Nasal Sentences Research Articles

Increased nasality of connected speech in patients underwent modified Lothrop procedure for refractory chronic rhinosinusitis: Cross-sectional and prospective study.

The endoscopic modified Lothrop procedure (EMLP) is performed to create a large frontal neostium in patients who had failed previous frontal sinus surgeries. EMLP causes obvious changes in the volume and anatomy of the sinuses, which may cause a more significant change in nasality. This study aimed to evaluate the changes in nasalance in patients who underwent EMLP by comparing their preoperative nasalance to the established normative values and postoperative nasalance. This was a prospective study. Twenty-one patients diagnosed with refractory frontal sinusitis who were indicated to undergo EMLP were enrolled. One hundred one healthy participants were enrolled as norm references. The Nasometer II Model 6400 (KayPENTAX) was used to analyze the nasalance scores. Nasalance scores were tested before surgery and 1 and 3 months after the surgery. The normative references of nasalance were (mean ± SD) 14.6% ± 6.7%, 39.4% ± 8.4%, and 55.8% ± 8.3% for the oral passage, oral-nasal passage, and nasal sentences, respectively. The mean nasalance scores pre-EMLP and 1 and 3 months post-EMLP were 23.2% ± 9.6%, 29.0% ± 9.3%, and 29.9% ± 0.4% for the oral passage; 48.7% ± 10.7%, 54.7% ± 7.7%, and 56.4% ± 7.2% for the oral-nasal passage; and 62.7% ± 10.9%, 69.8% ± 6.7%, and 70.7% ± 6.4% for the nasal sentences, respectively. Compared with the normative references, pre-EMLP nasalance was higher for all the three speech stimuli (t-test, p < 0.05). Post-EMLP nasalance also significantly increased for all the three stimuli at the 1- and 3-month follow-up visits (Paired t-test, p < 0.05). EMLP has a short-term impact on resonance; however, long-term follow-up is required for further study.

Long-term Average Spectrum and Nasal Accelerometry in Sentences of Differing Nasality and Forward-Focused Vowel Productions Under Altered Auditory Feedback

To investigate whether voice focus adjustments can alter the audio-vocal feedback and consequently modulate speech/voice motor control. Speaking with a forward-focused voice was expected to enhance audio-vocal feedback and thus decrease the variability of vocal fundamental frequency (F0). Twenty-two healthy, untrained adults (10 males and 12 females) were requested to sustain vowel /a/ with their natural focus and a forward focus and to naturally read the nasal, oral, and mixed oral-nasal sentences in normal noise-masked auditory conditions. Meanwhile, a miniature accelerometer was externally attached on the noise to detect the nasal vibrations during vocalization. Audio recordings were made and analyzed using the long-term average spectrum (LTAS) and power spectral analysis of F0. Compared with naturally-focused vowel production and oral sentences, forward-focused vowel productions and nasal sentences both showed significant increases in nasal accelerometric amplitude and the spectral power within the range of 200∼300 Hz, and significantly decreased the F0 variability below 3 Hz, which has been reported to be associated with enhanced auditory feedback in our previous research. The auditory masking not only significantly increased the low-frequency F0 variability, but also significantly decreased the ratio of the spectral power within 200∼300 Hz to the power within 300∼1000 Hz for the vowel and sentence productions. Gender differences were found in the correlations between the degree of nasal coupling and F0 stability as well as in the LTAS characteristics in response to noise. Variations in nasal-oral acoustic coupling not only change the formant features of speech signals, but involuntarily influence the auditory feedback control of vocal fold vibrations. Speakers tend to show improved F0 stability in response to a forward-focused voice adjustment.

