Nasal Sentences Research Articles

Furlow palatoplasty for previously repaired cleft palate with velopharyngeal insufficiency

ObjectiveVelopharyngeal insufficiency (VPI) is a common complication after cleft palate repair, it may be due to lack of levator sling reconstruction and/or palatal shortening. Furlow palatoplasty has the advantages of retro-positioning of levator palati muscles and palatal lengthening. The aim of this study was to assess the efficacy of Furlow palatoplasty in the treatment of VPI in patients who undergone previous palatoplasty. MethodsTwenty-three children with post-palatoplasty VPI were included in the study. Furlow technique which was not used in the primary repair, has been used as a secondary corrective surgery. Preoperative and postoperative evaluation of velopharyngeal function was performed, using auditory perceptual assessment (APA) and nasometry for speech, and flexible nasopharyngoscopy for velopharyngeal closure. ResultsSignificant improvement of APA and nasalance score for oral and nasal sentences was achieved. Flexible nasopharyngoscopy showed complete velopharyngeal closure in 19 patients (82%) postoperatively. ConclusionFurlow palatoplasty is considered a useful treatment option for VPI in patients with previously repaired cleft palate, it improves the speech and velopharyngeal closure.

Hypernasality after using the endoscopic endonasal transsphenoidal approach for skull base tumors.

The increasing number of endoscopic endonasal transsphenoidal approaches (EETSA) has resulted in several sinonasal complications, including voice changes. Here, we compared preoperative and postoperative voice changes according to age. We retrospectively reviewed the medical records. Patients were divided into the following three groups according to age: ≤ 30 years, 31 to 60 years, and ≥ 60 years. Patients underwent preoperative voice evaluation using acoustic analysis, a nasometer, and the voice handicap index (VHI). A nasometer was used to measure the nasalance scores. The subjects read or repeated three speech stimuli. For each stimulus, mean nasalance scores were obtained and age dependence was analyzed. Repeat testing was performed 6 months postoperatively. One hundred and seventy patients who underwent binostril four-hand EETSA with a bilateral modified rescue flap were included in this study. Mean nasalance scores for the oral passage, oronasal passage, and nasal passage--as well as mean jitter scores, shimmer scores, and VHI--were significantly increased in all of the EETSA patients (P < 0.05 for all). Mean nasalance scores for the nasal sentences were significantly increased in the ≤ 30 age group (all, P < 0.05). Scores for the oronasal passage and nasal passage were significantly increased in the 31 to 60 age group (all, P < 0.05). Scores for the oronasal passage, nasal passage, jitter, and shimmer were significantly increased in the > 60 age group (all, P < 0.05). Endoscopic endonasal transsphenoidal approaches might contribute to voice changes. In addition, older age might produce hypernasality and roughness after EETSA. Patients who plan to undergo EETSA should be informed that their voice may change after the operation. 4.

The role of auditory perceptual analysis of speech in predicting velopharyngeal gap size in children with velopharyngeal insufficiency

Abstract Assessment of velopharyngeal (VP) function starts with careful perceptual speech analysis, because it is the degree of speech impairment that dictates the need for intervention. The aim of this study was to evaluate the role of auditory perceptual analysis of speech in predicting VP gap size in children with VP insufficiency. This was a prospective correlation study conducted in a hospital-based setting. Referred sample of 38 participants with VP insufficiency and age ranging from 4 to 16 years were included in the study. The subjective evaluation of patients’ speech was carried out using four-point severity scales. This included degree of hypernasality, audible nasal emission of air, the compensatory articulations (glottal and pharyngeal articulation), and the overall intelligibility of speech. Nasalance scores for oral and nasal sentences were measured. A combination of nasopharyngoscopy and multiview videofluoroscopy was used to measure VP gap size, which was rated using the scale proposed by Golding-Kushner and colleagues. The studied patients were classified into three groups on the basis of the estimated gap size (small, moderate, and large VP gap groups). Statistical analysis was carried out using analysis of variance and post-hoc tests. There was a positive correlation between all studied auditory perceptual analysis variables and VP gap size. The degree of hypernasality and overall speech intelligibility had the strongest predictive values, followed by glottal articulation, nasal emission, pharyngeal articulation, and oral sentence nasalance score. The study finding suggests that the size of the VP opening can be predicted on the basis of perceptual assessment of speech, which helps to anticipate the appropriate line of intervention without the need for invasive procedures.

