Comparison of Nasalance Scores Obtained with the Nasometer, the NasalView, and the OroNasal System

The Role of Instructions in Motor Learning of Oral Versus Nasalized Speech Targets

PURPOSE

The purpose of this study was to investigate how general, implicit instructions with auditory-perceptual emphasis; specific, explicit instructions with biomechanical focus; or both affect learning of oral-nasal balance control in speech.

METHOD

Thirty healthy, vocally untrained participants were assigned to one of three instructional groups (i.e., implicit, explicit, and integrated) and learned to produce oral versus nasalized vowel-, syllable-, and phrase-level targets during once-weekly sessions over 4 weeks. Learning gains and performance variability were analyzed using nasometry.

RESULTS

We observed a significant main effect of instruction type on learning gains at phrase level (p = .016). Specifically, the integrated group (M = 59.8%) significantly outperformed the explicit group (M = 37.9%) and numerically outperformed the implicit group (M = 45.1%). For nasalized phrase targets, results revealed a significant main effect of instruction type on performance variability (p = .042), but pairwise comparisons between instruction groups were not significant.

CONCLUSIONS

The integration of implicit processes via auditory-perceptual modeling and explicit processes via relevant biomechanical directives resulted in larger motor learning gains, especially at higher levels of task complexity (i.e., phrase) compared to providing implicit or explicit instruction alone. The higher performance variability (i.e., less stable productions) that was sometimes induced by explicit instruction did not negatively impact learning when integrated with implicit instruction. Clinical implications for speech/voice therapy models are discussed.

The effect of functional endoscopic sinus surgery on nasal resonance

Background and objective

Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.

Methods

The nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.

Results

In both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But the P value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.

Conclusion

Changes in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.

Normative nasalance scores in Chilean adults

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.

The Impact of Fan-Type Rapid Palatal Expanders on Speech in Patients With Unilateral Cleft Lip and Palate

Rapid palatal expanders (RPEs) are commonly used in patients with cleft lip and palate (CLP) prior to secondary alveolar bone grafting (SABG). Their position and size can impede tongue movement and affect speech. This study assessed changes in perception and production of speech over the course of RPE treatment.

Prospective longitudinal.

Tertiary university-affiliated hospital.

Twenty-five patients with unilateral CLP treated with Fan-type RPEs, and their parents.

Patient and parent speech questionnaires and patient speech recordings were collected at baseline before RPE insertion (T1), directly after RPE insertion (T2), during RPE expansion (T3), during RPE retention (T4), directly after RPE removal but before SABG (T5), and at short-term follow-up after RPE removal and SABG (T6).

Ratings for patient and parent questionnaires, first (F1) and second (F2) formants for vowels /a/, /i/, and /u/, and nasalance scores for non-nasal and nasal sentences, were obtained and analyzed using mixed model analyses of variance.

Ratings worsened at T2. For the vowel /a/, F1 and F2 were unchanged at T2. For the vowel /i/, F1 increased and F2 decreased at T2. For the vowel /u/, F1 was unchanged and F2 decreased at T2. Nasalance was unchanged at T2. All outcome measures returned to T1 levels by T4.

RPE insertion resulted in initial adverse effects on speech perception and production, which decreased to baseline prior to removal. Information regarding transient speech dysfunction and distress may help prepare patients for treatment.

Nasalance Scores as a Function of Skeletal Malocclusion of English-Speaking Adults in the North Indian Population

OBJECTIVE

The objective of this study is quantitative assessment of nasalance for skeletal Class I (normative values), Class II, and III malocclusion in the English language for the North Indian population and to compare the normative values with the nasalance scores obtained from individuals with skeletal Class II and III malocclusion and to evaluate the normative values as a function of gender.

MATERIAL AND METHODS

The study was conducted on a total sample of 200 patients with 100, 50, and 50 in group 1 (control group, Skeletal Class I), group 2 (Skeletal Class II), and group 3 (Skeletal Class III), respectively. ANB angle (anteroposterior angle formed by point A, nasion, and point B) measured on lateral cephalogram was used to categorize the patients into 3 groups. The normative nasalance scores were compared for males and females in the control group. The nasalance scores of skeletal Class II and III subjects were compared to the combined normative scores of the control group. The NasalView was used for the objective assessment of nasalance. Oral syllables (/pa/and/pi/), nasal syllables (/ma/and/mi/), and 3 passages (Zoo passage, Rainbow passage, and Nasal sentences) were used to determine the nasalance scores.