Pharyngoplasty versus buccinator myomucosal flap in the management of velopharyngeal-insufficiency coronal pattern of closure

Background Velopharyngeal insufficiency (VPI) is an anatomical or structural defect that hinders sufficient velopharyngeal closure, as visualized on nasoendoscopy. Aim The aim of this work was to compare the result of sphincter pharygoplasty versus buccinator myomucosal flap in management of VPI cases with coronal pattern of closure in order to select the proper operation for managing these cases. Patients and methods This study included 20 patients in our institute with residual VPI after primary repair of cleft palate with age range between 3 and 12 years. Randomly, patients with coronal pattern of closure were categorized into two groups: (A) 10 patients underwent sphincteroplasty and (B) 10 patients underwent buccinator myomucosal flap. Preoperatively and 2 months after operation, every patient was evaluated by auditory perceptual assessment, flexible nasopharyngoscopy, and nasometry. The results were documented, tabulated, and statistically analyzed. Results There were statistically significant improvements of auditory perceptual assessment in obligatory speech disorders and intelligibility of speech, nasometeric evaluation in oral and nasal sentences in both groups. Additionally, there were significant improvements of nasoendoscopic evaluations in the degree of velar movement, presence or absence and size of persistent gap in both groups, and in the degree of lateral pharyngeal wall movements in group A. Conclusion Sphincterpharyngoplasty or buccinator myomucosal flap have satisfactory results in treatment of VPI patients with coronal pattern of closure with no statistically significant difference between both groups.

The Impact of Fan-Type Rapid Palatal Expanders on Speech in Patients With Unilateral Cleft Lip and Palate.

Rapid palatal expanders (RPEs) are commonly used in patients with cleft lip and palate (CLP) prior to secondary alveolar bone grafting (SABG). Their position and size can impede tongue movement and affect speech. This study assessed changes in perception and production of speech over the course of RPE treatment. Prospective longitudinal. Tertiary university-affiliated hospital. Twenty-five patients with unilateral CLP treated with Fan-type RPEs, and their parents. Patient and parent speech questionnaires and patient speech recordings were collected at baseline before RPE insertion (T1), directly after RPE insertion (T2), during RPE expansion (T3), during RPE retention (T4), directly after RPE removal but before SABG (T5), and at short-term follow-up after RPE removal and SABG (T6). Ratings for patient and parent questionnaires, first (F1) and second (F2) formants for vowels /a/, /i/, and /u/, and nasalance scores for non-nasal and nasal sentences, were obtained and analyzed using mixed model analyses of variance. Ratings worsened at T2. For the vowel /a/, F1 and F2 were unchanged at T2. For the vowel /i/, F1 increased and F2 decreased at T2. For the vowel /u/, F1 was unchanged and F2 decreased at T2. Nasalance was unchanged at T2. All outcome measures returned to T1 levels by T4. RPE insertion resulted in initial adverse effects on speech perception and production, which decreased to baseline prior to removal. Information regarding transient speech dysfunction and distress may help prepare patients for treatment.

Automatic speech processing software – New sensitive tool for the assessment of nasality

Introduction: Automatic speech processing (ASP) software is a nasality assessment tool. ASP studies focusing on investigating sentences to find nasality and correlating ASP scores with other objective assessment scores measuring nasality are scarce. Hence, the present study aimed at comparing the nasalance values of the ASP software with the nasometer in typically developing children (TDC) and children with repaired cleft palate (RCP) across different stimuli. Methods: Participants included 30 Kannada speaking TDC and 10 children with RCP (9–12 years). Speech stimuli (oral, nasal, and oronasal sentences) were recorded and the values were obtained from the ASP software as well as the nasometer. The following statistical tests were applied: mixed ANOVA, repeated measures ANOVA, paired samples t-test, independent samples t-test and Pearson's correlation. Results: Like nasometer, the nasalance values of ASP software were high for the nasal sentences followed by the oronasal sentences and the oral sentences, for both the populations. Higher nasalance values were found for children with RCP than for TDC across all the stimuli. Significant differences were found in nasalance values between the instruments in oral and oronasal sentences in TDC and nasal sentences and oronasal sentences in RCP. The nasalance values across the stimuli between nasometer and ASP software in both the groups showed no significant correlations. Conclusions: ASP software was successful in identifying nasalance in TDC and children with RCP. However, a major issue needs to be addressed concerning the dynamic range of the software and it has to be validated on a large number of populations.

