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Rogers HP, Hseu A, Kim J, Silberholz E, Jo S, Dorste A, Jenkins K. Voice as a Biomarker of Pediatric Health: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:684. [PMID: 38929263 PMCID: PMC11201680 DOI: 10.3390/children11060684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
The human voice has the potential to serve as a valuable biomarker for the early detection, diagnosis, and monitoring of pediatric conditions. This scoping review synthesizes the current knowledge on the application of artificial intelligence (AI) in analyzing pediatric voice as a biomarker for health. The included studies featured voice recordings from pediatric populations aged 0-17 years, utilized feature extraction methods, and analyzed pathological biomarkers using AI models. Data from 62 studies were extracted, encompassing study and participant characteristics, recording sources, feature extraction methods, and AI models. Data from 39 models across 35 studies were evaluated for accuracy, sensitivity, and specificity. The review showed a global representation of pediatric voice studies, with a focus on developmental, respiratory, speech, and language conditions. The most frequently studied conditions were autism spectrum disorder, intellectual disabilities, asphyxia, and asthma. Mel-Frequency Cepstral Coefficients were the most utilized feature extraction method, while Support Vector Machines were the predominant AI model. The analysis of pediatric voice using AI demonstrates promise as a non-invasive, cost-effective biomarker for a broad spectrum of pediatric conditions. Further research is necessary to standardize the feature extraction methods and AI models utilized for the evaluation of pediatric voice as a biomarker for health. Standardization has significant potential to enhance the accuracy and applicability of these tools in clinical settings across a variety of conditions and voice recording types. Further development of this field has enormous potential for the creation of innovative diagnostic tools and interventions for pediatric populations globally.
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Affiliation(s)
- Hannah Paige Rogers
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Anne Hseu
- Department of Otolaryngology, Boston Children’s Hospital, 333 Longwood Ave, Boston, MA 02115, USA
| | - Jung Kim
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA
| | | | - Stacy Jo
- Department of Otolaryngology, Boston Children’s Hospital, 333 Longwood Ave, Boston, MA 02115, USA
| | - Anna Dorste
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Kathy Jenkins
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Lucas C, Torres-Guzman R, James AJ, Corlew S, Stone A, Powell ME, Golinko M, Pontell ME. Machine Learning for Automatic Detection of Velopharyngeal Dysfunction: A Preliminary Report. J Craniofac Surg 2024:00001665-990000000-01509. [PMID: 38709082 DOI: 10.1097/scs.0000000000010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/16/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Even after palatoplasty, the incidence of velopharyngeal dysfunction (VPD) can reach 30%; however, these estimates arise from high-income countries (HICs) where speech-language pathologists (SLP) are part of standardized cleft teams. The VPD burden in low- and middle-income countries (LMICs) is unknown. This study aims to develop a machine-learning model that can detect the presence of VPD using audio samples alone. METHODS Case and control audio samples were obtained from institutional and publicly available sources. A machine-learning model was built using Python software. RESULTS The initial 110 audio samples used to test and train the model were retested after format conversion and file deidentification. Each sample was tested 5 times yielding a precision of 100%. Sensitivity was 92.73% (95% CI: 82.41%-97.98%) and specificity was 98.18% (95% CI: 90.28%-99.95%). One hundred thirteen prospective samples, which had not yet interacted with the model, were then tested. Precision was again 100% with a sensitivity of 88.89% (95% CI: 78.44%-95.41%) and a specificity of 66% (95% CI: 51.23%-78.79%). DISCUSSION VPD affects nearly 100% of patients with unrepaired overt soft palatal clefts and up to 30% of patients who have undergone palatoplasty. VPD can render patients unintelligible, thereby accruing significant psychosocial morbidity. The true burden of VPD in LMICs is unknown, and likely exceeds estimates from HICs. The ability to access a phone-based screening machine-learning model could expand access to diagnostic, and potentially therapeutic modalities for an innumerable amount of patients worldwide who suffer from VPD.
