Velopharyngeal function in adult speakers of Portuguese diagnosed with multiple sclerosis

ABSTRACTThe objective of this study was to determine normative nasalance scores for non-cleft children, adolescents and adults, native speakers of Brazilian Portuguese, during the production of words and syllables, for cross-linguistic comparisons in populations with and without cleft palate. Nasalance was assessed in 62 individuals, aged 6–10 years (n = 20), 11–17 years (n = 20) and 18–35 years (n = 22), using a nasometer II model 6450 (KayPENTAX), during production of one sequence of nine oral words (pipa, bis, burro, tatu, pilha, cuca, gui, fila, luz) and of sequences of isolated syllables (e.g. pa, pa, pa, pa, pa, pa) composed of plosive, fricative, liquid and nasal consonants with high and low vowels. In order to validate the new nasalance stimuli, nasalance scores for traditional oral and nasal stimuli were also obtained. Differences were analyzed at a significance level of 0.01. Mean nasalance scores (±SD) during the production of the sequence of words were 18 ± 5% (children), 18 ± 7% (adolescents) and 21 ± 5% (adults). Differences between age groups were not significant. During the production of syllables, adults had the highest mean nasalance scores (except for syllable /mi/); significant differences between age groups were observed only for /pa/ ,/sa/ and /la/. Nasalance scores were significantly higher in oral and nasal syllables with high vowels than with low vowels, and in nasal syllables than in oral syllables with high and low vowels. The nasalance scores obtained for the sentences were comparable to previously established norms. In conclusion, the nasalance scores defined for Brazilian Portuguese speakers, in different stimuli, may be adopted as normative values for local and cross-language comparisons in the identification of hypernasality related to conditions such as cleft palate, neurogenic disorders and syndromes.

Objectives: This study investigates whether a change in speaking voice focus affects the oral-nasal balance. The investigation was undertaken with different phonetic materials in speakers of Brazilian Portuguese, which features phonological and phonetic vowel nasalization. Methods: Ten females read oral, balanced oral-nasal, and nasal loaded sentences in their normal voice, and with a backward focus and a forward focus. Nasalance scores were collected with a Nasometer 6400. Results: A repeated measures ANOVA of the nasalance scores demonstrated a significant main effect of speaking condition (F(2, 18) = 12.87, p < 0.001). The mean nasalance scores across the stimuli in the backward focus and normal speaking conditions were 36.85% (SD 16.85) and 40.18% (SD 18.02), respectively, both significantly lower than the forward focus condition at 45.38% (SD 18.90). Conclusion: The results demonstrated that speaking focus influences oral-nasal balance in normal speakers. In future research, it should be investigated whether voice focus can also modify oral-nasal balance in hypernasal speakers with cleft palate and other disorders.

Purpose This study explored the role of auditory feedback in the regulation of oral-nasal balance in speakers of Brazilian Portuguese. Method Twenty typical speakers of Brazilian Portuguese (10 male, 10 female) wore a Nasometer headset and headphones while continuously repeating stimuli with oral and nasal sounds. Oral-nasal balance was quantified with nasalance scores. The signals from 2 additional oral and nasal microphones were played back to the participants through the headphones. The relative loudness of the nasal channel in the mix was gradually changed, so that the speakers heard themselves as more or less nasal. Results A repeated-measures analysis of variance of the mean nasalance scores of the stimuli at baseline, minimum, and maximum nasal feedback conditions demonstrated significant effects of nasal feedback condition (p < .0001) and stimuli (p < .0001). Post hoc analyses demonstrated that the mean nasalance scores were lowest for the maximum nasal feedback condition. The scores of the minimum nasal feedback condition were significantly higher than 2 of 3 baseline feedback conditions. The speaking amplitude of the participants did not change between the nasal feedback conditions. Conclusions Increased nasal signal level feedback led to a compensatory adjustment in the opposite direction, confirming that oral-nasal balance is regulated by auditory feedback. However, reduced nasal signal level feedback resulted in a compensatory response that was lower in magnitude. This suggests that, even in Brazilian Portuguese, a language with phonetic and phonological vowel nasalization, decreased nasality was not perceived as critically as increased nasality by the speakers.

