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Tye S, Hamilton MB, Speights Atkins M, Weaver AJ, Dillon KW, Sandage MJ. Perceptions of employability related to severity of hypernasality: a pilot study. CLINICAL LINGUISTICS & PHONETICS 2024; 38:21-39. [PMID: 36592048 DOI: 10.1080/02699206.2022.2155876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
The primary aim of this investigation was to evaluate listener auditory-perceptual assessment of employability for individuals with hypernasal speech. Using an online survey platform, listeners with managerial experience evaluated speech samples from individuals with varying hypernasal resonance disorder severity to determine auditory-perceptual judgements regarding intelligence and employability. Speech samples of individuals with hypernasal speech were rated lower on scales of intelligence and employability, and more likely to be selected for jobs with infrequent rates of communication and lower levels of responsibility. Additionally, males with hypernasal speech were perceived as less intelligent, less employable, and more likely to be selected for a job with infrequent communication in comparison to females with hypernasal speech. Results of this preliminary investigation suggest that individuals with hypernasal speech may face employment barriers. The conclusions collected from this initial investigation open the doors for further research addressing linguistic considerations and aspects of employability. This is an important consideration for individuals with either acquired or congenitally related hypernasal resonance disorder.
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Affiliation(s)
- Scott Tye
- Department of Speech, Language, and Hearing Sciences, Auburn University, Auburn, Alabama, USA
| | - Megan-Brette Hamilton
- Department of Speech, Language, and Hearing Sciences, Auburn University, Auburn, Alabama, USA
| | - Marisha Speights Atkins
- Department of Speech, Language, and Hearing Sciences, Auburn University, Auburn, Alabama, USA
| | - Aurora J Weaver
- Department of Speech, Language, and Hearing Sciences, Auburn University, Auburn, Alabama, USA
| | - K W Dillon
- Center for Cleft and Craniofacial Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, Auburn, Alabama, USA
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Kuwabara MS, Sitzman TJ, Szymanski KA, Perry JL, Miller JH, Cornejo P. The Pediatric Neuroradiologist's Practical Guide to Capture and Evaluate Pre- and Postoperative Velopharyngeal Insufficiency. AJNR Am J Neuroradiol 2023; 45:9-15. [PMID: 38164545 PMCID: PMC10756579 DOI: 10.3174/ajnr.a8055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024]
Abstract
Up to 30% of children with cleft palate will develop a severe speech disorder known as velopharyngeal insufficiency. Management of velopharyngeal insufficiency typically involves structural and functional assessment of the velum and pharynx by endoscopy and/or videofluoroscopy. These methods cannot provide direct evaluation of underlying velopharyngeal musculature. MR imaging offers an ideal imaging method, providing noninvasive, high-contrast, high-resolution imaging of soft-tissue anatomy. Furthermore, focused-speech MR imaging techniques can evaluate the function of the velum and pharynx during sustained speech production, providing critical physiologic information that supplements anatomic findings. The use of MR imaging for velopharyngeal evaluation is relatively novel, with limited literature describing its use in clinical radiology. Here we provide a practical approach to perform and interpret velopharyngeal MR imaging examinations. This article discusses the velopharyngeal MR imaging protocol, methods for interpreting velopharyngeal anatomy, and examples illustrating its clinical applications. This knowledge will provide radiologists with a new, noninvasive tool to offer to referring specialists.
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Affiliation(s)
- Michael S Kuwabara
- From the Radiology Department (M.S.K., J.H.M., P.C.), Phoenix Children's Hospital, Phoenix, Arizona
| | - Thomas J Sitzman
- Plastic Surgery Division (T.J.S.), Phoenix Children's Hospital, Phoenix, Arizona
| | - Kathryn A Szymanski
- Creighton University School of Medicine (K.A.S.), Phoenix Regional Campus, Phoenix, Arizona
| | - Jamie L Perry
- Department of Communication Sciences and Disorders (J.L.P.), East Carolina University, Greenville, North Carolina
| | - Jeffrey H Miller
- From the Radiology Department (M.S.K., J.H.M., P.C.), Phoenix Children's Hospital, Phoenix, Arizona
| | - Patricia Cornejo
- From the Radiology Department (M.S.K., J.H.M., P.C.), Phoenix Children's Hospital, Phoenix, Arizona
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3
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Mao Q, Li J, Yin X. Pearls and pitfalls in contemporary management of marginal velopharyngeal inadequacy among children with cleft palate. Front Pediatr 2023; 11:1187224. [PMID: 37609363 PMCID: PMC10440703 DOI: 10.3389/fped.2023.1187224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/29/2023] [Indexed: 08/24/2023] Open
Abstract
Marginal velopharyngeal inadequacy (MVPI) is a particular status of velopharyngeal closure after cleft palate repair. The physiological and phonological characteristics of patients with MVPI are significantly different from those with typical velopharyngeal insufficiency. The pathological mechanisms and diagnostic criteria of MVPI are still controversial, and there is limited evidence to guide the selection of surgical and non- surgical management options and a lack of recognized standards for treatment protocols. Based on a systematic study of the relevant literatures, this review identifies specific problems that are currently under-recognized in the diagnosis and treatment of MVPI and provides guidelines for further exploration of standardized and reasonable intervention protocols for MVPI.