Nasalance Scores as a Function of Skeletal Malocclusion of English-Speaking Adults in the North Indian Population

Objective: The objective of this study is quantitative assessment of nasalance for skeletal Class I (normative values), Class II, and III malocclusion in the English language for the North Indian population and to compare the normative values with the nasalance scores obtained from individuals with skeletal Class II and III malocclusion and to evaluate the normative values as a function of gender. Material and Methods: The study was conducted on a total sample of 200 patients with 100, 50, and 50 in group 1 (control group, Skeletal Class I), group 2 (Skeletal Class II), and group 3 (Skeletal Class III), respectively. ANB angle (anteroposterior angle formed by point A, nasion, and point B) measured on lateral cephalogram was used to categorize the patients into 3 groups. The normative nasalance scores were compared for males and females in the control group. The nasalance scores of skeletal Class II and III subjects were compared to the combined normative scores of the control group. The NasalView was used for the objective assessment of nasalance. Oral syllables (/pa/and/pi/), nasal syllables (/ma/and/mi/), and 3 passages (Zoo passage, Rainbow passage, and Nasal sentences) were used to determine the nasalance scores. Results: The intragroup comparison of nasalance scores in group 1 showed statistically significant differences for different stimuli. The gender-related comparison showed no statistically significant differences in nasalance scores. The intergroup comparison of nasalance scores for skeletal malocclusion showed no statistically significant differences for different stimuli except statistically significant lower nasalance values for nasal sentences in group 3 compared to the control group. Conclusion: The study concluded that the nasalance scores for nasal sentences in skeletal Class III malocclusion were significantly lower than in the control group and were not statistically significant between the 3 groups for all other stimuli.

Influence of native language on Nasalance values in Kannada and Malayalam speakers

Introduction: Nasalance values vary across languages. Therefore, establishing separate normative values of nasalance for each language and studying their influence on each other becomes important for the assessment and management of persons with resonance disorders. So the present study aimed at comparing the nasalance values of vowels, unvoiced syllables, and voiced syllables between native Kannada speakers and native Malayalam speakers. The present study also compared the nasalance values of meaningful words, oral sentences, and nasal sentences (for both English and Kannada languages) between native Kannada speakers and native Malayalam speakers. Materials and Methods: Twelve native Kannada speakers and 12 native Malayalam speakers (age range – 18–23 years) served as participants. The test stimuli included a standardized set of meaningful words, oral sentences, and nasal sentences in both English and Kannada, vowels, unvoiced syllables, and voiced syllables. The data were recorded and the values were obtained from the Nasometer. Results: The results revealed a higher nasalance value for Malayalam speakers (/a/-29,i/-45.41,u/-19.50, unvoiced syllables-16.96, voiced syllables-21.63, words-22.71, oral sentences-21.40, and nasal sentences-60.15) than for Kannada speakers (/a/-14.90,i/-32.60,u/-10.50, unvoiced syllables-11.59, voiced syllables-16.99, words-15.83, oral sentences-13.62, and nasal sentences-56.18) across all the stimuli considered. However, a statistically significant difference was found only on vowels. Conclusions: The present study indicated that in bilingual or trilingual speakers, there is an effect of native language on the Nasalance Values of second and/or third language.

