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Scarmagnani RH, Lohmander A, Salgado MH, Fukushiro AP, Trindade IEK, Yamashita RP. Models for Predicting Velopharyngeal Competence Based on Speech and Resonance Errors and Velopharyngeal Area Estimation. Cleft Palate Craniofac J 2024; 61:965-975. [PMID: 36594481 DOI: 10.1177/10556656221149516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To develop tools for predicting velopharyngeal competence (VPC) based on auditory-perceptual assessment and its correlation with objective measures of velopharyngeal orifice area. DESIGN Methodological study. PARTICIPANTS AND METHODS Sixty-two patients with repaired cleft palate, aged 6 to 45 years, underwent aerodynamic evaluation by means of the pressure-flow technique and audiovisual recording of speech samples. Three experienced speech-language pathologists analysed the speech samples by rating the following resonance, visual, and speech variables: hypernasality, audible nasal air emission, nasal turbulence, weak pressure consonants, facial grimacing, active nonoral errors, and overall velopharyngeal competence. The correlation between the perceptual speech variables and velopharyngeal orifice area estimates was analysed with Spearman's correlation coefficient. Two statistical models (discriminant and exploratory) were used to predict VPC based on the orifice area estimates. Sensitivity and specificity analyses were performed to verify the clinical applicability of the models. RESULTS There was a strong correlation between VPC (based on the orifice area estimates) and each speech variable. Both models showed 88.7% accuracy in predicting VPC. The sensitivity and specificity for the discriminant model were 92.3% and 97.2%, respectively, and 96.2% and 94.4% for the exploratory model. CONCLUSION Two predictor models based on ratings of resonance, visual, and speech variables and a simple calculation of a composite variable, SOMA (Eng. "sum"), were developed and found to be efficient in predicting VPC defined by orifice estimates categories based on aerodynamic measurements. Both tools may contribute to the diagnosis of velopharyngeal dysfunction in clinical practice.
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Affiliation(s)
- Rafaeli Higa Scarmagnani
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Speech-Language Pathology Unit, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ana Paula Fukushiro
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
- Department of Speech and Hearing Pathology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Inge Elly Kiemle Trindade
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
- Department of Speech and Hearing Pathology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Renata Paciello Yamashita
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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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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de Boer G, Marino VCDC, Dutka JDCR, Pegoraro-Krook MI, Bressmann T. Nasalance-Based Preclassification of Oral-Nasal Balance Disorders Results in Higher Agreement of Expert Listeners' Auditory-Perceptual Assessments: Results of a Retrospective Listening Study. Cleft Palate Craniofac J 2019; 57:448-457. [PMID: 31537110 DOI: 10.1177/1055665619873506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Reliable perceptual and instrumental assessment of oral-nasal balance disorders is a persistent problem in speech-language pathology. The goal of the study was to evaluate whether nasalance-based preclassification of oral-nasal balance disorders improves listener agreement. DESIGN Retrospective listening study. SETTING Tertiary university hospital. PARTICIPANTS Fifty-four randomly selected recordings of patients with repaired unilateral cleft lip and palate (UCLP). Three experienced speech-language pathologists participated as expert listeners. INTERVENTIONS Two listening experiments were based on nasalance scores and audio recordings of speakers with repaired UCLP. The speakers were preclassified as normal, hypernasal, hyponasal, or mixed based on their nasalance scores. Initially, the listeners determined the diagnostic category of the oral-nasal balance for 62 audio recordings (8 repeats). Six months later, they listened to 38 of the recordings (6 repeats) along with a spreadsheet indicating the nasalance-based categories for the oral-nasal balance. The listeners confirmed, or rejected and corrected, the nasalance-based preclassification. MAIN OUTCOME MEASURES Intralistener, interlistener agreement, and agreement between listener categories and nasalance-based oral-nasal balance categories. RESULTS In the first study, the agreement between the listeners' diagnostic category and the nasalance-based category was 45.1% and the interlistener agreement was 36.7%. In the second study, the agreement between the listeners' category and the nasalance-based category was 67.1% (75% agreement for the correct nasalance-based categories and 41.7% for the misclassifications), and the interlistener agreement was 85.4%. CONCLUSIONS Preclassification of oral-nasal balance disorders based on nasalance scores may help listeners achieve better diagnostic accuracy and higher agreement.