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Affiliation(s)
- Qirong Mao
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jingtao Li
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xing Yin
- Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Inostroza-Allende F, Palomares-Aguilera M, Jara MG, Gaponov CQ, Villarroel CG, Pegoraro-Krook MI. Normative nasalance scores in Chilean adults. Codas 2022; 34:e20210152. [PMID: 35352792 PMCID: PMC9886296 DOI: 10.1590/2317-1782/20212021152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The present study is aimed towards determining and comparing normative nasalance scores in Chilean Spanish-speaking adult men and women. METHODS 40 women (age range 18 to 35, X = 25.79, SD = 5.83) and 36 men (age range 18 to 35, X = 26.45, SD = 4.08) were invited to participate, all of them without any previous speech therapy, neurological pathologies, intellectual deficits, hearing loss, syndromes, or other diagnosed pathologies that could impact speech production.A study of proper velopharyngeal function was performed, using a perceptual resonance evaluation. Nasalance was determined using a model 6450 Nasometer, during the reading of three standardized speech samples in Spanish: a nasal passage (NP), an oronasal passage (ONP), and an oral passage (OP). Also, the nasalance distance was calculated. Genders were compared using Wilcoxon tests for independent samples. RESULTS The NP presented the highest percentage of nasalance, with 52.13% (± 4.73), followed by the ONP with 25.38% (± 3.7), and finally the OP, which presented the lowest value of 14.15% (± 5.03). Meanwhile, nasalance distance was 37.98% (± 5.32). Finally, no significant differences were observed when comparing the nasalance between genders (p >0.05). CONCLUSION The nasalance values obtained were similar to those observed for other Spanish speakers. Also, male and women showed similar scores. The results of this study are a contribution to the indirect assessment of velopharyngeal function in Chilean adults.
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Affiliation(s)
- Felipe Inostroza-Allende
- Departamento de Fonoaudiología, Universidad de Chile - Santiago, Chile.,Fundación Gantz - Hospital del Niño con Fisura - Santiago, Chile.
| | - Mirta Palomares-Aguilera
- Fundación Gantz - Hospital del Niño con Fisura - Santiago, Chile.,Smile Train - South American Medical Advisory Council – SAMAC - Santiago, Chile.
| | - Matías Gonzalez Jara
- Escuela de Fonoaudiología, Sede Santiago, Facultad de Salud, Universidad Santo Tomás - Santiago, Chile.
| | - Camilo Quezada Gaponov
- Departamento de Fonoaudiología, Universidad de Chile - Santiago, Chile.,Universidad de los Andes - Santiago, Chile.
| | - Carlos Giugliano Villarroel
- Fundación Gantz - Hospital del Niño con Fisura - Santiago, Chile.,Smile Train - South American Medical Advisory Council – SAMAC - Santiago, Chile.,Unidad de Cirugía Plástica, Servicio de Cirugía, Clínica Alemana - Santiago, Chile.
| | - María Inés Pegoraro-Krook
- Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru, Universidade de São Paulo – USP - Bauru (SP), Brasil.,Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo – USP - Bauru (SP), Brasil.
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Comprehensive evaluation of velopharyngeal function in myasthenia gravis patients. Acta Neurol Belg 2022; 122:1229-1236. [PMID: 35306634 DOI: 10.1007/s13760-022-01904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/17/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Hypernasality, which is a symptom of dysarthria, may be seen in patients with Myasthenia Gravis with bulbar symptoms. However, there is not enough evidence to show that these patients may have velopharyngeal dysfunction. This study investigates the features of velopharyngeal function in myasthenia gravis patients using objective and subjective measurement tools. METHODS Ten adult myasthenia gravis patients with bulbar symptoms and ten adult myasthenia gravis patients without bulbar symptoms were recruited for this study. Ten healthy subjects were also included as the control group. The nasalance scores of the participants were determined using a nasometer. The degree and pattern of velopharyngeal closure were scored using flexible nasoendoscopy during speech, blowing, dry swallowing, and food swallowing. Perceptual hypernasality was assessed. RESULTS Velopharyngeal dysfunction was detected in 50% of the myasthenia gravis patients with bulbar symptoms. Velopharyngeal dysfunction was not seen in myasthenia gravis patients without bulbar symptoms. The degree of velopharyngeal closure in patients with bulbar symptoms differed depending on the tasks being performed. No significant difference in velopharyngeal closure patterns was observed between the groups (p < 0.05). CONCLUSION Myasthenia gravis patients with bulbar involvement may have velopharyngeal dysfunction. It is important to conduct a comprehensive evaluation to assess all aspects of the velopharyngeal function.
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Lambert EM, You P, Kacmarynski DS, Rosenberg TL. Adenoidectomy and persistent velopharyngeal insufficiency: Considerations, risk factors, and treatment. Int J Pediatr Otorhinolaryngol 2021; 149:110846. [PMID: 34329831 DOI: 10.1016/j.ijporl.2021.110846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/05/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
IMPORTANCE Persistent velopharyngeal insufficiency (VPI) is a rare but well-recognized complication of adenoidectomy. VPI can have a significant impact on the communication of a child. OBJECTIVE To describe the pathophysiology of post-adenoidectomy VPI, identify its associated risk factors, and illustrate the techniques used to treat the entity. EVIDENCE REVIEW A search of English or translated English articles concerning adenoidectomy, partial adenoidectomy, superior adenoidectomy; and velopharyngeal insufficiency, speech and voice from 1980 to 2021 was performed using Pubmed and Embase. Data from prospective and retrospective studies and their relevant references were pooled. RESULTS By objective measures, hypernasality is noted in many pediatric patients post-adenoidectomy, but this typically resolves in 3-6 months. Risk factors for the development of post-adenoidectomy VPI include low birth weight, family history of hypernasality, and history of speech problems or nasal regurgitation. The cleft palate, submucous cleft palate, poor palate mobility, and a deep pharynx may indicate susceptibility to VPI. Speech therapy is successful in up to 50% of patients, while surgical intervention may be tailored based on the diagnostic evaluation of the velopharynx with videofluoroscopy or nasoendoscopy. CONCLUSION We present a comprehensive review of the literature on the pathophysiology, risk factors, and treatment of post-adenoidectomy VPI. We hope to bring awareness to the factors that can lead to a rare but potentially devastating complication in one of the most common procedures performed by Otolaryngologists.
