink while an endoscope is in place (usually passed through the nasal passage and down into the throat). The endoscope provides a bird's eye view to the transit of food through the upper aero-digestive tract. This provides information from the point of food bolus formation in the mouth to the movement of the base of the tongue; the movement of pharyngeal muscles; the deflection of the epiglottis to protect the airway including the closure of the vocal cords and the passage of food into the oesophagus. Any abnormality in these steps are noted during FEES. Liquids, thickened fluids, semi-solids and solids are some of the food textures that are tested.

  • Diagnostic testVideofluoroscopy

    A radio opaque dye is used to label the test food and drink items offered to the patient. Following this, x-ray technology is used to create a video of the outline of the patient and the structures responsible for chewing and swallowing as they injest the test materials. The study is carried out in real time in the radiology department in conjunction with a radiographer and an SLT.

  • OtherDysphagia Handicap Index (DHI)

    This is a 25-item questionnaire assessing three domains: physical (9 items), functional (9 items), and emotional aspects (7 items) of the Quality of Life (QOL) in patients suffering with dysphagia. For each statement the patient checks if it applies to him/her all the time, some of the time or never. The suggested scores are 0, 2 and 4, respectively. Using this scoring system amounts to a DHI score range of 0 - 100. The higher the score, the worse the dysphagia related QOL. The patient is also asked to provide a rating of their own impression of the severity of the dysphagia experienced on a scale from 1 (normal) to 7 (severe problem).

  • OtherVoice Symptom Scale (VoiSS)

    This is a 30-item validated quality of life tool that is also a self-reporting tool. It appraises the impact of the patient's abnormal voice from an emotional perspective, related physical symptoms and stratifies the impairment itself in context of day to day activities. VoiSS is currently the most psychometrically robust voice outcome measure. Each item is scored 0 - 4 on the frequency responses: never, occasionally, some of the time, most of the time, always. The total score of 120 measures general voice pathology which is made up of Impairment = maximum score of 60; Emotional = maximum score of 32; Physical = maximum score of 28.

05

What researchers measure

Primary outcomes

  1. Primary endpoint is severity of dysphonia and dysphagia at the time of initial assessment t = day 0 (for ITU patients: Day 0 = 24 hours after extubation or decannulation).

    Based on therapy outcome measures from FEES, VoiS

    Time frame: t = day 0 (for ITU patients: Day 0 = 24 hours after extubation or decannulation).

Secondary outcomes

  1. The severity of dysphonia and/or dysphagia over an initial 12 month period (at t = 14 days, 1 month, 3 months, 6 months, 9 months, 12 months)

    Clinical assessment including outcome measures, FEES and/or Videofluoroscopy

    Time frame: t = 14 days, 1 month, 3 months, 6 months, 9 months, 12 months

  2. The severity of dysphonia and/or dysphagia at t = day 5, day 10, day 14, day 21 - For in-patients only.

    Clinical assessment including outcome measures, FEES and/or Videofluoroscopy

    Time frame: t = day 5, day 10, day 14, day 21 - For in-patients only.

  3. Relationship between severity of dysphonia and/or dysphagia with grade of ARDS

    Clinical assessment including outcome measures, FEES and/or Videofluoroscopy

    Time frame: t = day 0 and 9 months

  4. Relationship between severity of dysphonia and/or dysphagia with length of intubation

    Clinical assessment including outcome measures, FEES and/or Videofluoroscopy

    Time frame: t = day 0 and 9 months

  5. Relationship between severity of dysphonia and/or dysphagia with duration of mechanical ventilation

    Clinical assessment including outcome measures, FEES and/or Videofluoroscopy

    Time frame: t = day 0 and 9 months

  6. Relationship between severity of dysphonia on quality of life using Voice Symptom Scale (VoiSS) questionnaire over time at day 0, 1 month and 9 months.

    Questionnaire assessment: This is a 30-item validated quality of life tool that is also a self-reporting tool. It appraises the impact of the patient's abnormal voice from an emotional perspective, related physical symptoms and stratifies the impairment itself in context of day to day activities. VoiSS is currently the most psychometrically robust voice outcome measure. Each item is scored 0 - 4 on the frequency responses: never, occasionally, some of the time, most of the time, always. The total score of 120 measures general voice pathology which is made up of Impairment = maximum score of 60; Emotional = maximum score of 32; Physical = maximum score of 28

    Time frame: t = day 0, 1 month and 9 months.

  7. Relationship between severity of dysphagia on quality of life using Dysphagia Handicap Index (DHI) questionnaire over time at day 0, 1 month and 9 months

    Questionnaire assessment: This is a 25-item questionnaire assessing three domains: physical (9 items), functional (9 items), and emotional aspects (7 items) of the Quality of Life (QOL) in patients suffering with dysphagia. For each statement the patient checks if it applies to him/her all the time, some of the time or never. The suggested scores are 0, 2 and 4, respectively. Using this scoring system amounts to a DHI score range of 0 - 100. The higher the score, the worse the dysphagia related QOL. The patient is also asked to provide a rating of their own impression of the severity of the dysphagia experienced on a scale from 1 (normal) to 7 (severe problem).

    Time frame: t = day 0, 1 month and 9 months

06

Study locations

1 site
  • Cambridge University Hospitals NHS Foundation Trust
    Cambridge, CB2 0QQ, United Kingdom
07

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT04584658
Lead sponsor
Cambridge University Hospitals NHS Foundation Trust
Responsible party
Ekpemi Irune (Consultant Otolaryngology, Head & Neck Surgeon., Cambridge University Hospitals NHS Foundation Trust) — Principal investigator
First posted
Oct 14, 2020
Start date
Sep 15, 2020
Primary completion
Nov 30, 2022
Completion
Jan 30, 2023
Last update
Jun 29, 2025

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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