Nasalance Scores for Normal Persian-Speaking Girls

Background: Obtaining normative nasalance scores is essential in the process of assessing and treating resonance disorders. The purpose of this study was to obtain nasalance scores in Persian-speaking girls aged 4-6 years and investigate the age-related differences. Materials and Methods: All participants (n=40) were screened to identify any overt problems relating to resonance, hearing, voice quality, or speech and language skills. The mean nasalance scores were obtained from normal-speaking girls during the repetition of the Persian version of the Simplified Nasometric Assessment Procedures (SNAP) test subtests. The Nasometer II (model 6450) was used to obtain the nasalance scores. Results: The mean nasalance score for the SNAP test subtests was obtained. Group mean and standard deviation (SD) nasalance scores of girls for oral and nasal sentences were 12.59±3.74 and 50.52±6.39, respectively. There was no significant difference between age groups (4, 5 and 6 years old) (P&lt;0.05). Conclusion: Our results provided normative nasalance scores based on the SNAP test that can be used for the evaluation and treatment of resonance problems in Persian-speaking girls.

Correlation of subjective and objective assessment of hypernasality in children with repaired cleft lip and palate

Introduction: Correlational studies between subjective and objective evaluations in the area of cleft lip and palate might provide evidence on the reliability and validity of subjective evaluations. This will, in turn, help in deciding to use subjective evaluations in remote areas. Such correlational studies are scanty in Indian languages. Aims: The present study aimed at correlating the perceptual rating of hypernasality with its instrumental measure in Kannada speaking children with repaired cleft lip and palate (RCLP) across different stimuli. The study also discusses various aspects that affect nasality (the type of speech stimuli and age of first palatal surgery) which helps in better understanding of RCLP cases and their characteristics. Settings and Design: This study was based on correlational research designs. Subjects and Methods: Twenty-three Kannada speaking children with RCLP served as participants. Speech samples (vowels, oral words, nasal words, oral sentences, nasal sentences, and oronasal sentences) of children with RCLP were recorded using a sound level meter and were perceptually evaluated using Henningsson's rating scale by three experienced speech-language pathologists. Furthermore, nasalance values were objectively obtained using a nasometer. Statistical Analysis: This study was statistically analyzed using the Shapiro–Wilk test of normality and Spearman's correlation. Results: The results revealed a high positive correlation (0.78) between the subjective and objective assessment. The different degrees of perceptually rated hypernasality were in a positive correlation with nasometry scores of vowels (0.766), words (0.785), and sentences (0.819). Conclusions: A good correlation was obtained between the subjective and objective measurement of nasality indicating the high utility of perceptual evaluation in remote areas.

Normative nasalance scores in Tamil-speaking Indian children

Objective The aim of this study was to obtain normative nasalance scores for Indian Tamil-speaking children. Methods Mean nasalance scores were obtained from 175 consecutive Tamil-speaking normal children (95 males, 80 females) aged 5–16 years during the repetition of six standardized sentences: two oral, two oronasal, and two nasal sentences. The nasal view was used to obtain nasalance scores for the standardized sentences Results Group mean and standard deviation (SD) nasalance scores of children for oral, oronasal, and nasal sentence were 35.65(SD 7.20), 44.42(SD 7.37), and 57.21(SD 8.15), respectively. The mean nasalance values of children aged 9–12 years were greater than children aged 5–8 years and 13–16 years for nasal sentences (p < .001). Males were found to have significantly higher nasalance scores for oral and oronasal sentences (p < .05) although these differences were within the range of normal variation. Conclusions The present study provides normative nasalance scores for Tamil-speaking Indian children.

Measurement of Nasalance Scores Without Touching the Philtrum for Better Comfort During Speech Assessment and Therapy: A Preliminary Study.

The Kay Pentax nasometer uses a separator plate that touches the philtrum of a patient to separate the nasal and oral sound energies for nasalance measurement. However, the separator plate can restrict the natural movement of the patient's upper lip and generate unpleasant pressure on the patient's philtrum. The present study was intended to measure nasalance scores without touching the philtrum for better comfort during speech assessment and therapy. Nasalance scores of 10 males and 10 females having no speech disorders were measured under 4 levels (0, 5, 10, and 15 mm) of the gap between the plate and the philtrum (denoted as plate-to-philtrum gap) using Nasometer II 6450 for nasal (Nasal Sentences) and oral (Zoo Passage) stimuli. Regression formulas were established to examine the relationships between nasalance score and plate-to-philtrum gap for the stimuli. To provide nasalance scores equivalent to those measured for the contact condition, compensation factors for the 5 mm plate-to-philtrum gap measurement condition were identified for the stimuli. The nasalance scores were significantly different between the 4 different plate-to-philtrum gaps for the stimuli. Compensation factors for the Nasal Sentences and the Zoo Passage were identified as 1.17 and 0.71, respectively. The 5 mm plate-to-philtrum gap condition after multiplying the compensation factors can provide equivalent nasalance scores to the conventional contact measurement condition which may provide better comfort in speech assessment and therapy.

