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Sitzman TJ, Baylis AL, Perry JL, Weidler EM, Temkit M, Ishman SL, Tse RW. Protocol for a Prospective Observational Study of Revision Palatoplasty Versus Pharyngoplasty for Treatment of Velopharyngeal Insufficiency Following Cleft Palate Repair. Cleft Palate Craniofac J 2024; 61:870-881. [PMID: 36562144 PMCID: PMC10287832 DOI: 10.1177/10556656221147159] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To present the design and methodology for an actively enrolling comparative effectiveness study of revision palatoplasty versus pharyngoplasty for the treatment of velopharyngeal insufficiency (VPI). DESIGN Prospective observational multicenter study. SETTING Twelve hospitals across the United States and Canada. PARTICIPANTS Individuals who are 3-23 years of age with a history of repaired cleft palate and a diagnosis of VPI, with a total enrollment target of 528 participants. INTERVENTIONS Revision palatoplasty and pharyngoplasty (either pharyngeal flap or sphincter pharyngoplasty), as selected for each participant by their treatment team. MAIN OUTCOME MEASURE(S) The primary outcome is resolution of hypernasality, defined as the absence of consistent hypernasality as determined by blinded perceptual assessment of a standard speech sample recorded twelve months after surgery. The secondary outcome is incidence of new onset obstructive sleep apnea. Statistical analyses will use propensity score matching to control for demographics, medical history, preoperative severity of hypernasality, and preoperative imaging findings. RESULTS Study recruitment began February 2021. As of September 2022, 148 participants are enrolled, and 78 have undergone VPI surgery. Enrollment is projected to continue into 2025. Collection of postoperative evaluations should be completed by the end of 2026, with dissemination of results soon thereafter. CONCLUSIONS Patients with VPI following cleft palate repair are being actively enrolled at sites across the US and Canada into a prospective observational study evaluating surgical outcomes. This study will be the largest and most comprehensive study of VPI surgery outcomes to date.
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Affiliation(s)
- Thomas J. Sitzman
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Adriane L. Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Plastic and Reconstructive Surgery and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Speech Language Hearing Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Jamie L. Perry
- Department of Communication Sciences and Disorders East Carolina University, Greenville, North Carolina, USA
| | - Erica M. Weidler
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - M’hamed Temkit
- Department of Clinical Research, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Stacey L. Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Raymond W. Tse
- Division of Craniofacial and Plastic Surgery, Department of Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
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Kollara L, Reiss SL, Singam S, Kellogg B. Velopharyngeal Characteristics in Aarskog-Scott Syndrome: A Case Report. Cleft Palate Craniofac J 2024; 61:892-896. [PMID: 36475306 DOI: 10.1177/10556656221141235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Aarskog-Scott syndrome (AAS), also known as facio-digito-genital syndrome, is a rare heterogenous syndrome characterized by facial dysmorphism, brachydactyly, and genetic abnormalities. Although severe craniofacial abnormalities have been reported in AAS, little is known about speech and resonance issues in AAS. Specifically, published data to date have only indicated reports of hypernasality associated with a cleft palate in AAS. This case report provides clinical and anatomic information surrounding hypernasal speech in the absence of an overt cleft palate in a patient with AAS.
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Affiliation(s)
- Lakshmi Kollara
- School of Communication Sciences and Disorders, College of Health Professions and Sciences, Biionix Cluster, University of Central Florida, Orlando, FL, USA
| | - Samantha L Reiss
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Sreekara Singam
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Brian Kellogg
- University of Central Florida College of Medicine, Orlando, FL, USA
- Division of Plastic & Craniofacial Surgery, Nemours Children's Hospital, Orlando, FL, USA
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Dunworth K, Sharif-Askary B, Grames L, Jones C, Kern J, Nyswonger-Sugg J, Suárez A, Thompson K, Ching J, Golden B, Merrill C, Nguyen P, Patel K, Rogers-Vizena CR, Rottgers SA, Skolnick GB, Allori AC. Using "Real-World Data" to Study Cleft Lip/Palate Care: An Exploration of Speech Outcomes from a Multi-Center US Learning Health Network. Cleft Palate Craniofac J 2023:10556656231207469. [PMID: 37844605 DOI: 10.1177/10556656231207469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To assess the ability of a cleft-specific multi-site learning health network registry to describe variations in cleft outcomes by cleft phenotypes, ages, and treatment centers. Observed variations were assessed for coherence with prior study findings. DESIGN Cross-sectional analysis of prospectively collected data from 2019-2022. SETTING Six cleft treatment centers collected data systematically during routine clinic appointments according to a standardized protocol. PARTICIPANTS 714 English-speaking children and adolescents with non-syndromic cleft lip/palate. INTERVENTION Routine multidisciplinary care and systematic outcomes measurement by cleft teams. OUTCOME MEASURES Speech outcomes included articulatory accuracy measured by Percent Consonants Correct (PCC), velopharyngeal function measured by Velopharyngeal Competence (VPC) Rating Scale (VPC-R), intelligibility measured by caregiver-reported Intelligibility in Context Scale (ICS), and two CLEFT-Q™ surveys, in which patients rate their own speech function and level of speech distress. RESULTS 12year-olds exhibited high median PCC scores (91-100%), high frequency of velopharyngeal competency (62.50-100%), and high median Speech Function (80-91) relative to younger peers parsed by phenotype. Patients with bilateral cleft lip, alveolus, and palate reported low PCC scores (51-91%) relative to peers at some ages and low frequency of velopharyngeal competency (26.67%) at 5 years. ICS scores ranged from 3.93-5.0 for all ages and phenotypes. Speech Function and Speech Distress were similar across phenotypes. CONCLUSIONS This exploration of speech outcomes demonstrates the current ability of the cleft-specific registry to support cleft research efforts as a source of "real-world" data. Further work is focused on developing robust methodology for hypothesis-driven research and causal inference.