RESULTS

The intragroup comparison of nasalance scores in group 1 showed statistically significant differences for different stimuli. The gender-related comparison showed no statistically significant differences in nasalance scores. The intergroup comparison of nasalance scores for skeletal malocclusion showed no statistically significant differences for different stimuli except statistically significant lower nasalance values for nasal sentences in group 3 compared to the control group.

CONCLUSION

The study concluded that the nasalance scores for nasal sentences in skeletal Class III malocclusion were significantly lower than in the control group and were not statistically significant between the 3 groups for all other stimuli.

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.

Speech stimuli and nasalance scores for the assessment of resonance in in Mandarin speaking Malaysian children

This study was designed to develop language-specific stimuli for the assessment of resonance and to obtain nasalance scores using the newly developed speech stimuli in Mandarin. Gender and age influences on nasalance scores for each of the stimulus were also examined. Participants recruited were typically developing Mandarin-speaking ethnic Chinese children aged 6;00-7;11 growing up in Malaysia. Perceptual ratings of nasality were made based on the GOS.SP.ASS.'98 (revised) for children while nasalance scores were recorded for each stimulus using the Nasometer II (Model 6400). Fifty Mandarin-speaking children (24 males and 26 females) were recruited. None of the participants were perceived with abnormal nasality on the three stimuli. The mean nasalance scores for the Mandarin stimuli were 16.08% (SD = 2.57, 95% CI = 15.35-16.81) for the Oral passage, 25.20% (SD = 3.63, 95% CI = 24.17-26.23) for the Oral-Nasal passage and 55.44% (SD = 4.17, 95% CI = 54.25-56.63) for the Nasal passage. No significant age- and gender-related differences were observed for all the three stimuli. This is the first set of Mandarin stimuli and nasalance norms for Mandarin-speaking children in Malaysia. The influence of phonetic content on nasalance is supported. Findings call for language-specific normative nasalance data and careful selection of stimuli for the assessment of resonance.

The Use of the Nasometer and Interpretation of Nasalance Scores

Purpose

The acoustic characteristics of oral–nasal coupling (nasalization) have clinical implications for speech-language pathologists because excessive oral–nasal coupling results in a resonance disorder referred to as hypernasality . Nasometry is a tool that allows clinicians to measure the effect of oral–nasal coupling in the clinical setting. This clinical focus article summarizes the large volume of research on nasometry and clarifies its clinical application.

Conclusion

Although the precise relationship between the acoustics of oral–nasal coupling and the perception of hypernasality remains unclear, measuring the acoustic effects of oral–nasal coupling is useful in the evaluation and treatment of resonance disorders.

Phonetic Transcription for Speech-Language Pathology in the 21st Century

The past few decades have seen rapid changes in speech-language pathology in terms of technology, information on speech production and perception, and increasing levels of multilingualism in communities. This tutorial provides an overview of phonetic transcription for the modern world, both for work with clients, and for research and training. The authors draw on their backgrounds in phonetics, phonology and speech-language pathology, and their crosslinguistic project in the phonological acquisition of children with typical versus protracted phonological development. Challenges and solutions are presented, as well as resources for further training of students, clinicians and researchers.

Nasal Coarticulation and Prosody in Kakataibo

This paper presents the first phonetic description of the patterns of nasal coarticulation in Kakataibo. While closely related Panoan languages have been described as having anticipatory nasal coarticulation in VN sequences, there are only a few reports of other types of nasal coarticulation. Based on a detailed investigation of the aerodynamic properties of nasality, we account for the full variety of nasal coarticulation patterns in Kakataibo and discuss their interaction with prosody. This paper shows that nasal coarticulation occurs in all contexts in which there is vowel-nasal contiguity, although the amount and patterns of nasal coarticulation are dependent on the directionality of the process, the presence or absence of a syllable boundary and stress.

