A Comparison of Oral-Nasal Balance Patterns in Speakers who are Categorized as “Almost but Not Quite” and “Sometimes but Not Always”

Models for Predicting Velopharyngeal Competence Based on Speech and Resonance Errors and Velopharyngeal Area Estimation

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.

Pearls and pitfalls in contemporary management of marginal velopharyngeal inadequacy among children with cleft palate

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.

Nasalance-Based Preclassification of Oral-Nasal Balance Disorders Results in Higher Agreement of Expert Listeners' Auditory-Perceptual Assessments: Results of a Retrospective Listening Study

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.

Nasalization Amplitude-Timing Characteristics of Speakers With and Without Cleft Palate

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 (r_s = .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.

Relationship between velopharyngeal closure, hypernasality, nasal air emission and nasal rustle in subjects with repaired cleft palate

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.

Nonlinear Dynamic Analysis of Vowels in Cleft Palate Children with or without Hypernasality

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.

Magnetic resonance imaging assessment of the velopharyngeal mechanism at rest and during speech in Chinese adults and children

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.

Patterns of oral-nasal balance in normal speakers with and without cleft palate

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.