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Affiliation(s)
- Kristina Dunworth
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Banafsheh Sharif-Askary
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Lynn Grames
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, St. Louis, USA
| | - Carlee Jones
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Jennifer Kern
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Jillian Nyswonger-Sugg
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Arthur Suárez
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Karen Thompson
- Cleft Lip and Palate Program/Craniofacial Program, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Jessica Ching
- University of Florida Craniofacial Center, University of Florida, Gainesville, FL, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Brent Golden
- Pediatric Cleft Lip and Palate Surgery Program, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Corinne Merrill
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Phuong Nguyen
- Division of Plastic Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kamlesh Patel
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, St. Louis, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Carolyn R Rogers-Vizena
- Cleft Lip and Palate Program/Craniofacial Program, Boston Children's Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - S Alex Rottgers
- Cleft and Craniofacial Center, Johns Hopkins Children's Center, Baltimore, MD, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Alexander C Allori
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
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Nguyen DC, Myint JA, Lin AY. The Role of Postoperative Nasal Stents in Cleft Rhinoplasty: A Systematic Review. Cleft Palate Craniofac J 2023:10556656231190703. [PMID: 37501651 DOI: 10.1177/10556656231190703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To evaluate the role of postoperative nasal stenting in preserving nasal shape and preventing nostril stenosis in cleft rhinoplasty, and to develop a classification system for postoperative nasal stents. DESIGN Systematic review. METHODS Electronic and manual searches of scientific literature were conducted from 3 databases (PubMed, SCOPUS, OVID). Primary evidence that described postoperative nasal stenting in cleft rhinoplasty were included. Exclusion criteria included secondary evidence, non-English articles, and studies focusing on preoperative nasal stents. PATIENTS AND PARTICIPANTS Patients with cleft lip/nose of any type were included. MAIN OUTCOME MEASURE(S) Role in preservation of nasal shape & symmetry, role in prevention of nostril stenosis, complications with the use of postoperative nasal stent. RESULTS Of the 13 articles, 9 papers described the preservation of nasal shape with nasal stents and three studies with a control group showed improved symmetry score. No studies evaluated the prevention of nostril stenosis; however, 2 studies reported improvement of nostril stenosis in secondary cleft rhinoplasty. The results of the included studies had significant heterogeneity. Nasal stents were classified into five types: Type I-spare parts assembled, Type II-prefabricated commercial, Type IIIa-patient specific 3D-printed static, Type IIIb-patient specific dynamic, and Type IV-internal absorbable. Total complications were 6.0%, including irritation (0.9%), infection (0.3%), and stent loss (4.6%). CONCLUSION Despite the lack of consensus with postoperative nasal stents, this review suggests its safety and role in preserving shape and improving stenosis. Our classification system highlights variability and the need for better quality studies to determine the efficacy of nasal stents.
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Affiliation(s)
- David C Nguyen
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Janine A Myint
- Department of Plastic Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Alexander Y Lin
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
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Williams JL, Cordero KN, Sitzman TJ. Assessing the Agreement of Hyper nasality and Audible Nasal Emission Ratings Between Audio-Recordings and a Clinic Setting. Cleft Palate Craniofac J 2023:10556656231185494. [PMID: 37357709 DOI: 10.1177/10556656231185494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Assess agreement of hypernasality and audible nasal emission (ANE) ratings between audio-recordings and a clinic setting. Cross-sectional study using retrospective clinical recordings. Audio-recording ratings by two trained speech language pathologists. Percent agreement and intra- and inter-rater reliability of perceptual ratings. Intra-rater reliability (AC2) of 167 audio-recorded speech samples for the primary and secondary raters, respectively, was 0.82 and 0.79 for hypernasality; for ANE, it was 0.57 and 0.75. Inter-rater reliability was 0.77 for hypernasality and 0.63 for ANE. When comparing ratings made from audio-recording versus the original clinical ratings, intra-rater reliability was 0.85 and 0.61 (primary and secondary rater, respectively) for hypernasality and 0.21 and 0.34 for ANE. Ratings for hypernasality made from audio recordings were consistent with clinical evaluation, while ratings of ANE were not. ANE ratings made from audio recordings may not be a valid measure of velopharyngeal insufficiency speech characteristics.