Clinical application of nasometry in patients with nasal obstruction

The purpose of this case-control study is to report on the clinical application of nasometry as a diagnostic tool in patients with the symptom of nasal obstruction compared with subjects with no history of nasal obstruction. Thirty-eight adult patients (mean age: 28.1 years) complaining of nasal obstruction were enrolled in the study, and another group of 38 adults (mean age: 25.9 years) with no history of nasal obstruction served as controls. Demographic data, including age and sex, were collected. Patients were asked to read three passages; the Zoo passage, the Rainbow passage, and nasal sentences. Nasalance scores were reported on all subjects using a Nasometer II instrument. The control and patient groups each included 22 men and 16 women. No statistically significant difference in nasalance score was found between the study group and the control group in any of the Zoo passage, Rainbow passage and nasal sentences. We conclude that nasometry has limited value in the objective assessment of nasal obstruction as a symptom, which we attribute to nasal obstruction's not always reflecting the volume and pressure in the nasal cavity.

Application of linear discriminant analysis to the nasometric assessment of resonance disorders: a pilot study

Objective : Nasalance scores have traditionally been used to assess hypernasality. However, resonance disorders are often complex, and hypernasality and nasal obstruction may co-occur in patients with cleft palate. In this study, normal speakers simulated different resonance disorders, and linear discriminant analysis was used to create a tentative diagnostic formula based on nasalance scores for nonnasal and nasal speech stimuli. Materials and Methods : Eleven female participants were recorded with the Nasometer 6450 while reading nonnasal and nasal speech stimuli. Nasalance measurements were taken of their normal resonance and their simulations of hyponasal, hypernasal, and mixed resonance. Results : A repeated-measures analysis of variance revealed a resonance condition-stimuli interaction effect (P < .001). A linear discriminant analysis of the participants' nasalance scores led to formulas correctly classifying 64.4% of the resonance conditions. When the hyponasal and mixed resonance conditions with obstruction of the less patent nostril were removed from the analysis, the resultant formulas correctly classified 88.6% of the resonance conditions. Conclusion : The simulations produced distinctive nasalance scores, enabling the creation of formulas that predicted resonance condition above chance level. The preliminary results demonstrate the potential of this approach for the diagnosis of resonance disorders.

Assessment of nasalance and nasality in patients with a repaired cleft palate

In patients with a repaired cleft palate, nasality is typically diagnosed by speech language pathologists. In addition, there are various instruments to objectively diagnose nasalance. To explore the potential of nasalance measurements after cleft palate repair by NasalView®, we correlated perceptual nasality and instrumentally measured nasalance of eight speech items and determined the relationship between sensitivity and specificity of the nasalance measures by receiver-operating characteristics (ROC) analyses and AUC (area under the curve) computation for each single test item and specific item groups. We recruited patients with a primarily repaired cleft palate receiving speech therapy during follow-up. During a single day visit, perceptive and instrumental assessments were obtained in 36 patients and analyzed. The individual perceptual nasality was assigned to one of four categories; the corresponding instrumental nasalance measures for the eight specific speech items were expressed on a metric scale (1-100). With reference to the perceptual diagnoses, we observed 3 nasal and one oral test item with high sensitivity. However, the specificity of the nasality indicating measures was rather low. The four best speech items with the highest sensitivity provided scores ranging from 96.43 to 100%, while the averaged sensitivity of all eight items was below 90%. We conclude that perceptive evaluation of nasality remains state of the art. For clinical follow-up, instrumental nasalance assessment can objectively document subtle changes by analysis of four speech items only. Further studies are warranted to determine the applicability of instrumental nasalance measures in the clinical routine, using discriminative items only.

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.

Comparison of Fundamental Frequency Nasalance between Trained Singers and Nonsingers for Sung Vowels

Objectives:

The purpose of this study was to determine the effect of vocal training on fundamental frequency nasalance measures under selected vowel and frequency conditions.

Methods:

Fundamental frequency nasalance measures were reported for 2 groups of women: 36 trained singers and 36 nonsingers. Each group sang and sustained the vowels (/i/, /æ/, /u/, /a/) for 6 seconds' duration at 3 frequency levels. A 3-second segment from the middle of each vowel was measured to generate fundamental frequency nasalance scores.

Results:

No significant differences were found in the mean fundamental frequency nasalance scores between the trained singers and the nonsingers. The fundamental frequency nasalance scores were significantly higher for front vowels for both groups. Additionally, both groups displayed a pattern of producing significantly higher fundamental frequency nasalance scores at lower fundamental frequencies than at higher fundamental frequencies.