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Affiliation(s)
- Claiborne Lucas
- Department of General Surgery, Prisma Health Greenville, Greenville, SC
| | | | - Andrew J James
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott Corlew
- Blavatnik Institute of Global Health & Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Amy Stone
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center
| | - Maria E Powell
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center
| | - Michael Golinko
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Division of Pediatric Plastic Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Matthew E Pontell
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Division of Pediatric Plastic Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN
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Ha JH, Lee H, Kwon SM, Joo H, Lin G, Kim DY, Kim S, Hwang JY, Chung JH, Kong HJ. Deep Learning-Based Diagnostic System for Velopharyngeal Insufficiency Based on Videofluoroscopy in Patients With Repaired Cleft Palates. J Craniofac Surg 2023; 34:2369-2375. [PMID: 37815288 PMCID: PMC10597411 DOI: 10.1097/scs.0000000000009560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/16/2023] [Indexed: 10/11/2023] Open
Abstract
Velopharyngeal insufficiency (VPI), which is the incomplete closure of the velopharyngeal valve during speech, is a typical poor outcome that should be evaluated after cleft palate repair. The interpretation of VPI considering both imaging analysis and perceptual evaluation is essential for further management. The authors retrospectively reviewed patients with repaired cleft palates who underwent assessment for velopharyngeal function, including both videofluoroscopic imaging and perceptual speech evaluation. The final diagnosis of VPI was made by plastic surgeons based on both assessment modalities. Deep learning techniques were applied for the diagnosis of VPI and compared with the human experts' diagnostic results of videofluoroscopic imaging. In addition, the results of the deep learning techniques were compared with a speech pathologist's diagnosis of perceptual evaluation to assess consistency with clinical symptoms. A total of 714 cases from January 2010 to June 2019 were reviewed. Six deep learning algorithms (VGGNet, ResNet, Xception, ResNext, DenseNet, and SENet) were trained using the obtained dataset. The area under the receiver operating characteristic curve of the algorithms ranged between 0.8758 and 0.9468 in the hold-out method and between 0.7992 and 0.8574 in the 5-fold cross-validation. Our findings demonstrated the deep learning algorithms performed comparable to experienced plastic surgeons in the diagnosis of VPI based on videofluoroscopic velopharyngeal imaging.
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Affiliation(s)
- Jeong Hyun Ha
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Seoul National University Hospital
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul
| | - Haeyun Lee
- Department of Electrical Engineering and Computer Science, Daegu Gyeongbuk Institute of Science and Technology, Daegu
- Medical Big Data Research Center, Seoul National University College of Medicine, Seoul
- Production Engineering Research Team, SAMSUNG SDI, Yongin-si, Gyeonggi-do Province
| | - Seok Min Kwon
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine
| | - Hyunjin Joo
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Korea
| | - Guang Lin
- Department of Aesthetic and Plastic Surgery, The First Affiliated Hospital ZHEJIANG University School of Medicine, Hangzhou, China
| | - Deok-Yeol Kim
- Department of Plastic Surgery, CHA Bundang Medical Center, and CHA Institute of Aesthetic Medicine, Seongnam-si, Gyeonggi-do Province
| | - Sukwha Kim
- Medical Big Data Research Center, Seoul National University College of Medicine, Seoul
- Department of Plastic Surgery, CHA Bundang Medical Center, and CHA Institute of Aesthetic Medicine, Seongnam-si, Gyeonggi-do Province
| | - Jae Youn Hwang
- Department of Electrical Engineering and Computer Science, Daegu Gyeongbuk Institute of Science and Technology, Daegu
- Interdisciplinary Studies of Artificial Intelligence, Daegu Gyeongbuk Institute of Science and Technology, Daegu
| | - Jee-Hyeok Chung
- Division of Pediatric Plastic Surgery, Seoul National University Children’s Hospital
| | - Hyoun-Joong Kong
- Medical Big Data Research Center, Seoul National University College of Medicine, Seoul
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
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Huqh MZU, Abdullah JY, AL-Rawas M, Husein A, Ahmad WMAW, Jamayet NB, Genisa M, Yahya MRB. Development of Artificial Neural Network-Based Prediction Model for Evaluation of Maxillary Arch Growth in Children with Complete Unilateral Cleft Lip and Palate. Diagnostics (Basel) 2023; 13:3025. [PMID: 37835768 PMCID: PMC10572375 DOI: 10.3390/diagnostics13193025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Cleft lip and palate (CLP) are the most common congenital craniofacial deformities that can cause a variety of dental abnormalities in children. The purpose of this study was to predict the maxillary arch growth and to develop a neural network logistic regression model for both UCLP and non-UCLP individuals. METHODS This study utilizes a novel method incorporating many approaches, such as the bootstrap method, a multi-layer feed-forward neural network, and ordinal logistic regression. A dataset was created based on the following factors: socio-demographic characteristics such as age and gender, as well as cleft type and category of malocclusion associated with the cleft. Training data were used to create a model, whereas testing data were used to validate it. The study is separated into two phases: phase one involves the use of a multilayer neural network and phase two involves the use of an ordinal logistic regression model to analyze the underlying association between cleft and the factors chosen. RESULTS The findings of the hybrid technique using ordinal logistic regression are discussed, where category acts as both a dependent variable and as the study's output. The ordinal logistic regression was used to classify the dependent variables into three categories. The suggested technique performs exceptionally well, as evidenced by a Predicted Mean Square Error (PMSE) of 2.03%. CONCLUSION The outcome of the study suggests that there is a strong association between gender, age, and cleft. The difference in width and length of the maxillary arch in UCLP is mainly related to the severity of the cleft and facial growth pattern.