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Affiliation(s)
- Jessica L Williams
- Phoenix Children's Center for Cleft and Craniofacial Care a Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Kelly N Cordero
- Phoenix Children's Center for Cleft and Craniofacial Care a Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Thomas J Sitzman
- Phoenix Children's Center for Cleft and Craniofacial Care a Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Fujiki RB, Kostas G, Thibeault SL. Relationship Between Auditory-Perceptual and Objective Measures of Resonance in Children with Cleft Palate: Effects of Intelligibility and Dysphonia. Cleft Palate Craniofac J 2023:10556656231162238. [PMID: 36890706 DOI: 10.1177/10556656231162238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
To investigate the relationship between auditory-perceptual ratings of resonance and nasometry scores in children with cleft palate. Factors which may impact this relationship were examined including articulation, intelligibility, dysphonia, sex, and cleft-related diagnosis. Retrospective, observational cohort study. Outpatient pediatric cranio-facial anomalies clinic. Four hundred patients <18 years of age identified with CP ± L, seen for auditory-perceptual and nasometry evaluations of hypernasality as well as assessments of articulation and voice. Relationship between auditory-perceptual ratings of resonance and nasometry scores. Pearson's correlations indicated that auditory-perceptual resonance ratings and nasometry scores were significantly correlated across oral-sound stimuli on the picture-cued portion of the MacKay-Kummer SNAP-R Test (r values .69 to.72) and the zoo reading passage (r = .72). Linear regression indicated that intelligibility (p ≤ .001) and dysphonia (p = .009) significantly impacted the relationship between perceptual and objective assessments of resonance on the Zoo passage. Moderation analyses indicated that the relationship between auditory-perceptual and nasometry values weakened as severity of speech intelligibility increased (P < .001) and when children presented with moderate dysphonia (p ≤ .001). No significant impact of articulation testing or sex were observed. Speech intelligibility and dysphonia alter the relationship between auditory-perceptual and nasometry assessments of hypernasality in children with cleft palate. SLPs should be aware of potential sources of auditory-perceptual bias and shortcomings of the Nasometer when following patients with limited intelligibility or moderate dysphonia. Future study may identify the mechanisms by which intelligibility and dysphonia affect auditory-perceptual and nasometry evaluations.
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Affiliation(s)
| | - George Kostas
- Department of Surgery, 5228University of Wisconsin Madison, Madison, WI, USA
| | - Susan L Thibeault
- Department of Surgery, 5228University of Wisconsin Madison, Madison, WI, USA
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Green J, Lignieres A, Obinero CG, Nguyen PD, Greives MR. Repeat Buccal Flaps Successfully Reduce Hyper nasality in a Patient with Cleft Palate. Cleft Palate Craniofac J 2023:10556656221149520. [PMID: 36594190 DOI: 10.1177/10556656221149520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Surgical intervention can contribute to the development of velopharyngeal insufficiency (VPI) leading to hypernasality and regurgitation. In this case, a patient with a history of bilateral buccal flaps used for her primary CP repair presented to clinic with hypernasality and VPI as assessed by speech exam and imaging. She underwent repeat bilateral buccal flap palatal lengthening with division of the pedicles 3 months later. Three months after her division, her hypernasality score improved from moderate to mild and her posterior gap decreased. This study concluded buccal flaps can be used a second time for patients needing palatal revisions for VPI.
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Affiliation(s)
- Jackson Green
- Division of Plastic Surgery, Department of Surgery, 12339McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Austin Lignieres
- Division of Plastic Surgery, Department of Surgery, 12339McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Chioma G Obinero
- Division of Plastic Surgery, Department of Surgery, 12339McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Phuong D Nguyen
- Division of Plastic Surgery, Department of Surgery, 12339McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Matthew R Greives
- Division of Plastic Surgery, Department of Surgery, 12339McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
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Ghanem AM, Ghorbanian S, Borg TM, Sell D, Sommerlad BC. Submucous Cleft Palate (SMCP): Indications and Outcomes of Radical Muscle Dissection Palatoplasty in Children Under 4 Years of Age. Cleft Palate Craniofac J 2022:10556656221088170. [PMID: 35306868 DOI: 10.1177/10556656221088170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To delineate the indications, referral sources and outcomes of radical muscle dissection palate repair in the first 4 years of life for patients with submucous cleft palate (SMCP). This study presents a retrospective analysis of a single surgeon's management. All children were treated at Great Ormond Street Hospital, United Kingdom. Twenty-three children with nonsyndromic SMCP were included in this study. All participants underwent radical muscle dissection repair before their fourth birthday. Parameters analyzed included: referral sources, indications for referral, extent of anatomical abnormality, and postoperative outcomes. Paediatricians provided the largest proportion of referrals to the cleft lip and palate clinic (39%) due to the presence of cleft lip/palate on prenatal scans or during neonatal examination. Over half (n = 12, 52%) of patients had severe anatomical anomalies being in grade IV (score 8-9), with the classical triad present to some extent in all but 2 of the patients. The main indication for surgery was nasal regurgitation of food and liquid (n = 9, 35%) followed by hypernasality (n = 6, 21%), difficulty feeding (n = 3, 8%), and severe anatomical defect (n = 2; 4%). Postoperatively, the presenting complaint improved in the majority of cases. Nonsyndromic SMCP is often missed, though may present with nasal regurgitation, feeding problems, and/or hypernasality, though may be missed in nonsyndromic children. Early radical muscle dissection repair in the first 4 years of life is safe and effective, facilitating normal speech development.