Conclusions:

These findings support the practice of training singers to elevate the velum when singing at high frequencies but not when singing at low ones.

Influence of pharyngeal flap surgery on nasality and nasalance scores of nasal sounds production in individuals with cleft lip and palate

OBJECTIVE

To verify the influence of pharyngeal flap surgery on the management of velopharyngeal insufficiency on nasality and speech nasalance on nasal sound production in individuals with cleft lip and palate.

METHODS

Prospective study in 159 individuals with repaired cleft palate ± lip, of both genders, aged 6 to 57 years old. All the participants presented residual velopharyngeal insufficiency and were submitted to pharyngeal flap surgery. Perceptual speech evaluation and nasometric assessment were performed before and after (14 months on average) the pharyngeal flap surgery. Hyponasality was rated as absent or present, and nasalance scores were determined by means of nasometer using nasal stimuli, with a cutoff score of 43% used as the lowest limit of normality. Nasality and nasalance were compared before and after surgery (p < 0.05).

RESULTS

On the basis of correlation between both the methods used, perceptual hyponasality was observed in 14% of the individuals, whereas nasalance scores indicating hyponasality (< 43%) were obtained in 25% of the patients after surgery.

CONCLUSION

Pharyngeal flap surgery influenced the production of nasal sounds, causing hyponasality in a significant proportion of individuals. The presence of this speech symptom can also be an indicator of upper airway obstruction caused by pharyngeal flap, which should be investigated objectively and prudently postoperatively.

[Quantitative study of phonation by aerophonoscopy: Reproducibility study on healthy volunteers]

INTRODUCTION

The aerophonoscope allows for recording buccal and nasal airflow during breathing and speech and the sounds emitted by the patient. It is known to be useful in the postoperative follow-up of cleft lip and palate children, but there are currently no studies that quantitatively validate its reliability in pathological or non-pathological situations. The aim of our study was to measure the reliability of aerophonoscopic measures in adult healthy volunteers.

MATERIAL AND METHODS

A quantitative evaluation of the reliability of aerophonoscopy has been carried out in 30 healthy adult volunteers by measuring its inter- and intra-individual reproducibility and its sensibility in relation with the degree of the velopharyngeal sphincter constriction using a test-retest protocol.

RESULTS

The aerophonoscope allows for inter- and intra-individual reproducible measures in healthy adult volunteers. Its sensibility to velopharyngeal sphincter constriction is good in healthy adult volunteers.

DISCUSSION

The interest of aerophonoscopy in the treatment strategy of cleft lip and palate patients remains unclear. More reliable quantitative data would be of major interest to determine whether this device is suitable for the follow-up of cleft lips and palate patients or not. This would also allow for planning a second soft-palate operation and for assessing the efficacy of revision surgery such as superior or inferior pedicled pharyngoplasty.

Dialectical effects on nasalance: a multicenter, cross-continental study

PURPOSE

This study investigated nasalance in speakers from six different dialectal regions across North America using recent versions of the Nasometer. It was hypothesized that many of the sound changes observed in regional dialects of North American English would have a significant impact on measures of nasalance.

METHOD

Samples of the Zoo Passage, the Rainbow Passage, and the Nasal Sentences were collected from young adult male and female speakers (N=300) from six North American dialectical regions (Midland/Mid-Atlantic; Inland North Canada; Inland North; North Central; South; and Western dialects).

RESULTS

Across the three passage types, effect sizes for dialect were moderate in strength and accounted for approximately 7%-9% of the variation in nasalance. Increased differences in nasalance tended to occur between speakers from distinctly different geographical regions, with the highest nasalance across all passages observed for speakers from the Texas South dialect region.

CONCLUSION

Clinicians and researchers who use perceptual and instrumental measures of speech production should be aware that dialectical and socially acquired speech patterns may influence the acoustic characteristics of speech and may also influence the interpretation of normative expectations and typical versus disordered cutoff scores for instruments such as the Nasometer.

Muscle weakness and speech in oculopharyngeal muscular dystrophy

PURPOSE

We documented speech and voice characteristics associated with oculopharyngeal muscular dystrophy (OPMD). Although it is a rare disease, OPMD offers the opportunity to study the impact of myopathic weakness on speech production in the absence of neurologic deficits in a relatively homogeneous group of speakers.

