Intraoral Air Research Articles

A case series of wind instrument players with cleft lip and/or palate.

It might be more difficult for patients with cleft lip and/or palate (CL/P) to generate sufficient muscle tension of the upper lip and intraoral air pressure to play a wind instrument. We aimed to explore and describe the key aspects of wind instrument playing with a repaired cleft. An in-depth interview was conducted among ten patients with CL/P and one with a functionally comparable problem and we found that: individuals with CL/P can achieve a professional level on a wind instrument; the oboe and trumpet may be less suitable for patients with CL/P because of the high lip muscle tension and intraoral air pressure that must be generated; air leakage through a fistula, unrepaired alveolus or velopharyngeal insufficiency can be troublesome; and for people with CL/P, a brass instrument with a large mouthpiece is easier than a small mouthpiece. While dentists, doctors and music teachers should discuss the probability that wind instrument playing might be more difficult for patients with CL/P, they should not discourage it.

Release of aroma components from agarose gels during human chewing: Effects of agarose molecular weight and chewing cycles

Experiments were conducted using a method of collecting aroma compounds in the mouth through one nostril. Three types of agarose gels with different molecular weights and nine types of aroma compounds were used as samples. After the agarose gel was chewed 0–30 times while holding breath, aroma compounds were collected by blowing intraoral air into the sampling bag through the nostril. The effects of the number of chewing cycles and the type of agarose gel on the release rate of aroma compounds were investigated using relative release values, Qc/Q0 (where Qc is the amount of aroma compounds collected after chewing and Q0 is the amount collected without chewing). The relative release value increased with increasing number of chewing cycles, and the degree of increase in the relative value depended on the molecular weight of agarose. The relative release values for low chewing cycles were similar for all types of gels. At higher chewing cycles, the relative release value increased in gels with lower network densities than in other types of gels. It was suggested that the molecular weight of agarose and the number of chewing cycles changed the mechanism of flavor release.

External photoglottography, intra-oral air pressure, airflow and acoustic data on the Korean fricatives /s’, s/

From simultaneous recordings of the external photoglottography, intra-oral air pressure (P_io), airflow and acoustic data from four native Seoul Korean speakers (2 male and 2 female), we have found that the two fricatives are not significantly different in glottal opening peak and airflow peak height either word-initially or word-medially and that the duration of aspiration is significantly reduced in word-medial /s/, compared to those in word-initial /s/, not in /s’/. We have also found that the duration of a high P_io plateau is significantly longer in /s/ than in /s’/ both word-initially and word-medially and that airflow resistance (R=P_io/U) at the onset and offset of a P_io plateau and at the time of airflow peak height is significantly higher in /s’/ than in /s/ across the contexts. However, the differences in P_io peak and F0 are not significant. In addition, the transition time to reach airflow peak height from the offset of a P_io plateau is found to be significantly longer in /s/ than /s’/ in both word-initial and word-medial positions. No significant differences in glottal opening peak and airflow peak height confirm that /s/ is specified as [–spread glottis] like /s’/. As for the other significant differences, we propose that /s/ is [–tense], and /s’/ [+tense].