Influence of Khasi Language on Nasal and Oral Passages in English: A Nasometric Study

Introduction&#x0D; Speech is a overlaid function of respiratory, phonatory, resonatory, articulatory systems . Nasalance can be defined as the relative amounts of oral and nasal acoustic energy in speech done by modification of oral and nasal cativities that is complex activity of the resonator system. Nasometer was developed by Samuel Fletcher, Larry Adams, and Martin McCutcheon at the University is a computer based instrument facilitating accurate analysis of signal yielding nasalance scores. There is no report regarding nasalence score variance in khasi language speakers speaking English.&#x0D; Materials and Methods&#x0D; The study aims at analysing and measuring nasalence score in Khasi speakers reading English passages. A total of 5 female subjects were chosen who were native speakers of khasi language and who had exposure of English language since childhoods were selected. Nasometer II Model 6400 (Software version 2.6) of Key Elemetrics Corporation was used. Three standardized passages (Zoo passage, Rainbow passage and nasal sentences) were used for the study.&#x0D; Results&#x0D; The mean nasalance scores obtained for zoo, rainbow and nasal sentences in female were 19.39± 12.21 SD, 38.13 ± 14.83 SD, 68.33 ± 15.29 SD and 18.26 ± 3.53 SD, 33.13 ± 1.68 SD, 63.20 ± 88 SD respectively. Standard norms show significant differences in nasalance scores obtained for Zoo, Rainbow and Nasal Sentences. Paired t-test was used for comparison among the sentences and computation of data show more significant differences for nasal sentences as compared to zoo and rainbow sentences, that is significant (p&gt;0.05). Rainbow sentences revealed more nasalance scores than zoo sentences (p&gt;0.05) i.e. level of significance.&#x0D; Conclusion&#x0D; The reported normative Nasalance data can be used by several voice clinicians for assessing resonance quantitively for khasi speakers using austrioasiatic language.

Pharyngeal flap for a poorly repaired cleft palate with posterior palatal defect

ObjectivePosterior palatal defect after cleft palate (CP) repair is not a rare problem, it may cause velopharyngeal insufficiency (VPI). The aim of this study was to assess the effectiveness of a superiorly-based pharyngeal flap (PF) with modification of its end to accommodate the defect in treatment of post-palatoplasty VPI. MethodsThirteen children with VPI due to posterior palatal defect after CP repair were included in this study. PF was used in treatment of all patients, the lower end of the flap was fashioned in a V-shape to accustom the shape of the defect with peeling of its overlying mucosa to enhance wound healing. The PF was inserted deeply into a tunnel created within the defect between the oral and nasal layers of the palate. Pre- and postoperative evaluation using auditory perceptual assessment (APA), nasometric assessment and velopharyngoscopy were performed. ResultsSignificant improvement of APA and nasalance score for both oral and nasal sentences was achieved. Also, velopharyngoscopy showed complete velopharyngeal closure in all patients postoperatively. ConclusionA modified PF is an effective treatment for VPI caused by posterior palatal defect that may be encountered after CP repair.

Concomitant adenotonsillectomy and cleft palate repair in one sitting.