METHODS

Twelve individuals with OPMD and 12 healthy age-matched controls underwent comprehensive assessment of the speech mechanism including spirometry (respiratory support), nasometry (resonance balance), phonatory measures (pitch, loudness, and quality), articulatory measures (diadochokinetic rates, segment duration measures, spectral moments, and vowel space), tongue-to-palate strength measures during maximal isometric and speechlike tasks, quality-of-life questionnaire, and perceptual speech ratings by listeners.

RESULTS

Individuals with OPMD had substantially reduced tongue strength compared to the controls. However, little impact on speech and voice measures or on speech intelligibility was observed except for slower diadochokinetic rates.

CONCLUSIONS

Despite having less than half the maximal tongue strength of healthy controls, the individuals with OPMD exhibited minimal speech deficits. The threshold of weakness required for noticeable speech impairment may not have been reached by this group of adults with OPMD.

Adult tonsillectomy: anatomical differences affect postoperative transient hypernasality

OBJECTIVE

Our purpose was to determine how anatomical conditions of the throat influence the degree and duration of posttonsillectomy transient hypernasality.

PATIENTS AND METHODS

A total of 82 tonsillectomies were performed. The participants were divided into groups: 1 – small tonsils, high soft palate position; 4 – large tonsils, low soft palate position, and 2 and 3 – intermediate tonsil dimensions and soft palate positions. Variables studied included the diameter of vapor (DV) on the mirror positioned under the patient's nose while articulating nasal sentences before and after surgery, the distance from the uvular tip to the posterior pharyngeal wall, healing grading as well as the degree and duration of hypernasality.

RESULTS

The mean hypernasality after tonsillectomy was greatest in group 4 and lowest in group 2. Before tonsillectomy, the mean DV was largest in group 2 and smallest in group 4. After tonsillectomy, the mean DV was largest in group 4 and smallest in group 3. Overall, the mean DV was significantly greater after tonsillectomy compared to the value before surgery.

CONCLUSION

The degree of hypernasality after tonsillectomy depends on the soft palate position in relation to the tongue base and the size of the tonsils. Hypernasality is greatest in patients with large tonsils and a low soft palate position in relation to the tongue base.

Comparison of nasalance scores obtained with the nasometers 6200 and 6450

OBJECTIVE

The study had the goal of comparing the new Nasometer 6450 to the older model 6200 using synthetic test sounds and control participants. A particular focus of the investigation was on the test-retest variability of the instruments.

MATERIALS AND METHODS

The Nasometers 6200 and 6450 were compared using square wave test sounds. Six repeated measurements of oral, balanced, and nasal test stimuli were recorded from 25 female participants over an average of 35 days.

RESULTS

The synthetic test sounds demonstrated that the two nasometers obtained similar results for a range of frequencies. The results for the clinically normal participants revealed that nasalance scores from the two instruments were within 1-2 points, depending on the test sentence. Variability in scores increased with the proportion of nasal consonants in the sentence. Test-retest variability was between 6 and 8 points for more than 90% of the participants. Participants with higher nasalance scores for oral stimuli had higher between-session variability.

CONCLUSIONS

The Nasometers 6200 and 6450 should yield comparable results in clinical practice. Depending on the phonetic content of the test materials, clinicians should allow for a 6- to 8-point between-session variability when interpreting nasalance scores.

