Treatment Outcomes of Interdisciplinary Care on Speech and Health-Related Quality of Life Outcomes in Adults With Cleft Palate

PURPOSE

Individuals born with a cleft palate with or without a cleft lip (CP ± L) often experience functional, aesthetic, and psychosocial consequences well into adulthood. This study aimed to investigate outcomes of speech and health-related quality of life (HRQoL) in adults with a CP ± L who received interdisciplinary cleft care at the Ghent University Hospital using valid, reliable, and condition-specific instruments.

METHOD

Thirteen Belgian Dutch-speaking participants with a CP ± L with a mean age of 25.4 years (SD = 5.1, range: 20-33 years) and an age- and gender-matched control group of 13 participants without a CP ± L with a mean age of 25.2 years (SD = 4.8, range: 20-32 years) were included in this study. Speech characteristics were evaluated perceptually and instrumentally. HRQoL was assessed through standardized patient-reported outcome measures. Outcomes were compared with those of the control group and to normative data where available.

RESULTS

Participants with a CP ± L in this sample demonstrated significantly lower speech acceptability (p < .001) and higher rates of hypernasality (p = .015) and nasal turbulence (p = .005) than the control group. They showed significantly higher satisfaction with appearance of the cleft scar compared with norms of adults with a CP ± L (p = .047). No other differences in speech characteristics, sociodemographics, or HRQoL were found between participants with and without a CP ± L.

CONCLUSIONS

The reduced speech acceptability and the presence of resonance and nasal airflow disorders may indicate the need for standardized long-term outcome measurement and interdisciplinary follow-up for speech characteristics and velopharyngeal insufficiency in young and middle adulthood in future clinical practice. Additional research is necessary to further substantiate these findings and to determine predictors for these continuing complications in adults with a CP ± L.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24243901.

Increased nasality of connected speech in patients underwent modified Lothrop procedure for refractory chronic rhinosinusitis: Cross-sectional and prospective study

BACKGROUND

The endoscopic modified Lothrop procedure (EMLP) is performed to create a large frontal neostium in patients who had failed previous frontal sinus surgeries. EMLP causes obvious changes in the volume and anatomy of the sinuses, which may cause a more significant change in nasality. This study aimed to evaluate the changes in nasalance in patients who underwent EMLP by comparing their preoperative nasalance to the established normative values and postoperative nasalance.

METHODS

This was a prospective study. Twenty-one patients diagnosed with refractory frontal sinusitis who were indicated to undergo EMLP were enrolled. One hundred one healthy participants were enrolled as norm references. The Nasometer II Model 6400 (KayPENTAX) was used to analyze the nasalance scores. Nasalance scores were tested before surgery and 1 and 3 months after the surgery.

RESULTS

The normative references of nasalance were (mean ± SD) 14.6% ± 6.7%, 39.4% ± 8.4%, and 55.8% ± 8.3% for the oral passage, oral-nasal passage, and nasal sentences, respectively. The mean nasalance scores pre-EMLP and 1 and 3 months post-EMLP were 23.2% ± 9.6%, 29.0% ± 9.3%, and 29.9% ± 0.4% for the oral passage; 48.7% ± 10.7%, 54.7% ± 7.7%, and 56.4% ± 7.2% for the oral-nasal passage; and 62.7% ± 10.9%, 69.8% ± 6.7%, and 70.7% ± 6.4% for the nasal sentences, respectively. Compared with the normative references, pre-EMLP nasalance was higher for all the three speech stimuli (t-test, p < 0.05). Post-EMLP nasalance also significantly increased for all the three stimuli at the 1- and 3-month follow-up visits (Paired t-test, p < 0.05).

CONCLUSION

EMLP has a short-term impact on resonance; however, long-term follow-up is required for further study.

Effects of different calibration schedules on the test-retest differences of nasalance scores obtained with the Nasometer 6450

Nasometry is used to assess nasality in speech but it is unclear whether overly frequent recalibration of the instrument adds measurement errors. The goal of the present research study was to describe the effect of the Nasometer 6450 calibration on the nasalance scores of repeated recordings. In a first experiment, the Nasometer calibration values stored in the computer's registry were manipulated to investigate the impact on nasalance scores. In the second experiment, a set of pre-recorded speech samples was re-recorded 40 times with a Nasometer 6450 in 4 different calibration regimens: Short-term repeated recordings without (R1) and with recalibration (R2C), and long-term repeated recordings over 10 days without (R3) and with recalibration (R4C). The first experiment showed that, compared to a calibration value of 1.0, a value of 0.9 resulted in nasalance scores that were on average 3 points lower while a calibration value of 1.1 resulted in scores that were 0.5 points higher. The results of the second experiment showed test-retest differences of less than 2 nasalance points for 91% of the data for a non-nasal stimulus. For a nasal stimulus, 91% of data were within 5 points for R3 and R4C. The results suggested that frequent recalibration of the Nasometer may slightly increase test-retest differences of nasalance scores. An alternative procedure for verifying microphone balance without recalibration is suggested.