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Affiliation(s)
- Gillian de Boer
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | | | - Jeniffer de Cassia Rillo Dutka
- Department of Speech-Language and Audiology, College of Dentistry of Bauru, and Graduate Programs, Hospital de Reabilitação de Anomalias Craniofaciais, and College of Dentistry of Bauru, University of São Paulo, Bauru, Brazil
| | - Maria Inês Pegoraro-Krook
- Department of Speech-Language and Audiology, College of Dentistry of Bauru, and Graduate Programs, Hospital de Reabilitação de Anomalias Craniofaciais, and College of Dentistry of Bauru, University of São Paulo, Bauru, Brazil
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
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Bae Y. Nasalization Amplitude-Timing Characteristics of Speakers With and Without Cleft Palate. Cleft Palate Craniofac J 2017; 55:45-56. [PMID: 34162060 DOI: 10.1177/1055665617718826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To examine the amplitude-temporal relationships of acoustic nasalization in speakers with a range of nasality and to determine the extent to which each domain independently predicts the speaker's perceived oral-nasal balance. DESIGN Rate-controlled speech samples, consisting of /izinizi/, /azanaza/, and /uzunuzu/, were recorded from 18 participants (14 with repaired cleft palate and 4 without cleft palate) using the Nasometer. The mean nasalance of the entire mid-vowel-nasal consonant-vowel (mid-VNV) sequence (amplitude-domain) and the duration of the nasalized segment of the mid-VNV sequence (temporal-domain) were obtained based on nasalance contours. RESULTS Strong linear and vowel-dependent relationships were observed between the 2 domains of nasalization (adjusted R2 = 71.5%). Both the amplitude- and temporal-domain measures were found to reliably predict the speaker's perceived oral-nasal balance, with better overall model fit and higher classification accuracy rates observed in /izinizi/ and /uzunuzu/ than in /azanaza/. Despite poor specificity, the temporal-domain measure of /azanaza/ was found to have a strong correlation with the participants' Zoo passage nasalance scores (rs = .897, p < .01), suggesting its potential utility as a severity indicator of perceived nasality. CONCLUSIONS With the use of relatively simple speech tasks and measurements representing the amplitude and temporal domains of nasalization, the present study provided practical guidelines for using the Nasometer in assessing patients with oral-nasal resonance imbalance. Findings suggest that both domain measures of nasalization should be examined across different vowel contexts, given that each domain may provide clinically relevant, yet different, information.
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Affiliation(s)
- Youkyung Bae
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, USA
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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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Nonlinear Dynamic Analysis of Vowels in Cleft Palate Children with or without Hypernasality. Int J Otolaryngol 2011; 2012:739523. [PMID: 22187565 PMCID: PMC3236469 DOI: 10.1155/2012/739523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 10/25/2011] [Indexed: 11/18/2022] Open
Abstract
Objectives. To clarify the difference between Lyapunov exponents (LEs) for cleft palate (CP) patients with hypernasality versus without hypernasality and to investigate the relationship between their LEs and nasalance scores (NSs). Material and Methods. Six CP patients with severe hypernasality (mean age 9.2 years) and six CP patients without hypernasality (mean age 8.0 years) were enrolled. Five Japanese vowels were recorded at 44.1 KHz, and the NSs were measured simultaneously. The mean first LE (mLE1) from all one-second intervals was computed. Results. The mLE1 for /o/ in patients with hypernasality was significantly higher than that in patients without hypernasality. The correlation coefficients between the mLE1 and NS for all vowels were not statistically different. Conclusion. The voice signal of /o/ for the patients with hypernasality was more instable than in those without hypernasality. The chaotic phenomenon was independent of nasal resonance in CP voice.
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Tian W, Yin H, Redett RJ, Shi B, Shi J, Zhang R, Zheng Q. Magnetic resonance imaging assessment of the velopharyngeal mechanism at rest and during speech in Chinese adults and children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2010; 53:1595-1615. [PMID: 20699337 DOI: 10.1044/1092-4388(2010/09-0105)] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE Recent applications of the magnetic resonance imaging (MRI) technique introduced accurate 3-dimensional measurements of the velopharyngeal mechanism. Further standardization of the data acquisition and analysis protocol was successfully applied to imaging adults at rest and during phonation. This study was designed to test and modify a noninvasive protocol for evaluating young children without using general anesthesia. In addition, the velopharyngeal structures and their maximal motion were compared between adults and children. METHOD MRI data were acquired in 12 young adults and 9 children at rest and during speech production. Multiple measurements were made on the velopharyngeal and craniofacial structures as well as on the levator veli palatini muscle. RESULTS Most of the ratio measurements of structural shape and maximal motion in the velopharyngeal and craniofacial regions were not significantly different between the adults and the children, despite the fact that the children had much smaller structures than the adults. CONCLUSION The proportion of the velopharyngeal mechanism remains stable in young children and adults so that the motions of the velum and pharyngeal walls are adequate to close the velopharyngeal port completely.
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Affiliation(s)
- Wei Tian
- University of Maryland at College Park, 0141D Lefrak Hall, College Park, MD 20742, USA.
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Jones DL. Patterns of oral-nasal balance in normal speakers with and without cleft palate. Folia Phoniatr Logop 2007; 58:383-91. [PMID: 17108696 DOI: 10.1159/000094999] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aero-acoustic aspects of nasalization that distinguish speakers with velopharyngeal adequacy from those with velopharyngeal inadequacy are well known. Differences in aerodynamic aspects of nasalization also have been demonstrated in normal speakers with cleft palate and their noncleft counterparts. The purpose of this study was to compare the amplitude and temporal patterns of oral-nasal balance in speakers with cleft palate and normal speech to those with normal speech without cleft palate. PATIENTS AND METHODS Using the Nasal Accelerometric Vibrational Index technique, the time course and amplitude of oral-nasal balance were studied in 10 children with cleft palate and velopharyngeal adequacy and 10 noncleft controls. The speech sample included syllable, word, and sentence contexts, most of which were devoid of nasal consonants. RESULTS The results indicate few differences between the two groups in contexts devoid of nasal consonants. However, significant differences were evident with regard to temporal aspects of oral-nasal balance in a nasal-oral consonant word context. CONCLUSIONS Subtle structural-motor differences that may exist between normal speakers with and without cleft palate may be more evident when the spatiotemporal requirements for velar movement become more complex and result in a greater possible combination of oral-nasal impedance ratios.
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Affiliation(s)
- David L Jones
- Division of Communication Disorders, University of Wyoming, Laramie, WY 82071, USA.
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