Теоретичні засади вивчення механізму піднебінно-глоткової дисфункції

Due to the growing number of children with congenital malformations of the lips and palate, it is important to reveal the theoretical foundations of their characteristic symptom - palatine-pharyngeal insufficiency. A retrospective analysis of recent research and publications shows an increase in scientific activity in the study of the mechanism of palatal-pharyngeal (velopharyngeal) closure. The article attempts to systematize information on the directions of scientific research on the mechanism of palatal-pharyngeal closure and palatal-pharyngeal dysfunction: anatomical-physiological, etiopathological, and restorative. The importance of anatomical integrity in the mechanism of palatal-pharyngeal closure is revealed, four physiological mechanisms in the movement of palatal-pharyngeal structures and pharyngeal wall are described: coronary, sagittal, circular, and circular with Passavan crest. The essence of the concept of "palatine-pharyngeal dysfunction" is clarified. Anatomical, functional, social, and symptomatic factors have been determined to be determinants of palatal-pharyngeal closure dysfunction. Therefore, the restoration of the function of the palatine-pharyngeal closure should be multidisciplinary: anatomically, physiologically, psychologically, and speech therapy. The article presents an algorithm for conducting a comprehensive assessment of the state of palatine-pharyngeal dysfunction and defines the criteria and indicators of the formation of palatal-pharyngeal closure. According to the results of the study of the state of palatopharyngeal dysfunction, a speech therapist will be able to assess the quality of speech and voice, the degree of hypernasalization, nasal emission, and intraoral air pressure. Analysis of scientific sources representing the study of the problem of correction of palatine-pharyngeal dysfunction in medical and pedagogical theory and practice, provide grounds for identifying ways of its comprehensive recovery: surgical treatment; prosthesis; logo-correction activity. The article attempts to accumulate the achievements of domestic scientists in the system of speech correction work to restore the palatinepharyngeal closure and activate the soft palate. The study and understanding of multidisciplinary knowledge of the theory and practice of overcoming palatal-pharyngeal dysfunction in children with congenital malformations and lips and palate will allow in practice to provide quality speech therapy services.

Evaluation of sandblasting with acid etching versus acid etching alone in the preparation of enamel for rebonding orthodontic brackets: An in vitro study and a randomized controlled trial

BackgroundNo clinical studies have evaluated shear bond strength and the clinical failure rates of the rebonded metallic brackets following different enamel-reconditioning methods. The objective of the study was to compare the in vivo clinical failure rate and the in vitro rebond strength of bonded brackets following two enamel surface preparation methods. MethodsFor the in vitro study, 45 extracted human premolars were etched; brackets were bonded using light-cured composite resin. Forty-five premolars were divided into three groups (15 in each group): the initial bonding group (IB group), the rebonding group in which enamel was reconditioned using sandblasting before acid etching (SBE group), and the rebonding group in which enamel was reconditioned using acid etching only (E group). For the in vivo study, 80 premolars in 20 patients (13–18 years old) were rebonded using the same procedures in the SBE group and E group. The two methods were used in all patients using a split-mouth design. The number of failing brackets was quantified over 6 months. Differences were statistically analyzed by one-way analysis of variance, followed by post hoc tests. ResultsThe mean shear bond strength for the IB, SBE, and E groups was 19.38, 22.37, and 17.31 MPa, respectively. A significant difference was observed in the bond strength of the three evaluated groups (P < 0.001). The differences in the bond strength were significant between the IB group and the SBE group, as well as between the SBE group and the E group. The clinical failure rate for bonded brackets was 10% in the SBE group, and 25% in the E group and this difference was statistically significant (P < 0.001). ConclusionsReconditioning of enamel surfaces using both intraoral air abrasion and etching in the rebonding process led to higher rebond strength than using acid etching alone and even higher than the initial brackets bonding. This trial was retrospectively registered at ClinicalTrials.gov (ID: NCT04606043).

Relationship between Intraoral Air Pressure and Sound Pressure during Pronunciation in Maxillectomy Patients with and without Obturator

Relationship between Intraoral Air Pressure and Sound Pressure during Pronunciation in Maxillectomy Patients with and without Obturator

0560 A single center cross-over and evaluator-blind Pivotal Study to Evaluate the Efficacy and Safety of intraoral Negative Air Pressure device in Adults with Obstructive Sleep Apnea

0560 A single center cross-over and evaluator-blind Pivotal Study to Evaluate the Efficacy and Safety of intraoral Negative Air Pressure device in Adults with Obstructive Sleep Apnea

Treatment of sleep apnea with a combination of a carbonic anhydrase inhibitor and an aldosterone antagonist: a patent evaluation of CA2958110 and IN6616DEN2012