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Affiliation(s)
- Mohamed Zahoor Ul Huqh
- Orthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Johari Yap Abdullah
- Craniofacial Imaging Lab, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia
| | - Matheel AL-Rawas
- Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Adam Husein
- Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Wan Muhamad Amir W Ahmad
- Department of Biostatistics, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Nafij Bin Jamayet
- Division of Restorative Dentistry (Prosthodontics), School of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia;
| | - Maya Genisa
- Biomedical Programme, Faculty of Pascasarjana, YARSI University, Jakarta 10510, Indonesia;
| | - Mohd Rosli Bin Yahya
- Oral & Maxillofacial Department, Hospital Raja Perempuan Zainab II, Kota Bharu 15586, Malaysia;
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Zhang Y, Zhang J, Li W, Yin H, He L. Automatic Detection System for Velopharyngeal Insufficiency Based on Acoustic Signals from Nasal and Oral Channels. Diagnostics (Basel) 2023; 13:2714. [PMID: 37627973 PMCID: PMC10453249 DOI: 10.3390/diagnostics13162714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Velopharyngeal insufficiency (VPI) is a type of pharyngeal function dysfunction that causes speech impairment and swallowing disorder. Speech therapists play a key role on the diagnosis and treatment of speech disorders. However, there is a worldwide shortage of experienced speech therapists. Artificial intelligence-based computer-aided diagnosing technology could be a solution for this. This paper proposes an automatic system for VPI detection at the subject level. It is a non-invasive and convenient approach for VPI diagnosis. Based on the principle of impaired articulation of VPI patients, nasal- and oral-channel acoustic signals are collected as raw data. The system integrates the symptom discriminant results at the phoneme level. For consonants, relative prominent frequency description and relative frequency distribution features are proposed to discriminate nasal air emission caused by VPI. For hypernasality-sensitive vowels, a cross-attention residual Siamese network (CARS-Net) is proposed to perform automatic VPI/non-VPI classification at the phoneme level. CARS-Net embeds a cross-attention module between the two branches to improve the VPI/non-VPI classification model for vowels. We validate the proposed system on a self-built dataset, and the accuracy reaches 98.52%. This provides possibilities for implementing automatic VPI diagnosis.