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Affiliation(s)
- Elton M Lambert
- Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street D.640, Houston, TX, 77030, USA.
| | - Peng You
- Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street D.640, Houston, TX, 77030, USA.
| | - Deborah S Kacmarynski
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
| | - Tara L Rosenberg
- Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street D.640, Houston, TX, 77030, USA.
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Kasthurirathne R, Forrest K, Ross J, Patel R. Nasalance in adolescents with autism spectrum disorders. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:517-525. [PMID: 31775529 DOI: 10.1080/17549507.2019.1691263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: Listener judgments indicate atypical nasal resonance in individuals with Autism Spectrum Disorders (ASD); however, listener perceptions are susceptible to bias and may give unreliable information about a speaker's production of nasal resonance. The current study used Nasometry to obtain an objective estimation of nasal resonance among adolescents with ASD and neurotypical controls.Method: The Nasometer II 6450 (PENTAX Medical, Lincoln Park, New Jersey) was used to collect nasalance from adolescents aged 15-17 years with ASD (n = 11) and matched controls (n = 11) across two separate speech tasks: (1) passage reading and (2) spontaneous speech.Result: Adolescents with ASD evidenced significantly higher nasalance scores compared to controls, particularly in the passage loaded with bilabial plosives and some nasals (Bobby) as well as non-nasal words extracted from spontaneous speech. In addition, adolescents with ASD had significantly higher nasalance ratios than controls. Significant group differences were driven by a subset of participants with ASD.Conclusion: Perceptual judgements of nasality noted in previous autism studies are quantified by an increase in nasal energy compared to oral energy. The current data suggest hypernasality is present in a subset of people with ASD rather than being a general feature of speech in autism.
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Affiliation(s)
- Rachel Kasthurirathne
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Karen Forrest
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Jared Ross
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Rita Patel
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
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8
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Paulsgrove K, Miller E, Seidel K, Kinter S, Tse R. Crowdsourcing to Assess Speech Quality Associated With Velopharyngeal Dysfunction. Cleft Palate Craniofac J 2020; 58:25-34. [PMID: 32806948 DOI: 10.1177/1055665620948770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To assess crowdsourced responses in the evaluation of speech outcomes in children with velopharyngeal dysfunction (VPD). DESIGN Fifty deidentified speech samples were compiled. Multiple pairwise comparisons obtained by crowdsourcing were used to produce a rank order of speech quality. Ratings of overall and specific speech characteristics were also collected. Twelve speech-language pathologists (SLPs) who specialize in VPD were asked to complete the same tasks. Crowds and experts completed each task on 2 separate occasions at least 1 week apart. SETTING On-line crowdsourcing platform. PARTICIPANTS Crowdsource raters were anonymous and at least 18 years of age, North American English speakers with self-reported normal hearing. Speech-language pathologists were recruited from multiple cleft/craniofacial teams. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Correlation of repeated assessments and comparison of crowd and SLP assessments. RESULTS We obtained 6331 lay person assessments that met inclusion criteria via crowdsourcing within 8 hours. The crowds provided reproducible Elo rankings of speech quality, ρ(48) = .89; P <.0001, and consistent ratings of intelligibility and acceptability (intraclass correlation coefficient [ICC] = .87 and .92) on repeated assessments. There was a significant correlation of those crowd rankings, ρ(10) = .86; P = .0003, and ratings (ICC = .75 and .79) with those of SLPs. The correlation of more specific speech characteristics by the crowds and SLPs was moderate to weak (ICC < 0.65). CONCLUSIONS Crowdsourcing shows promise as a rapid way to obtain large numbers of speech assessments. Reliability of repeated assessments was acceptable. Large groups of naive raters yield comparable evaluations of overall speech acceptability, intelligibility, and quality, but are not consistent with expert raters for specific speech characteristics such as resonance and nasal air emission.
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Affiliation(s)
- Kaylee Paulsgrove
- Speech & Language Services, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Erin Miller
- Division of Plastic Surgery, Department of Surgery, 21617University of Washington, Seattle, WA, USA
| | - Kristy Seidel
- CSATS Inc, A Division of Johnson & Johnson, Seattle, WA, USA
| | - Sara Kinter
- Speech & Language Services, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Raymond Tse
- Division of Plastic Surgery, Department of Surgery, 21617University of Washington, Seattle, WA, USA.,Division of Craniofacial and Plastic Surgery, Department of Surgery, 7274Seattle Children's Hospital, Seattle, WA, USA
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Santoni C, Thaut M, Bressmann T. Immediate effects of voice focus adjustments on hypernasal speakers' nasalance scores. Int J Pediatr Otorhinolaryngol 2020; 135:110107. [PMID: 32480137 DOI: 10.1016/j.ijporl.2020.110107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore the immediate effects of voice focus adjustments on the oral-nasal balance of hypernasal speakers, measured with nasalance scores. METHODS Five hypernasal speakers (2 M, 3 F) aged 5-12 (SD 2.7) learned to speak with extreme forward and backward voice focus. Speakers repeated oral, nasal, and phonetically balanced stimuli. Nasalance scores were collected with the Nasometer 6450. RESULTS From the average baseline of 34.27% for the oral stimulus, nasalance increased to 46.07% in forward and decreased to 30.2% in backward focus. From the average baseline of 64.53% for the nasal stimulus, nasalance decreased to 64.13% in forward and decreased to 51.73% in backward focus. From the average baseline of 51.33% for the phonetically balanced stimulus, nasalance increased to 58.87% in forward and decreased to 46.2% in backward focus. CONCLUSIONS Forward voice focus resulted in higher and backward voice focus resulted in lower nasalance scores during speech for a group of hypernasal speakers. However, there was an exception: One male speaker showed decreased nasalance in forward voice focus. Future research should investigate the longer-term effectiveness of the intervention.