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Affiliation(s)
- Ali M Ghanem
- 4952Barts and the London School of Medicine and Dentistry, London, UK
| | - Samim Ghorbanian
- 4952Barts and the London School of Medicine and Dentistry, London, UK
| | | | - Debbie Sell
- 4956Great Ormond Street Hospital for Children NHS Trust, London, UK
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Bressmann T. Covering Nasometer Microphones with Plastic Wrap for Infection Control Increases Retest Variability of Nasalance Scores. Cleft Palate Craniofac J 2021; 59:1314-1318. [PMID: 34812087 PMCID: PMC9465502 DOI: 10.1177/10556656211051582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Nasometer is a popular instrument for the acoustic assessment of nasality. In light of the currently ongoing COVID-19 global pandemic, clinicians may have wondered about the infection control procedures for the Nasometer. The current research investigated whether nasalance scores are affected if the Nasometer 6450 microphone casings are covered with a material such as rolled polyvinyl chloride household wrap. For the experiment, pre-recorded sound files from two speakers were played back through a set of small loudspeakers. Nasalance scores from two baselines and three wrap cover conditions were compared. While there was no statistically significant condition effect in a repeated-measures analysis of variance, the within-condition cumulative differences in nasalance scores were 2 for the initial baseline, 42 for wrap cover 1, 24 for wrap cover 2, 78 for wrap cover 3, and 8 for the final baseline. Mean differences between the wrap cover and the baseline conditions were 8.2 to 15.3 times larger, and cumulative differences were 8.3 to 16.6 times larger than between the two baselines. Based on the higher cumulative and mean differences observed, clinicians should not cover Nasometer microphones with household wrap as this increases variability of nasalance scores. Since there is evidence that the COVID-19 virus can survive for some time on metal surfaces, clinicians should be mindful of the fact that the Nasometer microphone housings can only be cleaned superficially and should be handled with gloves to minimize any possible risk of touch transfer of pathogens to the next speaker or the clinician.
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Affiliation(s)
- Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Tim Bressmann, Department of Speech-Language Pathology, University of Toronto, Canada, 160-500 University Avenue, Toronto, ON M5G1V7, Canada.
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Morrison MM, Mason NT, Forde BL, Stone PR, Fowler PV, Thompson JMD. Speech Outcomes of a National Cohort of Children with Orofacial Cleft at 5 and 10 Years of age. Cleft Palate Craniofac J 2021; 59:1400-1412. [PMID: 34672811 DOI: 10.1177/10556656211044939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess speech outcomes at five and ten years of age in a nationwide study of children with orofacial cleft. DESIGN Prospective study. PARTICIPANTS Children born with orofacial cleft and having primary surgery in New Zealand. Speech samples were available for 151 five-year-old, and 163 ten-year-old children. MAIN OUTCOME MEASURES Intelligibility, Acceptability, Velopharyngeal function, Hypernasality, Hyponasality, severity of airflow evaluated by perceptual speech assessment (using the standardised Rhinocleft assessment), and overall assessment of requirement for clinical intervention. RESULTS A large proportion of five-year-old children had speech that was considered to be not completely intelligible, was not acceptable, and had inadequate velopharyngeal function. The noted deficiencies led to a clinical judgement that further speech and/or surgical intervention was required in 85% with cleft lip and palate, 65% with cleft palate and 26% with cleft lip. The proportion of children with poor speech outcomes in the ten-year-old children was lower, though of clinical importance, further intervention required for 25% with CLP, 15% with CP and 3% with CL. The number of sound production errors in both age groups followed the same pattern with fewest in those with CL and most in those with CLP. CONCLUSIONS A significant proportion of children with orofacial cleft were found to have poor speech outcomes requiring further treatment. The outcomes are poor compared to centres reported in the UK and Scandinavia. New Zealand requires a review of the current services for individuals born with cleft to improve speech outcomes and interdisciplinary care.
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Affiliation(s)
- Maeve M Morrison
- Department of Allied Health, 1400Middlemore Hospital, Counties Manukau District Health Board.,Department of Plastics, 1400Middlemore Hospital, Counties Manukau District Health Board
| | - Nicola T Mason
- Speech Language Therapy, 67587Christchurch Hospital, Canterbury District Health Board
| | - Bryony L Forde
- Speech Language Therapy, 161292Hutt Valley Hospital, Hutt Valley District Health Board
| | - Peter R Stone
- Department of Obstetrics and Gynaecology, 1415University of Auckland, Auckland, New Zealand
| | | | - John M D Thompson
- Department of Obstetrics and Gynaecology, 1415University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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Shah R, Marcus J, Frank-Ito DO. Computational Analysis of Olfactory Airspace in Patients With Unilateral Cleft Lip Nasal Deformity. Cleft Palate Craniofac J 2021; 58:1242-1250. [PMID: 33356511 PMCID: PMC9984277 DOI: 10.1177/1055665620982754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the magnitude of olfactory recess opacity in patients with unilateral cleft lip nasal deformity (uCLND). DESIGN Subject-specific 3-dimensional reconstruction of the nasal airway anatomy was created from computed tomography images in 11 (4 males and 7 females) subjects with uCLND and 7 (3 males, and 4 females) normal subjects. The volume and surface area of each subject's unilateral and bilateral olfactory airspace was quantified to assess the impact of opacification. Qualitatively speaking, patients with 75% to 100% olfactory recess opacification were classified as extreme, 50% to 75% as severe, 25% to 50% as moderate, and 0% to 25% as mild. RESULTS Of the 11 subjects with uCLND, 5 (45%) were classified as having extreme olfactory recess opacification, 3 (27%) subjects had severe opacification, and 3 (27%) subjects had moderate opacification. Mean (±SD) bilateral olfactory recess volume was significantly greater in normal subjects than in subjects with uCLND (0.9668 cm3 ± 0.4061 cm3 vs 0.3426 cm3 ± 0.1316 cm3; P < .001). Furthermore, unilateral olfactory airspace volumes for the cleft and non-cleft sides in subjects with uCLND were considerably less than unilateral olfactory volume in subjects with normal anatomy (uCLND cleft side = 0.1623 cm3 ± 0.0933 cm3; uCLND non-cleft side = 0.1803 cm3 ± 0.0938 cm3; normal = 0.4834 cm3 ± 0.2328 cm3; P < .001). CONCLUSIONS Our findings indicate a high prevalence of olfactory recess opacification among subjects with uCLND when compared to subjects with normal anatomy. The majority of subjects with uCLND had extreme olfactory recess opacity, which will likely influence their sense of smell.