ABSTRACTIntroduction: Sleep apnoea syndrome (SAS), is a sleep disorder and characterized by very shallow breath or repetitive cessation of breathing during sleep (sleep apnoea). At present, no pharmacological agents have proved to be successful against SAS, and the syndrome is only treated by surgical interventions or devices such as intraoral mandibular advancement and Continuous Positive Air Pressure (CPAP) techniques.Areas covered: two patents published in 2016 describing a new pharmacological application of inhibitors of the metalloenzyme Carbonic Anhydrases (CAs, EC 4.2.1.1) and an aldosterone antagonist agents and their therapeutic application was analysed.Expert opinion: The present patents address an important healthcare problem by proposing a new pharmacological approach and may represent a valid alternative for the treatment of sleep apnea. One of the interesting points raised by these patents is the advantage of using a minor quantity of pharmacological agents in combination than active agent alone and consequently, a significant reduction of the side effects.

Toward an aerodynamic model of fricative consonants.

Determining the starting point of frication is a complex task involving aerodynamic factors dependent on adjustments controlling articulatory and laryngeal structures and on the regulation of air pressure. This study investigates the aerodynamic characteristics of the onset and offset of Belgian French fricative consonants using direct measurements of subglottal (Ps) and intraoral (Po) air pressure. Results show a higher difference between Ps and Po at the onset of voiced fricative consonants when compared to their voiceless counterparts. This accounts for the need for high air velocity through the glottal and consonantal constrictions for voiced fricatives. The offset of voiced fricatives is also characterized by a relatively large difference between Ps and Po, still lower for voiceless equivalents.

The Mechanism and Representation of Korean Three-Way Phonation Contrast: External Photoglottography, Intra-Oral Air Pressure, Airflow, and Acoustic Data

This paper aims to refine our understanding of the speech mechanism and laryngeal features involved in the Korean lenis (/p t k/), aspirated (/ph th kh/), and fortis (/p' t' k'/) plosives. For this purpose we made measurements using a new noninvasive technique called external lighting and sensing photoglottography (ePGG) as well as intra-oral air pressure (Pio) above the glottis, airflow, and acoustic data. From simultaneous recordings of the experimental data, we were ableto quantify the laryngeal-oral coordination of glottal opening and a consonant release, and the covariance of airflow peak and duration of aspiration with glottal opening. The phasing of glottal opening and the 3-way phonation contrast occurs in the order, from early to late, fortis, lenis < aspirated plosives, and the glottal opening peak ranges from low to high in the same order. We also found that a Pio peak, the durations of a high Pio plateau and an oral closure, and F0 are independent of the glottal opening mechanism, varying in the order lenis < aspirated and fortis plosives. From these findings, we propose that the 2 independent patterns are accounted for by the articulator-based features [±spread glottis] and [±tense], respectively.

Speech profile of patients undergoing primary palatoplasty.

To characterize the profile and speech characteristics of patients undergoing primary palatoplasty in a Brazilian university hospital, considering the time of intervention (early, before two years of age; late, after two years of age). Participants were 97 patients of both genders with cleft palate and/or cleft and lip palate, assigned to the Speech-language Pathology Department, who had been submitted to primary palatoplasty and presented no prior history of speech-language therapy. Patients were divided into two groups: early intervention group (EIG) - 43 patients undergoing primary palatoplasty before 2 years of age and late intervention group (LIG) - 54 patients undergoing primary palatoplasty after 2 years of age. All patients underwent speech-language pathology assessment. The following parameters were assessed: resonance classification, presence of nasal turbulence, presence of weak intraoral air pressure, presence of audible nasal air emission, speech understandability, and compensatory articulation disorder (CAD). At statistical significance level of 5% (p≤0.05), no significant difference was observed between the groups in the following parameters: resonance classification (p=0.067); level of hypernasality (p=0.113), presence of nasal turbulence (p=0.179); presence of weak intraoral air pressure (p=0.152); presence of nasal air emission (p=0.369), and speech understandability (p=0.113). The groups differed with respect to presence of compensatory articulation disorders (p=0.020), with the LIG presenting higher occurrence of altered phonemes. It was possible to assess the general profile and speech characteristics of the study participants. Patients submitted to early primary palatoplasty present better speech profile.

