Abstract
In patients with a repaired cleft palate, nasality is typically diagnosed by speech language pathologists. In addition, there are various instruments to objectively diagnose nasalance. To explore the potential of nasalance measurements after cleft palate repair by NasalView®, we correlated perceptual nasality and instrumentally measured nasalance of eight speech items and determined the relationship between sensitivity and specificity of the nasalance measures by receiver-operating characteristics (ROC) analyses and AUC (area under the curve) computation for each single test item and specific item groups. We recruited patients with a primarily repaired cleft palate receiving speech therapy during follow-up. During a single day visit, perceptive and instrumental assessments were obtained in 36 patients and analyzed. The individual perceptual nasality was assigned to one of four categories; the corresponding instrumental nasalance measures for the eight specific speech items were expressed on a metric scale (1–100). With reference to the perceptual diagnoses, we observed 3 nasal and one oral test item with high sensitivity. However, the specificity of the nasality indicating measures was rather low. The four best speech items with the highest sensitivity provided scores ranging from 96.43 to 100%, while the averaged sensitivity of all eight items was below 90%. We conclude that perceptive evaluation of nasality remains state of the art. For clinical follow-up, instrumental nasalance assessment can objectively document subtle changes by analysis of four speech items only. Further studies are warranted to determine the applicability of instrumental nasalance measures in the clinical routine, using discriminative items only.
Highlights
A cleft lip and palate (CLP) is a relatively common congenital malformation, with an incidence of about 1 in 700 newborns in the Caucasian population [1]
Because our study focused on hypernasality after cleft palate repair, we excluded three patients with obvious nasal obstructions, e.g., due to acute infections and in one case a Cul-de-sac resonance
The analysis showed no difference between the novice and the experienced observer, just to avoid intermediate scores, we plotted the diagnostic groups of the experienced speech therapist against the NasalView® measurements in box plots (Figs. 1, 2)
Summary
A cleft lip and palate (CLP) is a relatively common congenital malformation, with an incidence of about 1 in 700 newborns in the Caucasian population [1]. While an isolated cleft lip primarily is an aesthetic problem, complete CLP may cause velopharyngeal insufficiency (VPI) which can interfere with speaking, breathing, and swallowing. Often CLP is associated with an articulation disorder generally regarded as compensation to an anatomical abnormity leading to VPI. This may lead to dysfunctions of the velopharyngeal sphincter, and of the entire vocal tract [2]. CLP-associated VPI typically leads to deviations in the resonance such as hypernasality or hyponasality, nasal air emission and weak pressure consonants, and compensatory articulation [3]. Magnetic resonance imaging is an emerging diagnostic tool, to date not widely adopted [4, 5]
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