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Affiliation(s)
- Yu Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
| | - Jing Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
| | - Wen Li
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
| | - Heng Yin
- West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
| | - Ling He
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
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Huqh MZU, Abdullah JY, Wong LS, Jamayet NB, Alam MK, Rashid QF, Husein A, Ahmad WMAW, Eusufzai SZ, Prasadh S, Subramaniyan V, Fuloria NK, Fuloria S, Sekar M, Selvaraj S. Clinical Applications of Artificial Intelligence and Machine Learning in Children with Cleft Lip and Palate-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710860. [PMID: 36078576 PMCID: PMC9518587 DOI: 10.3390/ijerph191710860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The objective of this systematic review was (a) to explore the current clinical applications of AI/ML (Artificial intelligence and Machine learning) techniques in diagnosis and treatment prediction in children with CLP (Cleft lip and palate), (b) to create a qualitative summary of results of the studies retrieved. MATERIALS AND METHODS An electronic search was carried out using databases such as PubMed, Scopus, and the Web of Science Core Collection. Two reviewers searched the databases separately and concurrently. The initial search was conducted on 6 July 2021. The publishing period was unrestricted; however, the search was limited to articles involving human participants and published in English. Combinations of Medical Subject Headings (MeSH) phrases and free text terms were used as search keywords in each database. The following data was taken from the methods and results sections of the selected papers: The amount of AI training datasets utilized to train the intelligent system, as well as their conditional properties; Unilateral CLP, Bilateral CLP, Unilateral Cleft lip and alveolus, Unilateral cleft lip, Hypernasality, Dental characteristics, and sagittal jaw relationship in children with CLP are among the problems studied. RESULTS Based on the predefined search strings with accompanying database keywords, a total of 44 articles were found in Scopus, PubMed, and Web of Science search results. After reading the full articles, 12 papers were included for systematic analysis. CONCLUSIONS Artificial intelligence provides an advanced technology that can be employed in AI-enabled computerized programming software for accurate landmark detection, rapid digital cephalometric analysis, clinical decision-making, and treatment prediction. In children with corrected unilateral cleft lip and palate, ML can help detect cephalometric predictors of future need for orthognathic surgery.
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Affiliation(s)
- Mohamed Zahoor Ul Huqh
- Orthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia
| | - Johari Yap Abdullah
- Craniofacial Imaging Lab, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia
- Correspondence: (J.Y.A.); (L.S.W.); (S.S.)
| | - Ling Shing Wong
- Faculty of Health and Life Sciences, INTI International University, Nilai 71800, Malaysia
- Correspondence: (J.Y.A.); (L.S.W.); (S.S.)
| | - Nafij Bin Jamayet
- Division of Clinical Dentistry (Prosthodontics), School of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Mohammad Khursheed Alam
- Orthodontic Division, Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka 72345, Saudi Arabia
| | - Qazi Farah Rashid
- Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia
| | - Adam Husein
- Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia
| | - Wan Muhamad Amir W. Ahmad
- Department of Biostatistics, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia
| | - Sumaiya Zabin Eusufzai
- Department of Biostatistics, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia
| | - Somasundaram Prasadh
- National Dental Center Singapore, 5 Second Hospital Avenue, Singapore 168938, Singapore
| | | | | | | | - Mahendran Sekar
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Health Sciences, Royal College of Medicine Perak, Universiti Kuala Lumpur, Ipoh 30450, Malaysia
| | - Siddharthan Selvaraj
- Faculty of Dentistry, AIMST University, Bedong 08100, Malaysia
- Correspondence: (J.Y.A.); (L.S.W.); (S.S.)
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Where Is the Artificial Intelligence Applied in Dentistry? Systematic Review and Literature Analysis. Healthcare (Basel) 2022; 10:healthcare10071269. [PMID: 35885796 PMCID: PMC9320442 DOI: 10.3390/healthcare10071269] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 12/29/2022] Open
Abstract
This literature research had two main objectives. The first objective was to quantify how frequently artificial intelligence (AI) was utilized in dental literature from 2011 until 2021. The second objective was to distinguish the focus of such publications; in particular, dental field and topic. The main inclusion criterium was an original article or review in English focused on dental utilization of AI. All other types of publications or non-dental or non-AI-focused were excluded. The information sources were Web of Science, PubMed, Scopus, and Google Scholar, queried on 19 April 2022. The search string was “artificial intelligence” AND (dental OR dentistry OR tooth OR teeth OR dentofacial OR maxillofacial OR orofacial OR orthodontics OR endodontics OR periodontics OR prosthodontics). Following the removal of duplicates, all remaining publications were returned by searches and were screened by three independent operators to minimize the risk of bias. The analysis of 2011–2021 publications identified 4413 records, from which 1497 were finally selected and calculated according to the year of publication. The results confirmed a historically unprecedented boom in AI dental publications, with an average increase of 21.6% per year over the last decade and a 34.9% increase per year over the last 5 years. In the achievement of the second objective, qualitative assessment of dental AI publications since 2021 identified 1717 records, with 497 papers finally selected. The results of this assessment indicated the relative proportions of focal topics, as follows: radiology 26.36%, orthodontics 18.31%, general scope 17.10%, restorative 12.09%, surgery 11.87% and education 5.63%. The review confirms that the current use of artificial intelligence in dentistry is concentrated mainly around the evaluation of digital diagnostic methods, especially radiology; however, its implementation is expected to gradually penetrate all parts of the profession.