Normative nasalance scores in Tamil-speaking Indian children

OBJECTIVE

The aim of this study was to obtain normative nasalance scores for Indian Tamil-speaking children.

METHODS

Mean nasalance scores were obtained from 175 consecutive Tamil-speaking normal children (95 males, 80 females) aged 5-16 years during the repetition of six standardized sentences: two oral, two oronasal, and two nasal sentences. The nasal view was used to obtain nasalance scores for the standardized sentences.

RESULTS

Group mean and standard deviation (SD) nasalance scores of children for oral, oronasal, and nasal sentence were 35.65(SD 7.20), 44.42(SD 7.37), and 57.21(SD 8.15), respectively. The mean nasalance values of children aged 9-12 years were greater than children aged 5-8 years and 13-16 years for nasal sentences (p < .001). Males were found to have significantly higher nasalance scores for oral and oronasal sentences (p < .05) although these differences were within the range of normal variation.

CONCLUSIONS

The present study provides normative nasalance scores for Tamil-speaking Indian children.

English Nasalance Values of Chinese Learners of English

<b><i>Introduction:</i></b> Although a number of studies have been conducted to investigate nasalance scores of speakers of different languages, little research has examined the nasalance characteristics of second language learners. <b><i>Objective:</i></b> The goal of the current study was to examine whether English nasalance values of Mandarin Chinese speakers are similar to those of native English speakers, examining the potential effect of the first language on the nasalance scores of the second language production. <b><i>Methods:</i></b> Thirty-two adults (16 Mandarin Chinese speakers and 16 native English speakers) with a normal velopharyngeal anatomy participated. Nasalance scores of various speech stimuli were obtained using a nasometer and compared between the 2 groups. <b><i>Results and Conclusions:</i></b> Chinese learners of English produced higher nasalance scores than native English speakers on prolonged vowel /i/ and /a/, the syllable “nin,” and non-nasal sentences and passages. The first language effect on nasalance of the second language found in the current study suggests the importance of linguistic consideration in the clinical evaluation of resonance.

Measurement of Nasalance Scores Without Touching the Philtrum for Better Comfort During Speech Assessment and Therapy: A Preliminary Study

OBJECTIVE

The Kay Pentax nasometer uses a separator plate that touches the philtrum of a patient to separate the nasal and oral sound energies for nasalance measurement. However, the separator plate can restrict the natural movement of the patient's upper lip and generate unpleasant pressure on the patient's philtrum. The present study was intended to measure nasalance scores without touching the philtrum for better comfort during speech assessment and therapy.

METHODS

Nasalance scores of 10 males and 10 females having no speech disorders were measured under 4 levels (0, 5, 10, and 15 mm) of the gap between the plate and the philtrum (denoted as plate-to-philtrum gap) using Nasometer II 6450 for nasal (Nasal Sentences) and oral (Zoo Passage) stimuli. Regression formulas were established to examine the relationships between nasalance score and plate-to-philtrum gap for the stimuli. To provide nasalance scores equivalent to those measured for the contact condition, compensation factors for the 5 mm plate-to-philtrum gap measurement condition were identified for the stimuli.

RESULTS

The nasalance scores were significantly different between the 4 different plate-to-philtrum gaps for the stimuli. Compensation factors for the Nasal Sentences and the Zoo Passage were identified as 1.17 and 0.71, respectively.

CONCLUSIONS

The 5 mm plate-to-philtrum gap condition after multiplying the compensation factors can provide equivalent nasalance scores to the conventional contact measurement condition which may provide better comfort in speech assessment and therapy.