When adenotonsillar hypertrophy (ATH) is encountered in children during cleft palate (CP) repair, the decision for adenotonsillectomy is challenging. The aim of this study was to evaluate the effectiveness of adenotonsillectomy done during CP repair for children with ATH on speech and breathing. Nine children with CP and ATH underwent adenotonsillectomy prior to palatoplasty in same sitting. The age of patients ranged between 1.5 and 3.5years with a mean age of 2.3years at the time of operation. Auditory perceptual assessment (APA), nasometric assessment, and velopharyngeal function evaluation were performed when the children reached the age of 4years. No children developed obstructive breathing episodes postoperatively as witnessed by parents. APA showed normal nasality in six patients and mild hypernasality in three patients. Nasalance scores for both nasal and oral sentences were found to be comparable with that of normal children of the same age. Velopharyngeal closure was seen competent in four patients, borderline competent in three patients, and borderline incompetent in two patients. Performing adenotonsillectomy during CP repair does not deleteriously affect the speech and it prevents the occurrence of postoperative obstructive breathing episodes that may be caused by the hypertrophied tonsils and/or adenoid.

Normal Patterns of Nasometric Values in Adult Jordanian Speakers of Arabic.

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.

Evaluating Nasalance Values Among Bilingual Mandarin-English Speakers.

The goals of this research are (1) to establish normative nasalance values for bilingual Mandarin-English speakers and compare values to those of previously reported monolingual Mandarin speakers, and (2) to examine whether sex, age, dialect, and language proficiency affect levels of nasalance among Mandarin-English speakers in both English and Mandarin. All participants recorded the speech stimuli, constructed to include oral sentences, nasal sentences, oronasal sentences, and vowels /ɑ, i, u/ in Mandarin and English. Nasalance measurements were recorded using the Nasometer II 6450. A total of 45 (20 males and 25 females) native Mandarin speakers between 20 and 54 years of age from mainland China participated in the study. Mean nasalance scores of the Mandarin oral sentence (Mean [M] = 17.64, standard deviation [SD] = 7.33), oronasal sentence (M = 54.62, SD = 7.81), and nasal sentence (M = 68.73, SD = 8.09) are reported. Mean nasalance scores of the English oral sentence (M = 20.02, SD = 7.83), oronasal sentence (M = 58.71, SD = 7.59), and nasal sentence (M = 65.27, SD = 7.45) are reported. A repeated measures analysis of variance showed significant sex difference in nasalance scores for English stimuli ( P = .031) and Mandarin stimuli ( P = .040). There was no significant effects of age, dialect, and language proficiency on Mandarin or English stimuli. This is the first study to report normative values for Mandarin-English speakers using the Nasometer II. Values reported can be used for objective assessment of bilingual speakers.

Clinical application of nasometry in patients with nasal obstruction.

The purpose of this case-control study is to report on the clinical application of nasometry as a diagnostic tool in patients with the symptom of nasal obstruction compared with subjects with no history of nasal obstruction. Thirty-eight adult patients (mean age: 28.1 years) complaining of nasal obstruction were enrolled in the study, and another group of 38 adults (mean age: 25.9 years) with no history of nasal obstruction served as controls. Demographic data, including age and sex, were collected. Patients were asked to read three passages; the Zoo passage, the Rainbow passage, and nasal sentences. Nasalance scores were reported on all subjects using a Nasometer II instrument. The control and patient groups each included 22 men and 16 women. No statistically significant difference in nasalance score was found between the study group and the control group in any of the Zoo passage, Rainbow passage and nasal sentences. We conclude that nasometry has limited value in the objective assessment of nasal obstruction as a symptom, which we attribute to nasal obstruction's not always reflecting the volume and pressure in the nasal cavity.