This study was designed to examine whether nasalance score is changed in association with placement of a palatal lift prosthesis (PLP) and whether normative data previously reported are applicable to evaluate the effect of a PLP on velopharyngeal function as it relates to nasality. Nasalance scores were obtained as subjects read the Kitsutsuki Passage three times with the PLP in place and then removed. Forty-three children (mean age 9.0 years, SD = 3.6 years) with repaired cleft palate who were treated with a PLP were selected as subjects. Their speech was characterized by nasal emission of air, slight hypernasality without a PLP but within normal limits with a PLP in place, or both. Comparisons were made between normative scores and the average mean nasalance score of subjects with and without the PLP. Average values of the mean nasalance score for subjects were 17.3% (SD 7.6%) with the PLP in place and 33.5% (SD 13.3%) without the PLP in place. These scores were greater than the mean score of 9.1% (SD 3.9%) obtained from normal controls previously reported. A PLP can decrease nasalance scores for speakers with repaired cleft palate who exhibit velopharyngeal incompetence. It was suggested that the normative score obtained from normal adult speakers is not applicable to evaluate the effect of a PLP to improve velopharyngeal function for children wearing the PLP.

Objectives: This study establishes normative nasalance values for middle-aged and elderly Brazilian Portuguese-speakers and investigates age and gender effects across the life span. Methods: Nasalance scores were obtained from 62 middle-aged (45–59 years) and 60 elderly (60–79 years) participants with normal speech for 3 nonnasal, 1 phonetically balanced, and 2 nasal-loaded test sentences using the Nasometer II 6400. The data were combined with a published data set of 237 speakers in 4 groups: children (5–9 years), adolescents (10–19 years), young adults (20–24 years), and mature adults (25–35 years). A repeated-measures analysis of variance was used to investigate differences between the stimuli by gender and age groups. Results: There were statistically significant effects of stimulus, gender, and age group, as well as a stimulus-age group interaction effect and a gender-age group interaction effect. The females’ mean nasalance scores were higher than those of the males. The mean nasalance scores for the child, adolescent, and young and mature adult speakers were significantly lower than those for the elderly speakers, and the children’s scores were significantly lower than those of the middle-aged speakers. Conclusion: Higher nasalance scores among middle-aged and elderly speakers may indicate physiological changes affecting oral-nasal balance in speech across the life span.

To describe articulation and speech symptoms related to velopharyngeal impairment in children born with an isolated cleft palate. Blind assessment of speech at 3, 5, 7, and 10 years of age was performed. Two subgroups were formed based on the results at age 5 years, the no-VPI group and the VPI group, and they were compared with controls. A university hospital. Twenty-six children born with isolated cleft palate. Seventeen children served as controls. Soft palate closure at 7 months and hard palate closure at a mean age of 3 years and 11 months if the cleft extended into the hard palate. Perceptual assessments of four variables related to velopharyngeal function and of articulation errors were performed at all ages. Phonetic transcriptions of target speech sounds were obtained at 5, 7, and 10 years and nasalance scores were obtained at age 10 years. The no-VPI group continued to have no or minor difficulties. The VPI group improved but continued to have moderate velopharyngeal impairment. Both groups differed significantly from the controls at age 10 years. Persistent velopharyngeal impairment, as well as glottal misarticulation, were mostly found in children with the cleft as a part of a syndrome or together with multiple malformations. Small changes in velopharyngeal impairment were found across ages. Improvement seemed to be related to surgical intervention, and persistent problems seemed to be related to the presence of additional multiple malformations or syndromes.

Assessment of resonance characteristics is essential in research and clinical practice in individuals with velopharyngeal impairment. The purpose of this study was to systematically review correlations between auditory-perceptual ratings and nasalance scores obtained by a nasometer in individuals with resonance disorders and to identify factors that affected the correlations between these two measures. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted for studies reporting a correlation between nasality ratings and nasalance scores using six electronic databases based on predefined inclusion and exclusion criteria. A total of 27 studies were included in this systematic review. Characteristics of study components including participants, types of assessment and stimuli, correlation coefficients, and reliability values of each study were identified, and a narrative synthesis was conducted. The methodological quality of each study was also appraised. The correlation level between nasalance values and nasality ratings varied from nonsignificant to strong (r = .92). The quality rating scores of the selected studies ranged from 44% to 94%, with an average score of 75%. Factors that did or did not affect the varied correlation between nasality ratings and nasalance scores were discussed. Speech stimuli and the listeners' background were associated with correlations between the two measures. In addition, the sex of the speakers could be a factor affecting its correlation. However, the types of perceptual scales and listening conditions did not influence its correlations between the two measures. https://doi.org/10.23641/asha.19653207.