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Affiliation(s)
- Charlene Santoni
- Department of Music and Health Science, Faculty of Music, University of Toronto, Edward Johnson Building, 80 Queen's Park, Toronto, ON, M5S 2C5, Canada; Department of Speech-Language Pathology, University of Toronto, Rehabilitation Sciences Building, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Michael Thaut
- Department of Music and Health Science, Faculty of Music, University of Toronto, Edward Johnson Building, 80 Queen's Park, Toronto, ON, M5S 2C5, Canada.
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto, Rehabilitation Sciences Building, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
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Pegoraro-Krook MI, Rosa RR, Aferri HC, Andrade LKFD, Dutka JDCR. Pharyngeal bulb prosthesis and speech outcome in patients with cleft palate. Braz J Otorhinolaryngol 2020; 88:187-193. [PMID: 32771435 PMCID: PMC9422367 DOI: 10.1016/j.bjorl.2020.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/30/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Individuals with cleft palate can present with velopharyngeal dysfunction after primary palatoplasty and require a secondary treatment due to insufficiency. In these cases, the pharyngeal bulb prosthesis can be used temporarily while awaiting secondary surgery. Objective This study aimed to investigate the outcome of treatment of hypernasality with pharyngeal bulb prosthesis in patients with history of cleft palate presenting with velopharyngeal insufficiency after primary palatal surgery. We hypothesized that the use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency in patients with cleft palate. Methods Thirty speakers of Brazilian Portuguese (15 males and 15 females) with operated cleft palate, ages ranging from 6 to 14 years (mean: 9 years; SD = 1.87 years), participated in the study. All patients were fitted with a pharyngeal bulb prosthesis to manage velopharyngeal insufficiency while they were awaiting corrective surgery to be scheduled. Auditory-perceptual analysis of speech recorded in the conditions with and without pharyngeal bulb prosthesis were obtained from three listeners who rated the presence or absence of hypernasality for this study. Results Seventy percent of the patients eliminated hypernasality while employing the pharyngeal bulb prosthesis, while 30% still presented with hypernasality. The comparison was statistically significant (p < 0.001). Conclusion The use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency.
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Affiliation(s)
- Maria Inês Pegoraro-Krook
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Fonoaudiologia, Bauru, SP, Brazil; Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Serviço de Prótese de Palato, Bauru, SP, Brazil.
| | - Raquel Rodrigues Rosa
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Fonoaudiologia, Bauru, SP, Brazil
| | - Homero C Aferri
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Serviço de Prótese de Palato, Bauru, SP, Brazil
| | - Laura Katarine Félix de Andrade
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Programa de Pós-Graduação em Ciências da Reabilitação, Bauru, SP, Brazil
| | - Jeniffer de C R Dutka
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Fonoaudiologia, Bauru, SP, Brazil; Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Serviço de Prótese de Palato, Bauru, SP, Brazil
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11
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Velopharyngeal Insufficiency Impact and Nasopharngoscopy Discomfort and Cooperation: Patient, Parent, and Provider Perspectives. J Craniofac Surg 2020; 31:1713-1716. [PMID: 32310884 DOI: 10.1097/scs.0000000000006463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Velopharyngeal insufficiency (VPI) impacts resonance and articulation and contributes to social difficulties. Nasopharngoscopies (NPs) often inform VPI treatment planning. Using a mixed-model prospective design, this study describes the impact of VPI, NP perceptions, and ratings of pain, discomfort, and cooperation during NP from multiple perspectives. Participants (N = 33) were 7 to 16 years old (mean 8.8 years) with diagnoses primarily of cleft lip and palate (52%) or cleft palate (42%). Mostly mothers (82%) completed measures in English (58%). Patients (52%) reported some teasing related to VPI, with higher parent report of their child being teased (70%). Themes of not being understood, teasing, and negative emotions were described. Coping themes included social support, distraction, and speech therapy. Patients' Beck Youth Inventories-Second Edition scores were in the average range. Over half of patients and parents reported anxiety about NPs and about a third reported understanding NPs. The Faces Pain Scale-Revised mean of 2.5 ± 3.2 and the Face, Legs, Activity, Cry, Consolability scale mean of 2.5 ± 2.2 were low. Discomfort was most often rated as "a little" by patients (55%), parents (42%), speech-language pathologists (49%), and plastic surgeons (39%). There was concordance across pain and discomfort ratings. High cooperation (61%-72%) was seen across reporters, which was negatively correlated with pain measures. Patient anxiety was related to NP pain and discomfort, suggesting integrating coping for procedural anxiety into the NP preparation might benefit patients. Additionally, negative VPI social experiences should be screened for as part of VPI management.