Nasometry Normative Data for 4- to 6-Years-Old Persian Normal Boys in Isfahan City, Iran

Introduction: Every year, a group of children with velopharyngeal insufficiency (VPI) become candidate for secondary surgery in order to improve their resonance disorder, but the perceptual assessments that are based on clinician’s perceptual and quantitative judgments are not responsible for making decisions for secondary surgery. So, the perceptual assessment should be complemented by using aerodynamic and acoustical techniques. Aerodynamic and acoustical techniques are important, because they have potential to provide quantitative results. Nasometer measures the oral and nasal acoustical energy during the speech that is expressed as nasalance score and is a quantitative assessment. The aim of this study was to obtain the normative nasalance scores for 4- to 6-years-old boys speaking Persian language. Materials and Methods: This cross-sectional study was done in 2015 on 4- to 6-years-old Persian children in Isfahan City, Iran. All consented participants were initially screened to identify any overt difficulties relating to hearing, voice quality, resonance or speech and language skills. Mean nasalance scores were obtained from 43 normal speaking boys aged 4 to 6 years during the repetition of Persian version of Simplified Nasometric Assessment Procedures (SNAP) test. The Nasometer (model 6450) was used to obtain nasalance scores. Results: The mean obtained nasalance scores for SNAP test for oral and nasal sentences were 11.57 ± 3.16 and 48.51 ± 7.03, respectively. Conclusion: The present study provides normative nasalance scores for Persian-speaking boys that can be used as a reference in the clinical process including making decision for needing secondary surgery. As the gender and age are the factors that can affect the nasalance score, obtaining nasometer norm in other age groups and sex seems to be necessary.

Lateralization of the Pharyngeal Flap for Treatment of Lateral Velopharyngeal Gap.

Pharyngeal flap is usually used for treatment of velopharyngeal insufficiency (VPI); it is bridged between the posterior pharyngeal wall and the soft palate traversing the central part of the velopharyngeal port. The aim of this study was to assess the efficacy of lateralization of the pharyngeal flap for treatment of VPI in patients with lateral velopharyngeal gap. Fifteen patients with VPI due to lateral velopharyngeal gap were subjected to closure of the gap by pharyngeal flap that was lateralized to fill the gap. Preoperative and postoperative assessment of velopharyngeal functions including flexible nasopharyngoscopy, auditory perceptual assessment (APA), and nasometric assessment were performed. Postoperatively, flexible nasopharyngoscopy showed complete velopharyngeal closure in all the patients, with significant improvement of speech parameters as measured by APA. Also, nasalance score showed significant improvement for oral and nasal sentences that was measured by nasometry. Lateralization of the pharyngeal flap for treatment of VPI in patients with lateral velopharyngeal gap is an effective method; it improves the velopharyngeal closure and the speech of the patients.

The speech outcome of definitive obturators constructed using two different impression techniques

Abstract The aim of this study was to evaluate the accuracy of two different impression techniques through the assessment of the performance of the two definitive obturators fabricated by each technique. A total of six partially edentulous patients with unilateral maxillary surgical defects were selected from those admitted at the Prosthodontic Department, Faculty of Dentistry, Alexandria University. For every patient, two hollow bulb obturators were constructed, each using a different impression technique. Three patients started with the open face tray impression technique and the other three started with the altered cast impression technique. Each patient was given one obturator at a time and was instructed to use it for 2 months. All patients were subjected to the following: (a) a preprosthetic evaluation, (b) an evaluation 2 months after the insertion of the first obturator, and (c) an evaluation 2 months after the insertion of the second obturator. During each session, speech and swallowing were evaluated. Regarding the three formant frequencies of the vowel /a/, there was a statistically significant improvement only in F1 between the altered cast and the preprosthetic phase and between the altered cast and the open face impression techniques, whereas concerning vowel /e/, there was a statistically significant improvement in F2 in favor of the altered cast impression technique. The degree of nasality in the vowels and the plosives were significantly improved in the altered cast technique. However, there was no significant improvement in the nasality between the two techniques with regard to oral and nasal sentences. There was an observed improvement in the competence and the shape of the velopharyngeal valve with the obturator than without the obturator. The altered cast technique caused statistical improvement in the nasality of vowels and plosives as compared with the open face impression technique. Both treatment modalities caused general improvement in the patient’s satisfaction and in swallowing with no statistically significant difference between them.