Background:Hypernasality is a frequently encountered problem in the speech of individuals with velopharyngeal incompetence. The use of palatal lift appliance (PLA) is the main treatment option for correction of velopharyngeal incompetence. The literature on the outcomes of using prosthetics treatment for Arabic speaking patients is scarce.Objective:The aim of this study was to investigate the effect of using PLA on hypernasality of Arabic speaking patients with velopharyngeal incompetence.Methods:Six participants with age ranging from 9 to 61 years (4 males and 2 females) were recruited between October 2013 and August 2014. Written informed consents were taken from all the adult participants/the guardians of under-aged participants. All patients exhibited hypernasality with different etiologies for velopharyngeal incompetence (head injury, cerebrovascular accident, and neurological disorders). They were treated with PLAs which were constructed to elevate the dysfunctional soft palate. Nasalance scores and perceptual speech acceptability ratings were measured/evaluated in both situations; with and without appliances. Paired t-test was used to analyze the perceptual ratings and nasalance scores in order to detect any significant change in hypernasality pre and post insertion of PLA.Results:There was a statistically significant decrease (p>0.05) in nasalance scores (Pa, Pi, Ma, Mi, a, i) after PLA insertion. The subtest /u/ showed insignificant change (p= 0.056). Perceptual ratings showed significant reduction in hypernasality which was consistent with nasalance measurements.Conclusion:PLAs can reduce hypernasality in Arabic speaking patients who suffer from velopharyngeal impairment.

The purpose of this study was to assess the effect of speaking rate variation on aerodynamic and acoustic measures of velopharyngeal (VP) function. Twenty-seven healthy adult speakers (14 males, 13 females) participated in the study. The modified pressure-flow method was used to collect aerodynamic data of /m/ and /p/ segments in the word ‘hamper’ and the utterances ‘Mama made some lemon jam’ (MMJ) and ‘Buy Bobby a puppy’ (BBP). SPL was collected simultaneously with aerodynamic data for all utterances. A Nasometer was used to obtain nasalance scores and nasalance distance for MMJ and BBP. Sentences were produced at normal, fast, slow, and slowest speaking rates. The results showed that nasal airflow and VP orifice area were unaffected by speaking rate variations in males and females, whereas intra-oral pressure appeared to decrease as speaking rate slowed for both speaker groups. However, this effect was removed by statistically controlling SPL. Nasalance and nasalance distance (MMJ – BBP) did not change with speaking rate variation. There was a statistical difference between nasalance scores produced by male and female speakers. The results suggested that aerodynamic and acoustic measures of velopharyngeal function are not affected by variation in speaking rate in healthy males and females.

The study sought to establish normative nasometric values for adult Jordanian speakers of Arabic. Gender-related differences and intraspeaker variability of nasalance scores were investigated. A total of 113 adult speakers of Jordanian Arabic (56 men and 57 women) without speech-language and hearing impairments or craniofacial anomalies ranging in age between 18 and 55 participated in the study. Nasometer II, Model 6400 was used to obtain nasalance scores as speakers produced 3 recitations for each of the 3 standardized passages consisting of an oral passage, an oronasal passage, and nasal sentences. Descriptive statistics of nasalance scores for each passage were obtained and gender-related differences were determined by ANOVA. Standard deviation for the 3 repetitions for each passage was considered an index for intraspeaker variability. Average nasalance for each passage was (11.23%) for the oral passage, (25.48%) for the oronasal passage, and (51.92%) for the nasal sentence. There was no gender effect on nasalance on the oral passage, however women exhibited higher nasalance scores than men on the both oronasal passage (P = 0.002) and nasal sentences (P = 0.017). Intraspeaker variability for all speakers fell below 4.5% with repeated readings. The study provides normative nasometric data for Arabic speaking Jordanian adults to serve as references for the assessment of velopharyngeal dysfunction in craniofacial clinics. Arabic speakers demonstrated different nasalance scores than speakers of other languages. Gender differences can be attributed to variations in anatomical structure and velopharyngeal function between men and women.