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A Preliminary Dynamic Investigation on Velopharyngeal Movements During Blowing: A New Approach for Evaluation. J Craniofac Surg 2019; 31:464-467. [PMID: 31725505 DOI: 10.1097/scs.0000000000006013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To explore an alternative approach to evaluate velopharyngeal function on those speakers with compensatory misarticulation. METHOD Nasopharyngeal endoscopy was used to observe the velopharyngeal movement on 26 adult Mandarin speakers during articulation and different nonverbal state, including SCPS, DCPS, and ABS. RESULTS There were significant differences for the rate of velopharyngeal incompetence (RVPI) among the 4 different states. The RVPI was least for the Articulation State, followed by the Air Blowing and DCPS. The RVPI was largest for the SCPS. CONCLUSION The result indicated that the ABS may be used as an alternative approach to evaluate the velopharyngeal function instead of the articulation samples while patients cannot make clear articulation due to compensatory misarticulation habits. It merits further study on nonverbal activities, which could lay a foundation for exploring more effective approach for evaluation of the velopharyngeal function.
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Aparna VS, Pushpavathi M, Bonanthaya K. Velopharyngeal Closure and Resonance in Children Following Early Cleft Palate Repair: Outcome Measurement. Indian J Plast Surg 2019; 52:201-208. [PMID: 31602136 PMCID: PMC6785339 DOI: 10.1055/s-0039-1696608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction
Timing of cleft palate repair and the method of speech outcome measurement in children with cleft lip and palate are much debated topics. The associated problems and quality of life in these children depend on the timing of the surgery.
Aim
The aim of this study was to investigate the velopharyngeal (VP) function and resonance parameters in children following early cleft palate repair.
Method
A total of 25 Kannada-speaking children with early repaired cleft palate were subjected to speech assessment and videofluoroscopic assessment. Perceptual speech parameters measured were severity of hypernasality and presence of nasal air emission. Videofluoroscopy was interpreted in terms of closure ratios to predict the severity of VP dysfunction.
Results
The analysis of videofluoroscopic images indicated that 48% of children had complete VP closure and 52% had perceptually normal resonance. A good correlation was found between the closure ratio and hypernasality.
Conclusion
Understanding the perceptual speech parameters and their structural correlates for outcome measurement will give better evidence for refining the existing treatment protocols. Data on a larger population are warranted for establishing predictors of optimum speech outcome.
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Affiliation(s)
- V S Aparna
- Consultant Speech Language pathologist, Jain Unit of Smiletrain, Bhagwaan Mahaveer Jain hospital, Bangalore, Karnataka, India
| | - M Pushpavathi
- All India Institute of Speech and Hearing, Manasagangothri, Mysuru, Karnataka, India
| | - Krishnamurty Bonanthaya
- Consultant Maxillofacial Surgeon, Jain Unit of Smile Train, Bhagwaan Mahaveer Jain Hospital, Bangalore, Karnataka, India
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Reliability of the Dutch Cleft Speech Evaluation Test and Conversion to the Proposed Universal Scale. J Craniofac Surg 2018; 29:390-395. [DOI: 10.1097/scs.0000000000004261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kummer AW. Evaluation of Speech and Resonance for Children with Craniofacial Anomalies. Facial Plast Surg Clin North Am 2017; 24:445-451. [PMID: 27712812 DOI: 10.1016/j.fsc.2016.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Children with craniofacial anomalies often demonstrate disorders of speech and/or resonance. Anomalies that affect speech and resonance are most commonly caused by clefts of the primary palate and secondary palate. This article discusses how speech-language pathologists evaluate the effects of dental and occlusal anomalies on speech production and the effects of velopharyngeal insufficiency on speech sound production and resonance. How to estimate the size of a velopharyngeal opening based on speech characteristics is illustrated. Nasometry, nasopharyngoscopy, and low-tech tools are discussed as adjunct methods to aid in the evaluation, treatment planning, and measurement of outcomes.
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Affiliation(s)
- Ann W Kummer
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4011, Cincinnati, OH 45229-3039, USA.
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Rogers C, Konofaos P, Wallace RD. Superiorly Based Pharyngeal Flap for the Surgical Treatment of Velopharyngeal Insufficiency and Speech Outcomes. J Craniofac Surg 2017; 27:1746-1749. [PMID: 27763974 DOI: 10.1097/scs.0000000000003050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A retrospective chart review comparing pre and postoperative speech in 19 patients who underwent pharyngeal flap surgery for the diagnosis of velopharyngeal insufficiency. Eighteen of the patients had a history of cleft palate. Patients were assigned a speech grade between 1 and 5 based on the objective and subjective quality of their speech. Comparison of pre and postoperative speech showed significant improvement in speech quality from a mean grade of 3.37 to 2.00 (P < 0.001). This study demonstrates that a wide, superiorly based pharyngeal flap did lead to significant improvement in speech outcomes in this group of patients independent of gender or age.
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Affiliation(s)
- Cori Rogers
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN
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Scarmagnani RH, Oliveira ACDASFD, Fukushiro AP, Salgado MH, Trindade IEK, Yamashita RP. Impact of inter-judge agreement on perceptual judgment of nasality. Codas 2015; 26:357-9. [PMID: 25388067 DOI: 10.1590/2317-1782/20142014068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/28/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the effect of perceptual inter-judge agreement of hypernasality on velopharyngeal (VP) closure prediction. METHODS Two logistic regression models were developed aiming to verify the possibility of predicting the VP closure using the following characteristics: rating of VP closure (adequate, borderline, inadequate), determined by the pressure-flow technique, degree of hypernasality (absent, mild, moderate, severe), and the presence/absence of nasal air emission and nasal rustle determined perceptually by three experienced speech language pathologists. In the first model, 100 speech samples with a moderate agreement rate of hypernasality (kappa coefficient: 0.41) were used. In the second model, 43 speech samples with a perfect agreement among judges were included. The χ²-test was used to compare the models (p≤0.05). RESULTS In the first model, 65 of the 100 samples were rated in the correct VP closure category, with 42 adequate and 23 inadequate. The borderline VP closure was not predicted. The second model rated 31 of the 43 samples in the correct category, with 21 adequate VP closure, 5 in the borderline VP closure, and 5 inadequate. There was no difference (p=0.526) between the two models. However, the second model showed a higher proportion of accuracy (7%) than the first one, and it has also predicted the borderline VP closure. CONCLUSION These results showed the importance of high index of inter-judge agreement when using subjective parameters of speech evaluation, especially when compared to an instrumental evaluation. This suggests the need for strategies for training and calibration of judges in the perceptual judgment to improve the reliability of auditory-perceptual assessment.