Nasometer 6200 Versus Nasometer II 6400: Effect on Measures of Nasalance

Objective :  This study compared measures of nasalance obtained using the Nasometer 6200 versus the Nasometer II 6400 in typically speaking young adult males and females for the nonnasal Zoo Passage, the phonetically balanced Rainbow Passage, and the Nasal Sentences. Design :  Participants read passages at a comfortable pitch and loudness twice while wearing Nasometer 6200 or Nasometer II 6400 headgear. The order of Nasometer system was counterbalanced across participants, and the order of the reading passage was randomized. Participants :  Participants consisted of 25 males (mean age = 21.22 years) and 25 females (mean age = 23.83 years). Main Outcome Measures :  The main outcomes measures were nasalance scores (%) obtained for each system × passage per participant. Results :  Results showed that the Nasometer 6200 and the Nasometer II 6400 differed significantly on mean nasalance for the Zoo Passage (mean difference = 7.15%) and the Rainbow Passage (mean difference = 3.05%) but not for the Nasal Sentences (mean difference = 0.77%). Intersystem correlations and measures of predictive accuracy indicated that the ability to predict Nasometer 6200 nasalance scores from Nasometer II 6400 scores was relatively weak. Conclusions :  In addition to such factors as age, gender, and regional dialect, normative nasalance expectations and normal versus disordered nasalance cutoff scores must be considered with full knowledge of the specific system that was used to acquire the nasalance data. Intrasubject changes in nasalance can only be validly assessed when test versus retest measurements have been acquired using the same nasalance system.

Effects of computer system and vowel loading on measures of nasalance

PURPOSE

The purpose of this study was to determine similarities and differences in nasalance scores observed with different computerized nasalance systems in the context of vowel-loaded sentences. Methodology Subjects were 46 Caucasian adults with no perceived hyper- or hyponasality. Nasalance scores were obtained using the Nasometer 6200 (Kay Elemetrics Corp.), the Nasometer II 6400 (Kay Elemetrics Corp.), and the NasalView (Tiger DRS, Inc.) for sentences loaded with mixed, high front, high back, low front, or low back vowels.

RESULTS

Measures of nasalance obtained with the NasalView were significantly higher than those obtained with the Nasometer 6200, and the measures of nasalance obtained with the Nasometer 6200 were significantly higher than those obtained with the Nasometer II 6400. However, similar effects of vowel loading on measures of nasalance were observed, regardless of system. For all systems, the high front vowel sentence tended to result in higher measures of nasalance than did the high back, low front, and low back vowel sentences--the mixed vowel sentence tended to have a higher degree of nasalance than did any of the other sentences.

CONCLUSIONS

Although nasalance data computed using different systems are not readily comparable, all three systems that were evaluated produced similar effects of vowel loading on nasalance. Increased nasalance for high front versus low back vowels may be due to factors such as increased oral impedance, reduced radiated oral sound pressure, possible increases in airflow via the nasal cavity, and increased transpalatal nasalance.

A comparative study of two acoustic measures of hypernasality

PURPOSE

This study aimed to compare 2 quantitative acoustic measures of nasality in children with cleft lip and palate (CLP) and healthy controls using formalized perceptual assessment as a guide.

METHOD

Fifty participants (23 children with CLP and 27 age- and gender-matched healthy controls) aged between 4 and 12 years produced a variety of high and low vowels that allowed perceptual ratings of nasal resonance severity as well as acoustic analysis of spectral changes. Two objective measures of nasality were used: 1/3 octave spectra analysis and the voice low tone high tone ratio. Each respective technique has been evaluated in previous research, and their potential as an effective means of detecting changes in nasal resonance has been demonstrated.

RESULTS

Only 1/3 octave spectra analysis differentiated between participants with hypernasal speech and those perceived to have normal nasal resonance. Significant differences were also observed between varying levels of perceived severity on vowels within nonnasalized phonemic environments (/pIt/, /tIp/).

CONCLUSIONS

Perceptual judgment remains the primary means of evaluating levels of nasality in children with CLP. However, the development and validation of easy-to-use objective techniques remains an important goal for effective clinical and empirical practice.

[Measurement of nasal airflow and aerophonoscopy]

Diagnosis and treatment of rhinolalia are some of the most important elements in the follow-up of patients presenting with a cleft palate. In order to quantify the nasal airflow, speech therapists use either nasalance-measuring devices or devices related to aerophonoscopy. At the Maxillofacial Surgery Department in the Nantes University Hospital, we are currently trying to evaluate the inter- and intra-individual reproducibility of quantitative values provided by the aerophonoscope. We intend to use this device, originally designed in our department 25 years ago, as a reference tool for the measurement of nasal airflow after cleft surgery.

Relationship between nasal cavity volume changes and nasalance

OBJECTIVES

The patency and volume of the nasal cavity affect the acoustic characteristics of the voice. The aim of this study was to investigate the effect of a nasal decongestant on nasal volumes and nasalance scores, and to determine the relationship between these measures.