Influence of Altered Auditory Feedback on Oral-Nasal Balance in Speakers of Brazilian Portuguese

Purpose This study explored the role of auditory feedback in the regulation of oral-nasal balance in speakers of Brazilian Portuguese. Method Twenty typical speakers of Brazilian Portuguese (10 male, 10 female) wore a Nasometer headset and headphones while continuously repeating stimuli with oral and nasal sounds. Oral-nasal balance was quantified with nasalance scores. The signals from 2 additional oral and nasal microphones were played back to the participants through the headphones. The relative loudness of the nasal channel in the mix was gradually changed, so that the speakers heard themselves as more or less nasal. Results A repeated-measures analysis of variance of the mean nasalance scores of the stimuli at baseline, minimum, and maximum nasal feedback conditions demonstrated significant effects of nasal feedback condition (p < .0001) and stimuli (p < .0001). Post hoc analyses demonstrated that the mean nasalance scores were lowest for the maximum nasal feedback condition. The scores of the minimum nasal feedback condition were significantly higher than 2 of 3 baseline feedback conditions. The speaking amplitude of the participants did not change between the nasal feedback conditions. Conclusions Increased nasal signal level feedback led to a compensatory adjustment in the opposite direction, confirming that oral-nasal balance is regulated by auditory feedback. However, reduced nasal signal level feedback resulted in a compensatory response that was lower in magnitude. This suggests that, even in Brazilian Portuguese, a language with phonetic and phonological vowel nasalization, decreased nasality was not perceived as critically as increased nasality by the speakers.

Nasalance in Arabic-Speaking Jordanians: A Comparative Study

OBJECTIVE

This investigation sought to establish nasalance scores for Jordanian Arabic (JA) speakers, to develop nasalance speech stimuli for JA speakers, and to compare JA adult nasalance scores with those of Standard American English (SAE) speakers.

SUBJECTS AND METHODS

Participants included normal native JA speakers (n = 100; males/females and adults/children) and adult SAE speakers (n = 49). Four speech tasks for JA speakers were developed, which included repetition of vowels, syllables, words, and sentences. Parallel speech tasks were also developed for SAE speakers. A nasometer (Nasometer II 6400; PENTAX Medical, Montvale, NJ, USA) was used to establish nasalance scores for all speakers across all speech tasks.

RESULTS

Nasalance values were established for adult and child JA speakers. The nasalance values were higher for Jordanian adults than for Jordanian children. No differences in nasalance were found between male and female Arabic speakers for nonnasal elements. JA speakers were significantly more nasal than SAE speakers on selected speech tasks.

CONCLUSIONS

Nasalance values for JA speakers were established for both adults and children, and Arabic speech materials were developed. The results of this investigation add to the growing body of research documenting differences in nasalance scores for normal speakers across different languages.

Clinical Application of a New Approach to Identify Oral-Nasal Balance Disorders Based on Nasalance Scores

OBJECTIVE

A new approach to classify oral-nasal balance disorders based on instrumental measurements was developed based on linear discriminant analysis (LDA) of nasalance scores of simulated oral-nasal balance disorders by de Boer and Bressmann. The current study aimed to apply the newly developed functions to clinical data to investigate the applicability of this new approach.

DESIGN

Retrospective diagnostic accuracy study.

SETTING

Tertiary university hospital.

PARTICIPANTS

Fifty-five Dutch-speaking Flemish children (age 4-12 years) with normal (n = 20), hypernasal (n = 18), hyponasal (n = 12), or mixed nasality (n = 5).

INTERVENTIONS

Nasalance scores of an oral and a nasal text were used to calculate 3 sets of LDA function scores. Predicted classification was consecutively based on the function values of the group centroids originally determined by de Boer and Bressmann and adapted LDA functions and group centroids based on clinical data.

MAIN OUTCOME MEASURES

Discriminatory power of the linear discriminant formulas.

RESULTS

Based on the original LDA functions, 56% of the speech samples matched the perceptual classification. Applying a correction factor for age and language differences resulted in a 67% correct classification, although 83% of the hyponasal samples were ranked as "normal resonance." Rederivation of the LDA functions based on current clinical data resulted in an 80% correct classification.

CONCLUSIONS

The new approach of classifying oral-nasal balance disorders based on a combination of nasalance scores was promising. However, further clinical research is needed to refine the LDA functions and group centroids before clinical application is possible.

Nasalance of Brazilian Portuguese-speaking populations from two different states

Purpose

To measure the nasalance scores of Brazilian Portuguese-speaking young adults from the states of Sao Paulo and Minas Gerais in order to investigate whether dialect variations and gender affect these scores.