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The Feasibility of Cross-Linguistic Speech Evaluation in the Care of International Cleft Palate Patients. J Craniofac Surg 2022; 33:1413-1417. [PMID: 35275855 DOI: 10.1097/scs.0000000000008645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/09/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Many patients with cleft palate in developing countries never receive postoperative speech assessment or therapy. The use of audiovisual recordings could improve access to post-repair speech care. The present study evaluated whether English-speaking speech-language pathologists (SLPs) could assess cleft palate patients speaking an unfamiliar language (Tamil) using recorded media. Recordings obtained from Tamil-speaking participants were rated by 1 Tamil-speaking SLP and 3 English-speaking SLPs. Ratings were analyzed for inter-rater reliability and scored for percent correct. Accuracy of the English SLPs was compared with independent t tests and Analysis of Variance. Sixteen participants (mean age 14.5 years, standard deviation [SD] 7.4 years; mean age of surgery of 2.7 years, SD 3.7 years; time since surgery: 10.8 years, SD 5.7 years) were evaluated. Across the 4 SLPs, 5 speech elements were found to have moderate agreement, and the mean kappa was 0.145 (slight agreement). Amongst the English-speaking SLPs, 10 speech elements were found to have substantial or moderate agreement, and the mean kappa was 0.333 (fair agreement). Speech measures with the highest inter-rater reliability were hypernasality and consonant production errors. The average percent correct of the English SLPs was 60.7% (SD 20.2%). English SLPs were more accurate if the participant was female, under eighteen, bilingual, or had speech therapy. The results demonstrate that English SLPs without training in a specific language (Tamil) have limited potential to assess speech elements accurately. This research could guide training interventions to augment the ability of SLPs to conduct cross-linguistic evaluations and improve international cleft care by global health teams.
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Maryn Y, Zarowski A, Loomans N. Exploration of the Influences of Temporary Velum Paralysis on Auditory-Perceptual, Acoustic, and Tomographical Markers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4149-4177. [PMID: 34699253 DOI: 10.1044/2021_jslhr-20-00587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose To better understand hypernasality (HN), we explored the relations between velopharyngeal orifice, auditory perception of HN, and acoustic-spectral measures in an in vivo within-subject design: (a) with a normally functioning velum as the control condition and (b) with a temporarily paralyzed velum as the experimental condition. Method The velum of eight volunteers was injected with ropivacaine hydrochloride (Naropin) in the area of the levator veli palatini and tensor veli palatini muscles to induce temporary velopharyngeal inadequacy (VPI) and HN. Sustained [a] and [i] and oronasal text readings were recorded, and 3D cone-beam computed tomography images of the vocal tract were built before and during velar anesthesia. Differences between conditions and correlations in normal-to-numb differences between velopharyngeal cross-sectional area (VParea), mean ratings of HN severity, and nine acoustic-spectral measures were determined. Results Three subjects already had some incomplete velopharyngeal closure in the control condition. Temporary motor nerve blockage of the velum (increased VParea) was accomplished in seven subjects, leading to increased HN and changes in three acoustic-spectral measures. Furthermore, significant correlations only emerged between VParea, HN, and ModelKataoka. Conclusions In most of the participants, it was possible to temporarily increase the velopharyngeal orifice to investigate HN while controlling other speech variables and cephalic morphology. Although this study was exploratory and its are findings preliminary, it provided additional evidence for the possible clinical value of ModelKataoka, A 3-P 0, and B F1 for the objective measurement of VPI or HN.