METHODS

Acoustic rhinometry and nasometry were performed in a group of 21 adult volunteers both prior to and following application of a nasal decongestant. The relationship between changes in nasalance scores and acoustic rhinometric parameters was investigated.

RESULTS

After the application of nasal decongestant, statistically significant increases were observed in nasalance scores and in all of the acoustic rhinometric parameters assessed (i.e. minimal cross-sectional area, three cross-sectional areas, three volumes and total volume). However, no significant correlation was found between the changes in nasalance scores and acoustic rhinometric parameters.

CONCLUSIONS

Nasal decongestion causes an increase in nasalance scores and nasal cavity volumes. However, the findings of this study indicate that changes in nasalance scores may result from factors other than nasal cavity volume changes.

Comparison of Short-Term and Long-Term Variability in Nasalance Scores

Objective:

To evaluate long-term nasalance score variability while accounting for short-term variation associated with subject performance and headgear change variability.

Stimuli:

Turtle and Mouse Passages.

Design:

Short-term immediate test-retest nasalance score variability was assessed with no headgear change (NCHG) and with change of headgear (CHG). Long-term variability was assessed with scores obtained in the morning and afternoon of the same day, 1 day apart, and 1 week apart. Scores from the long-term conditions necessarily reflect variability associated with headgear change plus variability, which may be attributed to time.

Participants:

Twenty-six adults (19 to 70 years of age) with normal speech and resonance.

Main Outcome Measures:

Forty-six nasalance scores per subject.

Results:

Mean nasalance difference scores across conditions were compared. Three contrasts were significantly different, each involving comparison of nasalance difference scores in the NCHG condition to difference scores from a CHG condition. Overall, long-term variability was slightly greater than short-term variability. For the Turtle Passage, in the short-term CHG condition, 92% of repeated scores were within five points. In the long-term conditions, 83% to 89% of scores were within five points. For the Mouse Passage, 88% of repeated scores in the CHG condition were within five points. In the long-term conditions, 81% to 83% of scores were within five points.

Conclusions:

Nasalance scores obtained over time showed slightly greater variability than scores obtained in immediate test-retest conditions; however, variability did not increase as the length of time between measures increased.

Optimizing stimulus length for clinical nasalance measures in Swedish

Standardized passages used for speech nasalance measures may be too long for clinical use with very young or non-compliant patients. The aim of this study was to establish whether nasalance scores from shorter sections of three Swedish speech stimuli were equivalent to those from their corresponding whole stimulus. Nasalance recordings for three Swedish speech stimuli (oral, nasal and oronasal) were obtained from 29 typically developing Swedish children (7-11 years). Cumulative sentence combinations were evaluated for equivalence to their respective whole passages according to two different criteria: one based on t-testing and the other on cumulative frequencies of score differences. Results showed that shorter sequences of sentences could be considered equivalent to the whole passage for the oral and nasal stimuli, provided that the sentences were sequenced in order of increasing difference from the whole stimulus score and that those sentences with scores significantly different from the whole passage score were not included.

Veränderung der Nasalanz nach Le Fort-I Osteotomie

BACKGROUND

Nasalance represents a measure of the relative amount of oral and nasal acoustic energy produced by a speaker. Literature shows changes in nasalance after surgery of the oropharynx. The aim of this prospective study was to evaluate the outcome of speech and nasalance scores after Le-Fort-I-Osteotomy.

PATIENTS AND METHODS

A total of 20 individuals with normal speech development were examined preoperatively and 6 weeks postoperatively with the Nasometer 6200 (Kay-Elemetrics, USA) after bimaxillary surgery. The tone materials used comprised the standardized text passage: "Ein Kindergeburtstag", the vowels: /a/, /e/, /i/, /o/, /u/ and a syllable repetition subtest.

RESULTS

All patients showed changes in nasalance scores 6 weeks postoperatively. There were no significant changes reading the standard text. The syllable repetition test showed significant changes for repetition of "ma ma ma" and "na na na" (p=0,003, respectively p=0,033). Intonation of the vowel /a/1 also revealed significant changes regarding the pre- and postoperative values (p=0,006). However, the obtained values had no significant impact on the nasality characteristics of speech.

CONCLUSION

This study confirms that maxillary osteotomies can result in significant changes of nasalance scores. However these changes do not have any impact on normal speech and voice.