Aerodynamic and Laryngeal Characteristics of Place-Dependent Voice Onset Time Differences

Objective: To investigate aerodynamic and laryngeal factors associated with place-dependent voice onset time (VOT) differences. Methods: The speech materials were /p∧, t∧, k∧/, each produced 15 times by 10 adult English speakers in the carrier phrase “say __ again”. The sound pressure level was targeted within a ±3 dB range. Intraoral air pressure (Po) was obtained using a buccal-sulcus approach. VOT, Po, maximum Po declination rate (MPDR), duration of the laryngeal devoicing gesture (LDG), occlusion duration, and the duration of the Po drop to baseline (atmosphere) to the onset of voicing (PDOV) were determined for each stop. Results: VOT was longer for the alveolar and velar stops compared to the bilabial stop. A constant LDG was observed for all stops regardless of place of articulation. Occlusion duration, however, was significantly shorter for the alveolar and velar stops compared to the bilabial stop. Aerodynamically, Po was greatest for the velar stop, intermediate for the alveolar stop, and smallest for the bilabial stop. MPDR index showed a slower rate of Po drop for the velar and alveolar stops compared with the bilabial stop. PDOV was found to be longer for /p/ than /t/ and /k/. Conclusion: Findings provide empirical evidence for the inter-related roles of Po, rate of Po change, and laryngeal factors in place-dependent variations of VOT.

On ejective fricatives in Omani Mehri

Ejective fricatives are extremely rare cross-linguistically. This infrequency is generally attributed to the incompatibility of two aerodynamic requirements: airflow to create noise frication and a high intraoral air pressure to implement ejectivity. Seeking to determine how this incompatibility is solved, this study presents an acoustic investigation of initial and intervocalic ejective fricatives in Mehri, a Modern South Arabian language spoken in Oman. Based on data from 5 Mehri speakers, the analysis of different temporal and non-temporal parameters shows a high degree of variability in the way ejectivity is implemented in fricatives. Much of this variability is shaped by the position of the segments within the word. In initial position, the ejectivity of fricatives translates into a frequent presence of post-frication glottal lags, higher intensity and higher center of gravity. These acoustic attributes are less frequently encountered in intervocalic position. In this position, it is argued, the systematic diphthongization of the following long vowel, induced by ejectivity combined with dorsopharyngealisation, is salient enough to allow the contrast of ejectivity to be recovered.

Estimating Subglottal Pressure From Neck-Surface Acceleration During Normal Voice Production.

The purpose of this study was to evaluate the potential for estimating subglottal air pressure using a neck-surface accelerometer and to compare the accuracy of predicting subglottal air pressure relative to predicting acoustic sound pressure level (SPL). Indirect estimates of subglottal pressure (Psg') were obtained from 10 vocally healthy speakers during loud-to-soft repetitions of 3 different /p/-vowel gestures (/pa/, /pi/, /pu/) at 3 pitch levels in the modal register. Intraoral air pressure, neck-surface acceleration, and radiated acoustic pressure were recorded, and the root-mean-square amplitude of the acceleration signal was correlated with Psg' and SPL. The coefficient of determination between accelerometer level and Psg' was high when data were pooled from all vowel and pitch contexts for each participant (r2 = .68-.93). These relationships were stronger than corresponding relationships between accelerometer level and SPL (r2 = .46-.81). The average 95% prediction interval for estimating Psg' using accelerometer level was ±2.53 cm H2O, ranging from ±1.70 to ±3.74 cm H2O across participants. Accelerometer signal amplitude correlated more strongly with Psg' than with SPL. Future work is warranted to investigate the robustness of the relationship in nonmodal voice qualities, individuals with voice disorders, and accelerometer-based ambulatory monitoring of subglottal pressure.

