Successful nasoendoscopic and aerodynamic examinations of children with speech/voice disorders

Speech and Language Issues in the Cleft Palate Population: The State of the Art

Objective

State-of-the-art activity demands a look back, a look around, and, importantly, a look into the new millennium. The area of speech and language has been an integral part of cleft palate care from the very beginning. This article reviews the development and progression of our knowledge base over the last several decades in the areas of speech; language; anatomy and physiology of the velopharynx; assessment of velopharyngeal function; and treatment, both behavioral and physical, for velopharyngeal problems.

Method

The clear focus is on the cleft palate condition. However, much of what is reviewed applies to persons with other craniofacial disorders and with other underlying causes of velopharyngeal impairment. A major challenge in the next several years is to sort through speech disorders that have a clear anatomic underpinning, and thus are more amenable to physical management, versus those that may be treated successfully using behavioral approaches. Speech professionals must do a better job of finding and applying ways of treating individuals with less severe velopharyngeal impairment, thus avoiding the need for physical management in these persons or ignoring the speech problem altogether.

Conclusion

Early and aggressive management for speech and language disorders should be conducted. For most individuals born with cleft conditions, a realistic goal should be normal speech and language usage by the time the child reaches the school-age years.

Development of a minimum protocol for assessment in the paediatric voice clinic. Part 1: evaluating vocal function

The European Laryngological Society (ELS) recommend that functional assessment of voice disorder in adults requires evaluation of a number of different parameters. The current paper presents a discussion of four of the five parameters highlighted in the ELS protocol: perceptual evaluation of voice, videostroboscopic examination, evaluation of aerodynamic performance in voice, and acoustic analysis. Subjective rating of voice in children is explored in a companion paper. These parameters have been extensively evaluated in adults, and a review of the literature pertaining to the paediatric population is presented.

The minimum glottal airflow to initiate vocal fold oscillation

Phonation threshold flow (PTF) is proposed as a new aerodynamic parameter of the speech production system in this study. PTF is defined as the minimum airflow that can initiate stable vocal fold vibration. Because the glottal airflow can be noninvasively measured, it is suggested that the aerodynamic parameter PTF may be more practical for clinical vocal disease assessment. In order to investigate the relationship between PTF and phonatory system properties, the stability of the body-cover vocal fold model was analyzed. The study has theoretically shown that PTF is a sensitive aerodynamic parameter dependent on tissue properties, glottal configuration, and vocal tract loading. It was predicted that PTF can be reduced by decreasing tissue viscosity, decreasing mucosal wave velocity, increasing vocal fold thickness, or decreasing prephonatory glottal area. Furthermore, it was predicted that a divergent glottis or low vocal tract resistance lead to a reduced PTF. Also discussed is the potential significance of PTF in investigating the energy distribution in a vocal fold vibration system and related clinical applications.

Voice disorders in children

Pediatric patients with voice or speech problems usually should receive a team assessment in which communication between the pediatrician or primary care physician, the otolaryngologist, and speech pathologist occurs. Although speech or voice problems may prompt an otolaryngologic evaluation, the voice or speech problem simply may be the manifestation or symptom of a larger or more complex disease process. Whether that is the case of hypernasal speech, eventually leading to the diagnosis of velocardiofacial syndrome, or bilateral vocal fold paralysis, eventually leading to the diagnosis of hydrocephalus, it is apparent that patients with speech or voice disorders may eventually require multidisciplinary evaluation. The outlook for children with speech and voice difficulties is better than ever. Recent equipment advances, such as flexible laryngoscopy, video stroboscopy, and nasometry, for detection, evaluation, and management of speech problems have created a better environment than ever existed for care of these problems. Much research is being performed in the area of pediatric voice and speech problems. The National Institute of Deafness and Communicative Disorders and the National Institute of Dental Research have funded and currently fund many projects in these areas. Many pediatric hospitals now have voice or speech disorder clinics in which multiple disciplines are brought together to evaluate children with these problems. Children benefit best when speech and voice problems are managed in an interdisciplinary setting when necessary and by professionals who have experience and training in these specialized pediatric problems. Given the local, professional, and national resources that are expended toward recognition and treatment of speech disorders in children, it is truly a tragedy when those resources cannot be brought to assist children with voice and speech problems. Although voice and speech problems usually are recognized by parents or concerned family members, this task may rest on the pediatrician or other primary caregiver.

The developing role of a paediatric voice clinic: a review of our experience

OBJECTIVE

We report our experience in developing a paediatric voice clinic within a tertiary otolaryngology department and describe the emerging role of this specialized clinic.

MATERIALS

Currently our referral base is divided between other otolaryngologists within our department who require voice assessment as part of the pre- or post-operative management of laryngeal disorders (e.g. cysts, webs, vocal fold palsies, laryngo-tracheal reconstruction) and other professionals within our hospital who require characterisation of voice within the broader task of defining medical conditions in which voice abnormalities exist (e.g. mucopolysaccharidoses, functional dysphonias).

METHODS

The patients were assessed by a team consisting of a paediatric laryngologist and a speech and language therapist. Each patient underwent a perceptual voice assessment and qualitative voice assessment using electrolaryngography. Direct visualisation was attempted and methods of and suitability for, such examination are discussed.

RESULTS

Our experience is reviewed and guidelines for the establishment of a paediatric voice clinic are presented.