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Affiliation(s)
- Reanna Shah
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, N.C
| | - Jeffrey Marcus
- Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, N.C
| | - Dennis O. Frank-Ito
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, N.C.,Department of Mechanical Engineering and Materials Science, Duke University Pratt School of Engineering, Durham, N.C.,Computational Biology & Bioinformatics PhD Program, Duke University, Durham, N.C
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Okhiria ÅC, Jabbari F, Hakelius MM, Johansson MMB, Nowinski DJ. Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair. Cleft Palate Craniofac J 2021; 59:1030-1037. [PMID: 34259078 DOI: 10.1177/10556656211029537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the impact of cleft width and cleft type on the need for secondary surgery and velopharyngeal competence from a longitudinal perspective. DESIGN Retrospective, longitudinal study. SETTING A single multidisciplinary craniofacial team at a university hospital. PATIENTS Consecutive patients with unilateral or bilateral cleft lip and palate and cleft palate only (n = 313) born from 1984 to 2002, treated with 2-stage palatal surgery, were reviewed. A total of 213 patients were included. MAIN OUTCOME MEASURES The impact of initial cleft width and cleft type on secondary surgery. Assessment of hypernasality, audible nasal emission, and glottal articulation from routine follow-ups from 3 to 16 years of age. The assessments were compared with reassessments of 10% of the recordings. RESULTS Cleft width, but not cleft type, predicted the need for secondary surgery, either due to palatal dehiscence or velopharyngeal insufficiency. The distribution of cleft width between the scale steps on a 4-point scale for hypernasality and audible nasal emission differed significantly at 5 years of age but not at any other age. Presence of glottal articulation differed significantly at 3 and 5 years of age. No differences between cleft types were seen at any age for any speech variable. CONCLUSIONS Cleft width emerged as a predictor of the need for secondary surgery as well as more deviance in speech variables related to velopharyngeal competence during the preschool years. Cleft type was not related to the need for secondary surgery nor speech outcome at any age.
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Affiliation(s)
- Åsa C Okhiria
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Fatemeh Jabbari
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Malin M Hakelius
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Monica M Blom Johansson
- Department of Neuroscience, Speech-Language Pathology, 59592Uppsala University, Uppsala, Sweden
| | - Daniel J Nowinski
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
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13
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de Araújo LL, Alonso N, Fukushiro AP. Treatment of Cleft Lip and Palate in the Amazon Region in Brazil: Speech Results and Sociodemographic Aspects. Cleft Palate Craniofac J 2021; 59:595-602. [PMID: 34032142 DOI: 10.1177/10556656211017791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the speech outcomes in individuals with cleft lip and palate (CLP) from the Amazon region and determine their correlation with sociodemographic factors. DESIGN Cross-sectional, prospective, single-blind study. SETTING Tertiary care institute in Manaus, Amazonas, Brazil. PATIENTS Four hundred twenty individuals with CLP, aged 4 to 57 years. MAIN OUTCOME MEASURES The samples were judged by 3 speech pathologists experienced in the speech assessment of individuals with CLP. Hypernasality was scored using a 4-point scale, being 1 = absent, 2 = mild, 3 = moderate, and 4 = severe, and the active speech symptoms were classified as absent or present. The final score for each speech symptom was reached by consensus among the 3 examiners Descriptive analysis of sociodemographic data included origin, socioeconomic status, type of cleft, surgical technique employed, the age they underwent primary and secondary palatoplasty, and palatal fistula. RESULTS Absence of hypernasality was observed in 41% of the individuals, 18% had mild, 28% moderate, and 13% severe hypernasality. Active speech symptoms were observed in 57% of the individuals. Significant correlations were found between speech outcomes and the variables such as origin, socioeconomic status, age at primary and secondary palatoplasty, and presence of fistula. CONCLUSIONS Most individuals with repaired CLP from the Amazon region presented speech disorders, characterized by hypernasality and active errors. Patients living outside the state capital, of low socioeconomic level, underwent palatoplasty late and with presence of palatal fistula tended to have the worst speech outcomes.