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Affiliation(s)
- Youri Maryn
- Department of Otorhinolaryngology & Head and Neck Surgery, European Institute for ORL-HNS, GZA Sint-Augustinus, Wilrijk, Belgium
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- Department of Speech-Language Therapy and Audiology, University College Ghent, Belgium
- School of Logopedics, Faculty of Psychology and Educational Sciences, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Phonanium, Lokeren, Belgium
| | - Andrzej Zarowski
- Department of Otorhinolaryngology & Head and Neck Surgery, European Institute for ORL-HNS, GZA Sint-Augustinus, Wilrijk, Belgium
| | - Natalie Loomans
- Department of Maxillo-Cranio-Facial Surgery, Craniofacial and Cleft Lip & Palate Team GZA Sint-Augustinus, Wilrijk, Belgium
- Face Ahead, Private Maxillo-Cranio-Facial Surgery Clinic, Antwerp, Belgium
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Mathad VC, Scherer N, Chapman K, Liss JM, Berisha V. A Deep Learning Algorithm for Objective Assessment of Hypernasality in Children With Cleft Palate. IEEE Trans Biomed Eng 2021; 68:2986-2996. [PMID: 33566756 PMCID: PMC9023650 DOI: 10.1109/tbme.2021.3058424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Evaluation of hypernasality requires extensive perceptual training by clinicians and extending this training on a large scale internationally is untenable; this compounds the health disparities that already exist among children with cleft. In this work, we present the objective hypernasality measure (OHM), a speech-based algorithm that automatically measures hypernasality in speech, and validate it relative to a group of trained clinicians. METHODS We trained a deep neural network (DNN) on approximately 100 hours of a publicly-available healthy speech corpus to detect the presence of nasal acoustic cues generated through the production of nasal consonants and nasalized phonemes in speech. Importantly, this model does not require any clinical data for training. The posterior probabilities of the deep learning model were aggregated at the sentence and speaker-levels to compute the OHM. RESULTS The results showed that the OHM was significantly correlated with perceptual hypernasality ratings from the Americleft database (r = 0.797, p < 0.001) and the New Mexico Cleft Palate Center (NMCPC) database (r = 0.713, p < 0.001). In addition, we evaluated the relationship between the OHM and articulation errors; the sensitivity of the OHM in detecting the presence of very mild hypernasality; and established the internal reliability of the metric. Further, the performance of the OHM was compared with a DNN regression algorithm directly trained on the hypernasal speech samples. SIGNIFICANCE The results indicate that the OHM is able to measure the severity of hypernasality on par with Americleft-trained clinicians on thisdataset.
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Dhillon H, Chaudhari PK, Dhingra K, Kuo RF, Sokhi RK, Alam MK, Ahmad S. Current Applications of Artificial Intelligence in Cleft Care: A Scoping Review. Front Med (Lausanne) 2021; 8:676490. [PMID: 34395471 PMCID: PMC8355556 DOI: 10.3389/fmed.2021.676490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 01/30/2023] Open
Abstract
Objective: This scoping review aims to identify the various areas and current status of the application of artificial intelligence (AI) for aiding individuals with cleft lip and/or palate. Introduction: Cleft lip and/or palate contributes significantly toward the global burden on the healthcare system. Artificial intelligence is a technology that can help individuals with cleft lip and/or palate, especially those in areas with limited access to receive adequate care. Inclusion Criteria: Studies that used artificial intelligence to aid the diagnosis, treatment, or its planning in individuals with cleft lip and/or palate were included. Methodology: A search of the Pubmed, Embase, and IEEE Xplore databases was conducted using search terms artificial intelligence and cleft lip and/or palate. Gray literature was searched using Google Scholar. The study was conducted according to the PRISMA- ScR guidelines. Results: The initial search identified 458 results, which were screened based on title and abstracts. After the screening, removal of duplicates, and a full-text reading of selected articles, 26 publications were included. They explored the use of AI in cleft lip and/or palate to aid in decisions regarding diagnosis, treatment, especially speech therapy, and prediction. Conclusion: There is active interest and immense potential for the use of artificial intelligence in cleft lip and/or palate. Most studies currently focus on speech in cleft palate. Multi-center studies that include different populations, with collaboration amongst academicians and researchers, can further develop the technology.
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Affiliation(s)
- Harnoor Dhillon
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Kumar Chaudhari
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Kunaal Dhingra
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rong-Fu Kuo
- Medical Device Innovation Centre, National Cheng Kung University, Tainan, Taiwan
| | - Ramandeep Kaur Sokhi
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shandar Ahmad
- School of Computational and Integrative Sciences, Jawaharlal Nehru University, New Delhi, India
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