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Affiliation(s)
- Rafaeli Higa Scarmagnani
- Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo - USP, Bauru, SP, Brasil
| | | | - Ana Paula Fukushiro
- Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo - USP, Bauru, SP, Brasil
| | | | - Inge Elly Kiemle Trindade
- Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo - USP, Bauru, SP, Brasil
| | - Renata Paciello Yamashita
- Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo - USP, Bauru, SP, Brasil
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Yamashita RP, Curiel CA, Fukushiro AP, Medeiros MNLD, Trindade IEK. Comparação entre cirurgia do retalho faríngeo e esfincteroplastia: análise nasométrica e aerodinâmica. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201514614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: comparar o efeito do retalho faríngeo e da esfincteroplastia sobre a hipernasalidade da fala e o fechamento velofaríngeo no tratamento de indivíduos com insuficiência velofaríngea residual, por meio de avaliação instrumental. MÉTODOS: foram avaliados 30 pacientes, com fissura de palato±lábio reparada, submetidos à correção cirúrgica da insuficiência velofaríngea (15 com retalho faríngeo e 15 com esfincteroplastia), avaliados antes e, no mínimo, 1 ano após a cirurgia. A hipernasalidade foi estimada a partir dos escores de nasalância (correlato físico da nasalidade) obtidos por meio da nasometria, durante a leitura de 5 sentenças contendo, exclusivamente, sons orais, considerando como limite de normalidade o escore de 27%. O fechamento velofaríngeo foi aferido a partir da medida da área velofaríngea obtida por meio da técnica fluxo-pressão e foi classificado em: 0-4,9mm2=adequado; 5-19,9mm2=marginal e, >20mm2=inadequado. Diferenças entre as duas técnicas foram consideradas estatisticamente significantes ao nível de 5%. RESULTADOS: antes da cirurgia, os valores médios de nasalância foram de 43±8,4% e 45±14,2% e de área velofaríngea foram 51±35,4mm2, e 69±29,2mm2, para os grupos retalho faríngeo e esfincteroplastia, respectivamente. Após a cirurgia, os valores médios de nasalância reduziram para 27±10,1% e 31±14,2% e de área velofaríngea para 3,6±5,5mm2 e 24±32,7mm2 para os grupos retalho faríngeo e esfincteroplastia, respectivamente. A redução dos valores de nasalância e área velofaríngea foi estatisticamente significante nos dois grupos. CONCLUSÃO: estes resultados sugerem que o retalho faríngeo foi mais eficiente do que a esfincteroplastia na eliminação da hipernasalidade e adequação do fechamento velofaríngeo nos pacientes estudados.
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Scarmagnani RH, Barbosa DA, Fukushiro AP, Salgado MH, Trindade IEK, Yamashita RP. Relationship between velopharyngeal closure, hypernasality, nasal air emission and nasal rustle in subjects with repaired cleft palate. Codas 2015. [DOI: 10.1590/2317-1782/20152014145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To investigate the correlation among velopharyngeal closure, hypernasality, audible nasal air emission (NAE) and nasal rustle (NR), in individuals with repaired cleft palate. METHODS: One hundred patients with repaired cleft palate and lip, submitted to pressure-flow study for measurement of velopharyngeal orifice area (velopharyngeal area) and speech sample recordings. Velopharyngeal area was estimated during the production of the sound /p/ inserted in a sentence, and the velopharyngeal closure was classified as adequate, borderline or inadequate. Hypernasality was rated using a 4-point scale, NAE and NR were rated as absent or present, by three speech language pathologists, using recorded speech samples. Inter and intra-judge agreements were established. Statistical analysis was performed using the Spearman correlation coefficient considering p<0.05. An ordinal logistic regression model was developed to investigate whether the characteristics of speech can predict velopharyngeal closure. For this, the speech samples included in this analysis were those that obtained 100% agreement among raters as to the degree of hypernasality (43 out of 100). RESULTS: Significant correlation was found between hypernasality and velopharyngeal area; audible NAE and velopharyngeal area. A negative correlation was observed between the NR and velopharyngeal area. The regression analysis showed that the perceptual speech characteristics contributed significantly to predict the velopharyngeal closure. CONCLUSION: There is significant correlation between velopharyngeal closure and hypernasality, NAE and NR. It suggests that the perceptual speech characteristics can predict velopharyngeal closure, favoring the diagnosis and the definition of treatment conduct of velopharyngeal dysfunction.