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Affiliation(s)
- Laryssa Lopes de Araújo
- Yaçuri da Amazônia Institute, Manaus, Brazil.,Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Nivaldo Alonso
- Department of Plastic Surgery, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Ana Paula Fukushiro
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.,Speech-Language Pathology Department, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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14
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Kaye A, Tracy M, Noel-MacDonnell J, Dent K. Conversion Furlow Palatoplasty and the Use of Preoperative Video Nasendoscopy. Cleft Palate Craniofac J 2021; 59:629-636. [PMID: 34000849 DOI: 10.1177/10556656211015008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess outcomes after conversion Furlow palatoplasty with and without routine preoperative flexible fiberoptic video nasendoscopy (FFVN). DESIGN Retrospective cohort study. SETTING Tertiary Children's Hospital. PATIENTS Greater than 3 years of age with cleft palate and velopharyngeal insufficiency (VPI) after straight-line palatoplasty requiring secondary surgery performed with a Furlow palatoplasty. MAIN OUTCOME MEASURES The number of children with and without routine FFVN prior to conversion Furlow palatoplasty for VPI after initial straight-line palatoplasty. Groups were compared for surgical timing, speech outcomes, and need for additional surgery after conversion Furlow palatoplasty. RESULTS Fifty-eight patients underwent preoperative FFVN versus 29 without. Mean age at FFVN was 73.8 (SD 34) months. Mean age for secondary palatal surgery by conversion Furlow palatoplasty was 81.5 (SD 34.8) months with FFVN versus 73.4 (SD 34.0) months without FFVN. There was a significant difference (P < .001) for VPI diagnosis and time to surgery between the groups. Preoperative hypernasality ratings were similar between groups. Postoperatively 65.5% of FFVN and non-FFVN patients corrected to normal resonance. Only 6.9% of all patients rated moderate-severe hypernasality after surgery compared to 42.5% preoperatively. Of total, 5.7% of patients had unchanged hypernasality and only 1 patient rated worse. Seven patients ultimately required additional surgery in attempt to normalize their resonance. CONCLUSIONS Routine preoperative FFVN does not offer any advantage for improved outcomes in children undergoing conversion Furlow palatoplasty after straight-line repair. Routine preoperative FFVN was associated with increased time to surgery after diagnosis of VPI compared to those without FFVN.
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Affiliation(s)
- Alison Kaye
- Pediatric Surgery, 4204Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Meghan Tracy
- 4204Children's Mercy Kansas City, Kansas City, MO, USA
| | - Janelle Noel-MacDonnell
- Department of Health Services and Outcomes Research, 4204Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kathryn Dent
- Speech-Language Pathology, Children's Mercy Kansas City, Kansas City, MO, USA
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15
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Santos TDD, Pardo JS, Bressmann T. Interlocutor accommodation of gradually altered nasal signal levels in a model speaker. Phonetica 2021; 78:95-112. [PMID: 33651926 DOI: 10.1515/phon-2019-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Phonetic accommodation is observed when interacting speakers gradually converge (or diverge) on phonetic features over the course of a conversation. The present experiment investigated whether gradual changes in the nasal signal levels of a pre-recorded model speaker would lead to accommodation in the nasalance scores of the interlocutor in a speech-shadowing experiment. METHODS Twenty female speakers in two groups repeated sentences after a pre-recorded model speaker whose nasal signal level was gradually increased or decreased over the course of the experiment. Outcome measures were the mean nasalance scores at the initial baseline, maximum nasal signal level, minimum nasal signal level and final baseline conditions. The order of presentation of the maximum and minimum nasal signal levels was varied between the two groups. RESULTS The results showed a significant effect of condition in F(3) = 2.86, p = 0.045. Both groups of participants demonstrated lower nasalance scores in response to increased nasal signal levels in the model (phonetic divergence). The group that was first presented with the maximum nasal signal levels demonstrated lower nasalance scores for the minimum nasal signal level condition (phonetic convergence). CONCLUSION Speakers showed a consistent divergent reaction to a more nasal-sounding model speaker, but their response to a less nasal-sounding model may depend on the order of presentation of the manipulations. More research is needed to investigate the effects of increased versus decreased nasality in the speech of an interlocutor.
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Affiliation(s)
- Telma Dias Dos Santos
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Department of Speech-Language Pathology, Pontifical Catholic University of São Paulo, São Paulo, SP, Brazil
| | - Jennifer S Pardo
- Department of Psychology, Montclair State University, Montclair, NJ, USA
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
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16
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Bettens K, Bruneel L, Alighieri C, Sseremba D, Musasizib D, Ojok I, Hodges A, Galiwango G, Adriaansen A, D'haeseleer E, Vermeersch H, Van Lierde K. Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients With Cleft Palate. Cleft Palate Craniofac J 2020; 58:999-1011. [PMID: 33380217 DOI: 10.1177/1055665620980249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To provide speech outcomes of English-speaking Ugandan patients with a cleft palate with or without cleft lip (CP±L). DESIGN Prospective case-control study. SETTING Referral hospital for patients with cleft lip and palate in Uganda. PARTICIPANTS Twenty-four English-speaking Ugandan children with a CP±L (15 boys, 9 girls, mean 8.4 years) who received palatal closure prior to 6 months of age and an age- and gender-matched control group of Ugandan children without cleft palate. INTERVENTIONS Comparison of speech outcomes of the patient and control group. MAIN OUTCOME MEASURES Perceptual speech outcomes including articulation, resonance, speech understandability and acceptability, and velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary surgery. RESULTS Normal speech understandability was observed in 42% of the patients, and 38% were judged with normal speech acceptability. Only 16% showed compensatory articulation. Acceptable resonance was found in 71%, and 75% of the patients were judged perceptually to present with competent velopharyngeal function based on the VPC-sum. Additional speech intervention was recommended in 25% of the patients. Statistically significant differences for all these variables were still observed with the control children (P < .05). CONCLUSIONS Overall, acceptable speech outcomes were found after early primary palatal closure. Comparable or even better results were found in comparison with international benchmarks, especially regarding the presence of compensatory articulation. Whether this approach is transferable to Western countries is the subject for further research.