Aerodynamic factors for place-dependent voice onset time differences

Studies have shown that voice onset time (VOT) tend to increase as place of articulation moves further back in the oral cavity. Different aerodynamic factors have been postulated for place-dependent VOT differences; although no direct aerodynamic measures have been reported in this regard. The objective of this study was to investigate aerodynamic factors which lead to variation of VOT according to place of articulation. The speech materials of the study were /pa, ta, ka/, each produced 30 times by an adult female (27 yrs) in the carrier phrase “say -- again”. SPL was targeted within a ±3 dB range. Intraoral air pressure (Po) was obtained using a buccal-sulcus approach. VOT, Po, and maximum Po declination rate (MPDR) were measured for each stop. Results showed that: (a) the further back the place of articulation, the longer the VOT; (b) Po was greatest for the velar stop, intermediate for the alveolar stop, and smallest for the bilabial stop; and (c) the MPDR index showed slower pressure drop for the vela...

Nasometry, videofluoroscopy, and the speech pathologist's evaluation and treatment.

The speech-language pathologist (SLP) plays an important role in the assessment and management of children with velopharyngeal insufficiency (VPI). The SLP assesses speech sound production and oral nasal resonance and identifies the characteristics of nasal air emission to guide the clinical and surgical management of VPI. Clinical resonance evaluations typically include an oral motor exam, identification of nasal air emission, and analysis of the speech sound repertoire. Additional elements include perceptual assessment of intra-oral air pressure, the degree of hypernasality, and vocal loudness/quality. Clinical speech and resonance evaluations are typically the gold-standard evaluation method until a child reaches 3-4 years of age, when sufficient compliance levels and speech-language abilities allow for participation in instrumental testing. At that time, objective assessment measures are introduced, including nasometry, videofluoroscopy, and/or nasopharyngoscopy. Nasometry is a computer-based tool that quantifies nasal air escape and allows comparison of the score against normative data. Videofluoroscopy is a radiographic tool used to assess the shaping of the velum and closure of the velopharyngeal mechanism during speech production. Evaluation findings guide decision making regarding surgical candidacy and/or the therapeutic management of VPI. Surgery should always be pursued first when an anatomic deficit prevents velopharyngeal closure. Therapy should always be pursued in children who present with velopharyngeal mislearning and/or motor planning issues resulting in VPI. It is not uncommon for children to receive a combination of surgical intervention and speech resonance therapy during their VPI management course. Collaborative decision making between the otorhinolaryngologist and the SLP provides optimal patient care.

Secondary gestures for consonants: An electromagnetic articulometer study of troughs

Troughs, defined as a discontinuity in anticipatory coarticulation (Perkell 1968), have been shown to occur in the tongue body (TB) in /ipi/ and lips in /usu/. In V1CV1 contexts articulators retract from their vowel target during C when not active during C. We investigate the trough phenomenon by testing three hypotheses: (1) high intraoral air pressure during the consonant pushes TB down; (2) absence of vowel articulator activation during C in VCV causes TB to move to the neutral position; (3) the trough is a gesture in itself. Electromagnetic articulometer (EMA) data of the tongue, lips, and jaw were tracked for a trained phonetician producing non-words and real words, varying vowel context and the place, manner, and consonant length. For H1, /iCi/ productions with C={/p,f,m/} and three C durations were studied. For H2, /h/ and /ʔ/ in /iCi/ were examined. Troughs were found in all the labials but not in /h, ʔ/, disproving hypothesis 2; trough magnitude decreased in the order: /f/ &amp;gt; /p/ &amp;gt; /m/, disproving hypothesis 1. Trough magnitude increased with C duration, consistent with H3. Results from asymmetric vowel contexts also support H3, and will be discussed within the context of Articulatory Phonology. [Work supported by NIH.]