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Medeiros MNLD, Ferlin F, Fukushiro AP, Yamashita RP. Ressonância da fala após tratamento cirúrgico da insuficiência velofaríngea secundária à cirurgia ortognática. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201511514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO:investigar o efeito da cirurgia corretiva da insuficiência velofaríngea sobre a ressonância da fala de indivíduos nascidos com fissura palatina que passaram a apresentar hipernasalidade, após a cirurgia ortognática.MÉTODOS:foram analisados os resultados da ressonância de 23 pacientes com fissura labiopalatina corrigida cirurgicamente que apresentavam ressonância oronasal equilibrada antes da cirurgia ortognática e foram submetidos à correção cirúrgica da insuficiência velofaríngea, devido ao aparecimento de hipernasalidade após a cirurgia ortognática. Os pacientes foram submetidos à avaliação perceptivo-auditiva da fala para classificação da hipernasalidade, em três situações: 3 dias antes e 5 meses, em média, após a cirurgia ortognática e, 13 meses, em média, após a cirurgia corretiva da insuficiência velofaríngea. A hipernasalidade foi classificada utilizando-se escala de 4 pontos: 1=ausência de hipernasalidade; 2=hipernasalidade leve; 3=moderada e 4=grave. Os escores de hipernasalidade nas três situações estudadas foram comparados por meio do teste de Friedman, com nível de significância de 5% e, posteriormente, pelo teste de Tukey para comparações múltiplas.RESULTADOS:do total de 23 pacientes, houve eliminação do sintoma de fala após a correção da insuficiência velofaríngea em 83% (19/23), sendo os escores médios de nasalidade antes da cirurgia ortognática=1, após a cirurgia ortognática=3 e após a correção da insuficiência velofaríngea=1. Houve diferença estatisticamente significante entre as três situações estudadas (p<0,001).CONCLUSÃO:a cirurgia corretiva da insuficiência velofaríngea foi um tratamento efetivo na grande maioria dos casos que apresentaram hipernasalidade secundária à cirurgia ortognática, com retorno à condição de normalidade.
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Padilha EZ, Dutka JDCR, Marino VCDC, Lauris JRP, Silva MJFD, Pegoraro-Krook MI. Avaliação da nasalidade de fala na fissura labiopalatina. AUDIOLOGY: COMMUNICATION RESEARCH 2015. [DOI: 10.1590/s2317-64312015000100001444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo Descrever os resultados da nasalidade de fala de indivíduos com fissura labiopalatina e comparar os achados de nasalidade estabelecidos por meio do julgamento perceptivo-auditivo realizado ao vivo com os achados estabelecidos por análise de gravações por juízes, em dois tipos de amostras de fala. Métodos O estudo envolveu a análise retrospectiva dos resultados de avaliações perceptivo-auditivas da nasalidade de fala realizadas ao vivo por uma fonoaudióloga e o julgamento prospectivo, por consenso de juízas de 100 gravações de amostras de fala, obtidas durante a produção de dois conjuntos de estímulos de fala: um com consoantes de alta pressão (CAP, n=100) e outro com consoantes de baixa pressão (CBP, n=100). Os dados pertenciam a pacientes de ambos os gêneros, com idades entre 5 e 12 anos, que tiveram a fissura labiopalatina operada por um mesmo cirurgião. Resultados A ausência de hipernasalidade foi constatada em 69% dos julgamentos ao vivo. Quando presente, a hipernasalidade leve foi constatada em 23% dos casos, enquanto a hipernasalidade moderada em 8%. Para os julgamentos das amostras gravadas, 50% foram identificadas com hipernasalidade durante a produção das amostras CAP e 62% durante a das amostras CBP. Diferença significativa foi encontrada entre o resultado do julgamento ao vivo e o julgamento pelas juízas nas amostras CAP. A concordância entre as modalidades de avaliação variou de 79% para as amostras CAP e 80% para as amostras CBP, sendo considerada moderada. Conclusão O julgamento perceptivo ao vivo da nasalidade de fala pode detectar melhor a ausência de hipernasalidade, seguida pela hipernasalidade de grau leve, em comparação com o julgamento realizado por juízes múltiplos, a partir de amostras gravadas. Contudo, tem a desvantagem de os dados não poderem ser reproduzidos, nem quantificados, nem compartilhados por outros membros da equipe.
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Self-reported speech problems in adolescents and young adults with 22q11.2 deletion syndrome: a cross-sectional cohort study. Arch Plast Surg 2014; 41:472-9. [PMID: 25276637 PMCID: PMC4179349 DOI: 10.5999/aps.2014.41.5.472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/08/2014] [Accepted: 07/12/2014] [Indexed: 11/08/2022] Open
Abstract
Background Speech problems are a common clinical feature of the 22q11.2 deletion syndrome. The objectives of this study were to inventory the speech history and current self-reported speech rating of adolescents and young adults, and examine the possible variables influencing the current speech ratings, including cleft palate, surgery, speech and language therapy, intelligence quotient, and age at assessment. Methods In this cross-sectional cohort study, 50 adolescents and young adults with the 22q11.2 deletion syndrome (ages, 12-26 years, 67% female) filled out questionnaires. A neuropsychologist administered an age-appropriate intelligence quotient test. The demographics, histories, and intelligence of patients with normal speech (speech rating=1) were compared to those of patients with different speech (speech rating>1). Results Of the 50 patients, a minority (26%) had a cleft palate, nearly half (46%) underwent a pharyngoplasty, and all (100%) had speech and language therapy. Poorer speech ratings were correlated with more years of speech and language therapy (Spearman's correlation= 0.418, P=0.004; 95% confidence interval, 0.145-0.632). Only 34% had normal speech ratings. The groups with normal and different speech were not significantly different with respect to the demographic variables; a history of cleft palate, surgery, or speech and language therapy; and the intelligence quotient. Conclusions All adolescents and young adults with the 22q11.2 deletion syndrome had undergone speech and language therapy, and nearly half of them underwent pharyngoplasty. Only 34% attained normal speech ratings. Those with poorer speech ratings had speech and language therapy for more years.