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Affiliation(s)
- Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Daniel Sseremba
- Speech-Language Pathologist, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Duncan Musasizib
- Speech-Language Pathologist, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Isaac Ojok
- Speech-Language Pathologist, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Andrew Hodges
- Plastic and Reconstructive Surgeon, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - George Galiwango
- Plastic and Reconstructive Surgeon, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Anke Adriaansen
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Hubert Vermeersch
- Department of Head and Skin, 26656Ghent University, Ghent, Belgium.,Department of Plastic Surgery, 26656Ghent University Hospital, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
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17
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Paulsgrove K, Miller E, Seidel K, Kinter S, Tse R. Crowdsourcing to Assess Speech Quality Associated With Velopharyngeal Dysfunction. Cleft Palate Craniofac J 2020; 58:25-34. [PMID: 32806948 DOI: 10.1177/1055665620948770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To assess crowdsourced responses in the evaluation of speech outcomes in children with velopharyngeal dysfunction (VPD). DESIGN Fifty deidentified speech samples were compiled. Multiple pairwise comparisons obtained by crowdsourcing were used to produce a rank order of speech quality. Ratings of overall and specific speech characteristics were also collected. Twelve speech-language pathologists (SLPs) who specialize in VPD were asked to complete the same tasks. Crowds and experts completed each task on 2 separate occasions at least 1 week apart. SETTING On-line crowdsourcing platform. PARTICIPANTS Crowdsource raters were anonymous and at least 18 years of age, North American English speakers with self-reported normal hearing. Speech-language pathologists were recruited from multiple cleft/craniofacial teams. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Correlation of repeated assessments and comparison of crowd and SLP assessments. RESULTS We obtained 6331 lay person assessments that met inclusion criteria via crowdsourcing within 8 hours. The crowds provided reproducible Elo rankings of speech quality, ρ(48) = .89; P <.0001, and consistent ratings of intelligibility and acceptability (intraclass correlation coefficient [ICC] = .87 and .92) on repeated assessments. There was a significant correlation of those crowd rankings, ρ(10) = .86; P = .0003, and ratings (ICC = .75 and .79) with those of SLPs. The correlation of more specific speech characteristics by the crowds and SLPs was moderate to weak (ICC < 0.65). CONCLUSIONS Crowdsourcing shows promise as a rapid way to obtain large numbers of speech assessments. Reliability of repeated assessments was acceptable. Large groups of naive raters yield comparable evaluations of overall speech acceptability, intelligibility, and quality, but are not consistent with expert raters for specific speech characteristics such as resonance and nasal air emission.
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Affiliation(s)
- Kaylee Paulsgrove
- Speech & Language Services, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Erin Miller
- Division of Plastic Surgery, Department of Surgery, 21617University of Washington, Seattle, WA, USA
| | - Kristy Seidel
- CSATS Inc, A Division of Johnson & Johnson, Seattle, WA, USA
| | - Sara Kinter
- Speech & Language Services, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Raymond Tse
- Division of Plastic Surgery, Department of Surgery, 21617University of Washington, Seattle, WA, USA.,Division of Craniofacial and Plastic Surgery, Department of Surgery, 7274Seattle Children's Hospital, Seattle, WA, USA
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18
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Nyberg J, Hagberg E, Havstam C. "She Sounds Like a Small Child or Perhaps She has Problems"-Peers' Descriptions of Speech in 7-Year-Olds Born With Cleft Palate. Cleft Palate Craniofac J 2019; 57:707-714. [PMID: 31818136 DOI: 10.1177/1055665619890785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore how 7-year-olds describe speech in children born with cleft palate in their own words and to investigate whether they perceive signs of velopharyngeal incompetence (VPI) and articulation errors, and if so, which terminology they use. METHODS/PARTICIPANTS Twenty 7-year-olds participated in 6 focus group interviews where they listened to 8 speech samples with different types of cleft speech characteristics and described what they heard. The same speech samples had been assessed by speech-language pathologists and comprised normal speech, different degrees of VPI, oral articulation disorders, and glottal articulation. The interviews were analyzed with qualitative content analysis. RESULTS The analysis resulted in 4 interlinked categories: descriptions of speech, thoughts on personal traits, consequences for communication, and emotional reactions and associations. Each category contains 4 to 5 subcategories with the children's descriptions and reflections. Glottal articulation and severe signs of VPI caused the most negative emotional reactions and were described as sounding scary and incomprehensible and the children speculated on the risk of social rejection of the speakers. Retracted oral articulation was also noted and described but with a vocabulary similar to the professionals. Minor signs of VPI were not noted. CONCLUSIONS Seven-year-olds are direct and straightforward in their reactions to cleft palate speech characteristics. More pronounced signs of VPI and articulatory difficulties, also minor ones, are noted. Clinically, articulatory impairments may be more important to treat than minor signs of VPI.