Dialectical effects on nasalance: a multicenter, cross-continental study.

This study investigated nasalance in speakers from six different dialectal regions across North America using recent versions of the Nasometer. It was hypothesized that many of the sound changes observed in regional dialects of North American English would have a significant impact on measures of nasalance. Samples of the Zoo Passage, the Rainbow Passage, and the Nasal Sentences were collected from young adult male and female speakers (N=300) from six North American dialectical regions (Midland/Mid-Atlantic; Inland North Canada; Inland North; North Central; South; and Western dialects). Across the three passage types, effect sizes for dialect were moderate in strength and accounted for approximately 7%-9% of the variation in nasalance. Increased differences in nasalance tended to occur between speakers from distinctly different geographical regions, with the highest nasalance across all passages observed for speakers from the Texas South dialect region. Clinicians and researchers who use perceptual and instrumental measures of speech production should be aware that dialectical and socially acquired speech patterns may influence the acoustic characteristics of speech and may also influence the interpretation of normative expectations and typical versus disordered cutoff scores for instruments such as the Nasometer.

Nasalance Scores in Lebanese English-Speaking Adults Using Nasometric Analysis

To obtain normative data for nasalance scores in Middle Eastern English-speaking adult population. Cross-sectional study. A total of 102 subjects were recruited in the study, 26 were excluded, thus, 77 Middle Eastern English-speaking adults (mean age = 23.77 ± 4.295; 39 males, 38 females) with normal speech and no hearing problems participated in the study. Using Nasometer II 6450, nasalance scores were obtained for each participant's readings of 3 passages: Zoo and Rainbow passages and nasal sentences. Mean nasalance score, standard deviation and range. Mean nasalance scores for Zoo passage, Rainbow passage and nasal sentences were 25.21 ± 11.07, 34.04 ± 9.30 and 41.29 ± 9.87 respectively. Mean scores didn't differ significantly between males and females, though scores for the Zoo passage were slightly higher among males (26.51 ± 11.66) than females (23.87 ± 10.42). In within-session reliability testing, 86% of retests for all three passages fell within 5 nasalance points of the previous test. In across-session reliability testing, 93% of retests for all 3 passages were within 5 points of initial test. This study provides normative data for nasalance scores among Middle-Eastern adults, which can help make nasometer and determination of nasalance more clinically useful in this population.

Adult Tonsillectomy: Anatomical Differences Affect Postoperative Transient Hypernasality

Objective: Our purpose was to determine how anatomical conditions of the throat influence the degree and duration of posttonsillectomy transient hypernasality. Patients and Methods: A total of 82 tonsillectomies were performed. The participants were divided into groups: 1 - small tonsils, high soft palate position; 4 - large tonsils, low soft palate position, and 2 and 3 - intermediate tonsil dimensions and soft palate positions. Variables studied included the diameter of vapor (DV) on the mirror positioned under the patient's nose while articulating nasal sentences before and after surgery, the distance from the uvular tip to the posterior pharyngeal wall, healing grading as well as the degree and duration of hypernasality. Results: The mean hypernasality after tonsillectomy was greatest in group 4 and lowest in group 2. Before tonsillectomy, the mean DV was largest in group 2 and smallest in group 4. After tonsillectomy, the mean DV was largest in group 4 and smallest in group 3. Overall, the mean DV was significantly greater after tonsillectomy compared to the value before surgery. Conclusion: The degree of hypernasality after tonsillectomy depends on the soft palate position in relation to the tongue base and the size of the tonsils. Hypernasality is greatest in patients with large tonsils and a low soft palate position in relation to the tongue base. © 2014 S. Karger AG, Basel