Methods

Nasalance was assessed in 36 individuals: 20 native residents of Sao Paulo state (mean age=23 y.o.) and 16 native residents of Minas Gerais state (mean age=24 y.o.), following the same criteria. Nasalance measures were taken using the Nasometer II 6400 (KayPentax) device based on the reading of three texts (nasal-1, nasal-2, and oral). Intergroup nasalance scores were compared using the unpaired Student's t test considering two experimental groups.

Results

The nasalance scores in individuals from the states of Sao Paulo and Minas Gerais were 52.7% and 48.8% for the nasal-1 text, 49.6% and 49.9% for the nasal-2 text, and 14.3% and 9.8% for the oral text, respectively. Statistical analysis comparing the mean nasalance scores in both groups showed significant difference (p=0.03) only for the oral text, in which individuals from Sao Paulo state presented higher scores.

Conclusion

Although nasalance scores were lower in individuals from Minas Gerais state compared with those of individuals from Sao Paulo state, both groups presented values within the normal range. The variable gender was not relevant in the nasalance assessment; however, a tendency for higher scores was observed in women compared with men from Minas Gerais state in the same group in the reading of the nasal-2 text. This study contributes to the knowledge of nasalance reference scores for two different populations of Brazilian Portuguese speakers; however, the results herein reported should be interpreted with caution due to the small study sample size.

Influence of gender and age on the Nasality Severity Index 2.0 in Dutch-speaking Flemish children and adults

This study aimed to explore the influence of gender and age on the Nasality Severity Index 2.0 (NSI 2.0), an instrumental multiparametric index to determine hypernasality. Additionally, reference values will be established for this new index. Influence of gender and age on the NSI 2.0 was explored in 80 Flemish-speaking children (4-12 years; 40 boys, 40 girls) and 60 Flemish-speaking adults (18-60 years, 30 men, 30 women) without resonance disorders by determining its incorporated acoustic parameters: nasalance of the vowel/u/and an oral text, determined by a Nasometer, and voice low tone to high tone ratio (VLHR) of the vowel/i/. The equation yields NSI 2.0 = 13.20 - (0.0824 × nasalance/u/(%)) - (0.26 × nasalance oral text (%)) - (0.242 × VLHR/i/4.47*F0 Hz (dB)). No effect of gender or age was found on the NSI 2.0 in children. However, significant differences were found for the NSI 2.0, nasalance of/u/and an oral text between adult men and women. Additionally, an interaction effect between gender and age was found for these parameters. Consequently, separate reference values for the NSI 2.0 in children, adult men and adult women were established. Based on these reference scores, deviation of the NSI 2.0 score in patients with resonance disorders can be defined, which can determine the need for (additional) intervention. Further research can explore the possible influence of language on the index.

Short-term and long-term test-retest reliability of the Nasality Severity Index 2.0

PURPOSE

The Nasality Severity Index 2.0 (NSI 2.0) forms a new, multiparametric approach in the assessment of hypernasality. To enable clinical implementation of this index, the short- and long-term test-retest reliability of this index was explored.

METHODS

In 40 normal-speaking adults (mean age 32y, SD 11, 18-56y) and 29 normal-speaking children (mean age 8y, SD 2, 4-12y), the acoustic parameters included in the NSI 2.0 (i.e. nasalance of the vowel /u/ and an oral text, and the voice low tone to high tone ratio (VLHR) of the vowel /i/) were obtained twice at the same test moment and during a second assessment two weeks later. After determination of the NSI 2.0, a comprehensive set of statistical measures was applied to determine its reliability.

RESULTS

Long-term variability of the NSI 2.0 and its parameters was slightly higher compared to the short-term variability, both in adults and in children. Overall, a difference of 2.82 for adults and 2.68 for children between the results of two consecutive measurements can be interpreted as a genuine change. With an ICC of 0.84 in adults and 0.77 in children, the NSI 2.0 additionally shows an excellent relative consistency. No statistically significant difference was withheld in the reliability of test-retest measurements between adults and children.

CONCLUSION

Reliable test-retest measurements of the NSI 2.0 can be performed. Consequently, the NSI 2.0 can be applied in clinical practice, in which successive NSI 2.0 scores can be reliably compared and interpreted.

LEARNING OUTCOMES

The reader will be able to describe and discuss both the short-term and long-term test-retest reliability of the Nasality Severity Index 2.0, a new multiparametric approach to hypernasality, and its parameters. Based on this information, the NSI 2.0 can be applied in clinical practice, in which successive NSI 2.0 scores, e.g. before and after surgery or speech therapy, can be compared and interpreted.