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Kummer AW. Speech and Resonance Disorders Related to Cleft Palate and Velopharyngeal Dysfunction: A Guide to Evaluation and Treatment. ACTA ACUST UNITED AC 2014. [DOI: 10.1044/sbi15.2.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Children with speech and/or resonance disorders due to structural anomalies present challenges for speech-language pathologists in all settings. The purpose of this article is to provide current, practical information regarding the evaluation and treatment of children with speech/resonance disorders secondary to cleft palate and noncleft causes of velopharyngeal dysfunction. Simple “no-tech” procedures for assessment will be described so that the reader will be able to determine which children will benefit from therapy and which will require surgical intervention. Finally, specific speech therapy techniques will be given for changing placement from the pharynx to the oral cavity, thus eliminating phoneme-specific nasal emission.
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Affiliation(s)
- Ann W. Kummer
- Division of Speech Pathology, Cincinnati Children's Hospital Medical Center Department of Clinical Pediatrics, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical CenterCincinnati, OH
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Epstein R, Remacle A, Morsomme D. From Reactive Intervention to Proactive Prevention: The Evolution of Occupational Dysphonia. ACTA ACUST UNITED AC 2011. [DOI: 10.1044/vvd21.2.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Voice clinicians long have been aware of the concept of professional voice users: individuals who work in professions that have a higher incidence and increased risk for voice disorders. This realization, coupled with the documented impact of work-related dysphonia on the economy, has resulted in a growing international interest in developing occupational health benchmarks for voice use, similar to other standards developed for work-related factors such as noise-induced hearing loss. In this article, we review current perspectives and examine some issues related to occupational vocal health.
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Affiliation(s)
- Ruth Epstein
- Royal National Throat Nose & Ear Hospital and Ear Institute, University College London, UK
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Yamashita RP, Carvalho ELL, Fukushiro AP, Zorzetto NL, Trindade IEK. Efeito da veloplastia intravelar sobre a nasalidade em indivíduos com insuficiência velofaríngea. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: verificar o efeito da palatoplastia secundária realizada com veloplastia intravelar sobre a nasalidade e nasalância dos pacientes com fissura de palato reparada e insuficiência velofaríngea (IVF) e comparar os resultados entre estes pacientes, de acordo com o grau de fechamento velofaríngeo aferido na nasofaringoscopia. MÉTODO: estudo prospectivo com 40 pacientes de ambos os sexos, com idades entre 4 e 48 anos, com fissura de palato reparada e IVF residual, avaliado 3 dias antes e 8 meses após a palatoplastia, em média, divididos em dois grupos: um com 25 pacientes com falhas pequenas (grupo I) e outro com 15 pacientes com falhas médias a grandes (grupo II) no fechamento velofaríngeo. A hipernasalidade foi avaliada perceptivamente e nasalância foi avaliada por meio da nasometria. Diferenças entre grupos e etapas foram consideradas significativas ao nível de 5%. O estudo foi aprovado pelo Comitê de Ética para Pesquisa com Seres Humanos da Instituição. RESULTADOS: após a cirurgia, verificou-se redução da hipernasalidade em 84% dos pacientes do grupo I e em 73% dos pacientes do grupo II. Redução da nasalância foi observada em 52% dos casos do grupo I e em 43% dos pacientes do grupo II. CONCLUSÃO: a palatoplastia secundária com veloplastia intravelar levou à melhora da nasalidade na maioria dos pacientes analisados. Os resultados também demonstraram que a cirurgia foi mais efetiva nos pacientes que apresentavam falhas pequenas no fechamento velofaríngeo.
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Affiliation(s)
| | | | | | - Neivo Luiz Zorzetto
- Universidade de São Paulo; Universidade Estadual Paulista Julio de Mesquita Filho
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Mayr S, Burkhardt K, Schuster M, Rogler K, Maier A, Iro H. The use of automatic speech recognition showing the influence of nasality on speech intelligibility. Eur Arch Otorhinolaryngol 2010; 267:1719-25. [PMID: 20422201 DOI: 10.1007/s00405-010-1256-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 04/12/2010] [Indexed: 11/25/2022]
Abstract
Altered nasality influences speech intelligibility. Automatic speech recognition (ASR) has proved suitable for quantifying speech intelligibility in patients with different degrees of nasal emissions. We investigated the influence of hyponasality on the results of speech recognition before and after nasal surgery using ASR. Speech recordings, nasal peak inspiratory flow and self-perception measurements were carried out in 20 German-speaking patients (8 women, 12 men; aged 38 ± 22 years) who underwent surgery for various nasal and sinus pathologies. The degree of speech intelligibility was quantified as the percentage of correctly recognized words of a standardized word chain by ASR (word recognition rate; WR). WR was measured 1 day before (t1), 1 day after with nasal packings (t2), and 3 months after (t3) surgery; nasal peak flow on t1 and t3. WR was calculated with program for the automatic evaluation of all kinds of speech disorders (PEAKS). WR as a parameter of speech intelligibility was significantly decreased immediately after surgery (t1 vs. t2 p < 0.01) but increased 3 months after surgery (t2 vs. t3 p < 0.01). WR showed no association with age or gender. There was no significant difference between WR at t1 and t3, despite a post-operative increase in nasal peak inspiratory flow measurements. The results show that ASR is capable of quantifying the influence of hyponasality on speech; nasal obstruction leads to significantly reduced WR and nasal peak flow cannot replace evaluation of nasality.
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Affiliation(s)
- S Mayr
- Department of Otolaryngology, Head and Neck Surgery, University Hospital, University Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany.
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Velopharyngeal insufficiency: current concepts in diagnosis and management. Curr Opin Otolaryngol Head Neck Surg 2008; 16:530-5. [DOI: 10.1097/moo.0b013e328316bd68] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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