Fraca pressão aérea intraoral na fala após correção cirúrgica da fissura palatina

INTRODUCAO: Diversas alteracoes anatomicas e funcionais sao observadas nos individuos portadores de fissuras labiopalatinas, dentre elas anormalidades estruturais da musculatura orofaringea, que podem causar prejuizo da funcao velofaringea e, consequentemente, de funcoes como succao, degluticao e fala. O presente estudo teve por objetivo avaliar a presenca de fraca pressao aerea intraoral na fala de individuos com fissura palatina submetidos a palatoplastia primaria em tempo adequado e tardiamente, e comparar se o momento do procedimento cirurgico pode acarretar maior ocorrencia do disturbio. A hipotese e de que os individuos submetidos a palatoplastia primaria tardiamente apresentam maior ocorrencia de fraca pressao aerea intraoral em comparacao aqueles que realizaram a palatoplastia primaria no momento adequado. METODO: Participaram do estudo 37 individuos de ambos os sexos, com diagnostico de fissura de palato associada ou nao a fissura de labio, divididos em dois grupos: 1) grupo precoce (GP), composto por 22 pacientes submetidos a palatoplastia primaria ate o 2o ano de vida; e 2) grupo tardio (GT), composto por 15 pacientes submetidos a palatoplastia primaria tardiamente, apos o periodo de aquisicao dos sons da fala. Todos os participantes foram submetidos a rotina de avaliacao fonoaudiologica com intervalo de, no minimo, 3 meses de pos-operatorio. Dentre os parâmetros avaliados encontra-se a analise da fraca pressao aerea intraoral, que foi a variavel considerada para este estudo. RESULTADOS: A analise dos dados possibilitou observar maior frequencia de fraca pressao aerea intraoral no GT (33%) em comparacao ao GP (18%). Entretanto, tal diferenca nao foi estatisticamente significante (P = 0,44). CONCLUSOES: A hipotese do estudo foi rejeitada. A presenca de fraca pressao aerea intraoral foi observada na fala dos dois grupos estudados, nao sendo a idade na ocasiao da palatoplastia primaria um fator determinante.

Speech therapy for compensatory articulations and velopharyngeal function: a case report

The objective of this study was to describe the process of intensive speech therapy for a 6-year-old child using compensatory articulations while presenting with velopharyngeal insufficiency (VPI) and a history of cleft lip and palate. The correction of VPI was temporarily done with a pharyngeal obturator since the child presented with very little movement of the pharyngeal walls during speech, compromising the outcome of a possible pharyngeal flap procedure (pharyngoplasty). The program of intensive speech therapy involved 3 phases, each for duration of 2 weeks incorporating 2 daily sessions of 50 minutes of therapy. A total of 60 sessions of intervention were done with the initial goal of eliminating the use of compensatory articulations. Evaluation before the program indicated the use of co-productions (coarticulations) of voiceless plosive and fricative sounds with glottal stops (simultaneous production of 2 places of productions), along with weak intraoral pressure and hypernasality, all compromising speech intelligibility. To address place of articulation, strategies to increase intraoral air pressure were used along with visual, auditory and tactile feedback, emphasizing the therapy target and the air pressure and airflow during plosive and fricative sound productions. After the first two phases of the program, oral place of articulation of the targets were achieved consistently. During the third phase, velopharyngeal closure during speech was systematically addressed using a bulb reduction program with the objective of achieving velopharyngeal closure during speech consistently. After the intensive speech therapy program involving the use of a pharyngeal obturator, we observed absence of hypernasality and compensatory articulation with improved speech intelligibility.

Affricating ejective fricatives: The case of Tigrinya

The production of an ejective fricative involves an aerodynamic dilemma. An ejective requires increased intraoral air pressure, while a fricative requires air to be continuously vented through a narrow constriction. This venting may defeat the pressure increase. Because ejectivity is realized by forming a complete oral closure, we hypothesize that complete closure (i.e. affrication) may also typify ejective fricatives in some languages. We test this hypothesis through an acoustic production experiment with speakers of Tigrinya. We find substantial evidence that Tigrinya /s’/ is commonly realized as [ts’] and comment on the plausibility of affrication as a general strategy for the realization of ejective fricatives.