To establish nasalance score norms for adolescent and young adult native speakers of American English and also determine age-group and gender differences using the Simplified Nasometric Assessment Procedures (SNAP) Test-R and Nasometer II. Prospective study using a randomly selected sample of participants. Greater Cincinnati area and Miami University of Ohio. Participants had a history of normal speech and language development and no history of speech therapy. Participants in the adolescent group were recruited from schools in West Clermont and Hamilton County, whereas the young adults were recruited from Miami University of Ohio. The participants of both groups were residents of Cincinnati, Ohio or Oxford, Ohio and spoke midland American English dialect. Mean nasalance scores for the SNAP Test-R. Normative nasalance scores were obtained for the Syllable Repetition/Prolonged Sounds, Picture-Cued, and Paragraph subtests. Results showed statistically significant nasalance score differences between adolescents and young adults in the Syllable Repetition, Picture-Cued, and Paragraph subtests, and between males and females in the Syllable Repetition and the Sound-Prolonged subtests. A significant univariate effect was found for the syllables and sentences containing nasal consonants and high vowels compared to syllables and sentences containing oral consonants and low vowels. Across all the SNAP Test-R subtests, the females' nasalance scores were higher than the males. A significant univariate effect was also found across nasal syllables, and high vowels such that the females' nasalance scores were higher than the males. Tables of normative data are provided that may be useful for clinical purposes. Norms obtained demonstrated nasalance score differences according to age and gender, particularly in the Syllable Repetition/Prolonged Sound subtest. These differences were discussed in light of potential reasons for their existence and implications for understanding velopharyngeal function. In addition, nasalance scores are affected by the vowel type and place of articulation of the consonant. These facts should be considered when nasometry is used clinically and for research purposes.

Objective: To establish normative nasalance scores for the Nasometer II for children speaking Quebec French. Design: Prospective study using a randomly selected sample of children with typical speech. Setting: Two children’s hospitals in the province of Quebec, Canada. Participants: Eighty-eight children with typical speech, language and hearing development, aged between 6;00 and 11;11 years, were enrolled at the Centre hospitalier universitaire Sainte-Justine in Montreal and the Centre hospitalier universitaire de Québec-Université Laval in Quebec City, Canada. Outcome Measure: Mean nasalance scores. Results: Mean nasalance scores were obtained for oral vowels, nasal vowels, repeated syllables, oral sentences, a nasal sentence, mixed sentences as well as a short text. While there were no meaningful significant effects of sex and age on the nasalance scores, most nasalance scores obtained at the hospital site in Montreal were statistically significantly higher than in Quebec City. Mean nasalance scores, standard deviations and theoretical critical threshold values are provided and can be used for clinical assessment and research. Conclusions: Nasalance scores differences according to hospital sites may be attributable to dialectal differences, to differences between the nasalance scores obtained by the nasometers in the 2 clinics, or to a combination of the 2. In future research, diagnostic cutoff scores for different nasal resonance disorders can be developed based on these normative scores.

Nasalance scores for normal Korean-speaking adults and children: Effects of age, vowel context, and stimulus length

The Kay Elemetrics nasometer measures nasalance, a parameter of speech that reflects the proportion of total acoustic energy that is emitted nasally, making it possible to infer velopharyngeal (VP) function noninvasively. Nasometric evaluation is potentially widely applicable in the clinical assessment of suspected VF impairment. For clinical use, a patient’s mean nasalance on a passage of known phonetic composition must be compared to age-appropriate population norms. Most potential clinical subjects are young; many are preliterate. Passages for which norms have been established (Zoo, Rainbow, NasalSentences) are syntactically, semantically, and lexically complex, phonetically heterogeneous, phonologically mature, and long. Individual child subjects’ nasalance scores, if obtained at all, are therefore likely to be contaminated by artifacts created through hesitation noises, filled pauses, phonetic deviance from normed target, age differences, and measurement errors induced by coaching procedures. Differences in phonetic content between normed and actual utterances are almost inevitable; they lead to uninterpretable results. This study reports a technique for obtaining clinically useful nasalance scores from young, preliterate subjects, even those evidencing phonological deficits or noncompliant behavior. Large-n norms for preschool and primary children are presented.

The purpose was to compare differences in production of plosive phonemes through the voice onset time (VOT) measurement in the speech of monolingual children, speakers of Brazilian Portuguese and bilingual children, speakers of both Brazilian Portuguese and English. The sample consisted of three monolingual children and three bilingual children; average age was 7 years. A speech emission was recorded for the investigation, which had the following vehicle phrase: “Diga ‘papa’ baixinho” (“Say ‘papa’ quietly”). Papa was then replaced by “baba”, “tata”, “dada”, “caca” and “gaga”. The measurements of the acoustic signals were performed through broadband spectrograms, and VOT was descriptively analyzed for the non-voiced sounds [p, t, k] and voiced [b, d, g] plosive sounds. Monolingual children presented higher average VOT values for [p, t, k] compared to bilingual children. For the [b, d, g] sounds, monolingual children had lower average VOT values, as compared to bilingual children. It was concluded that in the comparison of VOT measures of the speech samples, the monolingual children of Brazilian Portuguese presented higher values for the non voiced ones and lower for the voiced ones in relation to the bilingual children speakers of Brazilian Portuguese and English.