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Affiliation(s)
- Jill Nyberg
- Division of Speech and Language Pathology, Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Hagberg
- Division of Speech and Language Pathology, Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Stockholm Craniofacial Team, Patient Area Craniofacial Disorders and Functional Area Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Havstam
- Division of Speech-Language Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology/Speech-Language Pathology Unit, Sahlgrenska Academy at University of Gothenburg, Sweden
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19
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Velik K, Bae Y, Fox RA. Effects of regional dialect on oral-nasal balance and nasality perception. Clin Linguist Phon 2019; 33:587-600. [PMID: 30646769 DOI: 10.1080/02699206.2019.1566402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
While cross-dialectal variations in nasalance have been investigated in previous studies, the influence of regional dialect on listeners' perceptual ratings of nasality has received limited research attention. This study explored cross-dialectal differences in the production of oral-nasal balance and the perception of nasality, with special emphasis on Inland North (IN) and Midland (M) dialects in the USA. Twenty-six adults representing the IN (n = 15) and M (n = 11) dialects participated in the study. Oral-nasal balance characteristics and nasality perception were compared between dialects using mean nasalance of various speech stimuli, measured via nasometry, and perceptual ratings of nasality of synthetic vowel stimuli, measured using direct magnitude estimation (DME). Despite similar mean nasalance scores between two regional dialects for standardized passage readings and sustained vowels, IN and M groups significantly differed in their perceptual ratings of nasality, with the DMEs of IN listeners being consistently and significantly higher, i.e. more nasal, than those of M listeners. Our findings provide evidence for perceptual variations of nasality that may exist at a dialectal level in addition to cross-linguistic variations in the perception of nasality as reported by Lee et al. (2008). Further research is needed to determine to what extent perceptual variations of nasality exist in other dialects and how these variations manifest in perceptual judgments of hypernasality and its severity ratings.
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Affiliation(s)
- Karl Velik
- a Department of Speech and Hearing Science , The Ohio State University , Columbus , OH , USA
| | - Youkyung Bae
- a Department of Speech and Hearing Science , The Ohio State University , Columbus , OH , USA
| | - Robert Allen Fox
- a Department of Speech and Hearing Science , The Ohio State University , Columbus , OH , USA
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Abstract
Normative nasalance scores are essential for the treatment and assessment purposes for clinicians. Till date, no studies have been done on nasalance in Estonia. This research was conducted to develop Estonia-specific optimized speech stimuli for Nasometer II and establish the normative nasalance scores. Ninety-two randomly selected healthy and 14 cleft palate Estonian monolingual children, aged four to seven years, were included as participants. Estonian language-specific test material was developed. The Estonian test material consisted of 24 speech stimuli. Based on the phoneme content, the stimuli were divided into three groups: (1) sentences that included oral and nasal phonemes and targeted the same phoneme distribution as in spontaneous speech, (2) sentences that included only oral phonemes and (3) sentences that were loaded with nasal phonemes. Nasometer II software was used to calculate the nasalance scores for each child and each sentence. Results indicated that there were significant differences in nasalance scores for oronasal and oral stimuli scores, and no significant differences were found in nasal stimuli scores between the study and control group. The threshold for oronasal stimuli was 42.1-18.9, oral stimuli was 27.9-3.9 and nasal stimuli was 69.4-46.2. In conclusion, Estonia-specific optimized speech stimuli were developed and normative nasalance scores were established. These normative scores can be used for the diagnosis and follow-up treatment of patients with resonance disorders, especially for patients with cleft palate.
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Affiliation(s)
- Lagle Lehes
- a Institute of Dentistry , University of Tartu , Tartu , Estonia
- b Departement of Special Education , University of Tartu , Tartu , Estonia
| | - Reet Horn
- b Departement of Special Education , University of Tartu , Tartu , Estonia
| | - Pärtel Lippus
- c Institute of Estonian and General Linguistics , University of Tartu , Tartu , Estonia
| | - Marika Padrik
- b Departement of Special Education , University of Tartu , Tartu , Estonia
| | - Priit Kasenõmm
- d Department of Oto-Rhino-Laryngology , University of Tartu , Tartu , Estonia
| | - Triin Jagomägi
- a Institute of Dentistry , University of Tartu , Tartu , Estonia
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Abstract
OBJECTIVE This report describes the design and printing of personalized nasal stents for cleft lip using 3-dimensional (3D) technology. MATERIALS AND METHODS We used silicone rubber to make the impressions, a 3D laser scanner to obtain 3D data, and Dental SG resin cartridges as printing material. We printed the personalized nasal stents using a photosensitive resin printer. RESULTS We placed the stents in patients after cleft lip surgery. They enabled personalized adjustment and good anastomosis, with a low probability of slipping from the nasal cavity. CONCLUSION With this technique, we can provide good nasal support for patients with cleft lip.
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Affiliation(s)
- Dongyuan Luo
- 1 Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Ting Li
- 2 The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Hongtao Wang
- 1 Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Yiyang Chen
- 3 Department of Oral and Maxillary Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
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22
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Bunton K. Effects of nasal port area on perception of nasality and measures of nasalance based on computational modeling. Cleft Palate Craniofac J 2018; 52:110-4. [PMID: 24437587 DOI: 10.1597/13-126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study examined the relation between nasal port area, nasalance, and perceptual ratings of nasality for three English corner vowels, /i/, /u/, and /a/. DESIGN Samples were simulated using a computational model that allowed for exact control of nasal port size and direct measures of nasalance. Perceptual ratings were obtained using a paired stimulus presentation. PARTICIPANTS Four experienced listeners. MAIN OUTCOME MEASURES Nasalance and perceptual ratings of nasality. RESULTS Findings show that perceptual ratings of nasality and nasalance increased for samples generated with nasal port areas up to and including 0.16 cm(2) but plateaued in samples generated with larger nasal port areas. No vowel differences were noted for perceptual ratings. CONCLUSIONS This work extends previously published work by including nasal port areas representative of those reported in the literature for clinical populations. Continued work using samples with varied phonetic context and varying suprasegmental and temporal characteristics are needed.
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