Standardization of nasalance scores in normal Saudi speakers

Objective. The aims of this study were to obtain normative nasalance scores for a normal Saudi population with different ages and genders, to develop nasometric Arabic speech materials, and to make cross-linguistic comparison.Subjects. Participants included 219 normal Saudi native monolingual Arabic speakers of different ages. Subjects were classified into four groups according to age and gender. Subjects did not have any history of oral, nasal, or velopharyngeal abnormality.Methods. Arabic speech samples were developed to evaluate nasalance scores, which included syllables repetition, three oral sentences, three oro-nasal sentences, and three nasal sentences. Nasalance data were obtained using Nasometer II–6400.Results. Normative nasalance values were determined. Significant differences between the male and female children groups were noticed in many parameters. Nasalance scores were higher in adults, with significant differences between all groups.Conclusion. Normative nasalance scores for Saudi Arabic speakers have been developed for both adults and children. The Arabic speech materials developed in this study appear to be easy to use and applicable for different age groups.

Evaluation of a modular palatal lift prosthesis with a silicone velar lamina for hypernasal patients

Speech bulbs and palatal lift prostheses are used to improve oral-nasal balance in speakers with hypernasality resulting from velopharyngeal dysfunction. Fabricating such speech prostheses is often a protracted process, and the nasopharyngeal impression can be uncomfortable for the client. The purpose of this study was to develop and test a modular palatal lift prosthesis with a silicone velar lamina that can be fabricated without a nasopharyngeal impression. Six adult participants with different etiologies were treated with both a conventional palatal lift prosthesis and the new prosthesis. The outcome measures were nasalance scores, speech acceptability ratings, and participant responses on a questionnaire. Inferential statistical analyses were conducted with nonparametric Friedman tests and 2-tailed paired Wilcoxon signed ranks tests. The probability was set at P<.1. Among the 3 speaking conditions (no prosthesis, acrylic resin prosthesis, modular silicone palatal lift prosthesis), no differences were found in nasalance scores for the oral stimuli. For the nasal sentences, a numerically greater reduction was observed for the silicone than for the acrylic resin prosthesis. Speech acceptability was better with the modular silicone palatal lift prosthesis (z=2.032, P<.05) and the acrylic resin prosthesis (z=1.753, P<.1) than with no prosthesis. The questionnaire showed better subjective speech acceptability with the acrylic resin prosthesis (z=1.706, P<.05) and the modular silicone palatal lift prosthesis (z=1.706, P<.05) than with no prosthesis. Swallowing comfort was also numerically better for the acrylic resin prosthesis than for the modular silicone palatal lift prosthesis. This study demonstrates the feasibility of a new design for a flexible and modular palatal lift prosthesis. The functional outcomes were comparable to those of the traditional design. Although the overall results in this study favored the traditional prosthesis, the new design may be viable for patients who require alternative treatment solutions.

Impact of Nasal Surgery on Speech Resonance

The nose and paranasal sinuses contribute to speech resonance and changes to these structures may alter speech nasality. This change may influence one's vocational and social functioning and quality of life. Our investigation explored objective and subjective changes in nasality following nasal surgery in a prospective and longitudinal fashion. Recordings of sustained vowel and sentence stimuli and voice-related quality of life measurements were obtained preoperatively and at 2, 4, 8, and 24 weeks postoperatively from individuals undergoing nasal and/or sinus surgery. Objective measures of fundamental frequency, jitter, shimmer, and harmonic to noise ratio (HNR) were determined. Pre- and postoperative speech samples were assessed by 15 naïve listeners. In all, 15 subjects completed the study. Neither speakers nor listeners perceived a subjective change in nasality following surgery. No statistically significant change in microacoustic measures were identified. Although nasal sentences did not reveal differences for 3 microacoustic measures, a difference in HNR was identified. Patients undergoing nasal surgery did not exhibit subjective changes in resonance postoperatively. Aside from a difference in HNR for the nasal sentence, objective microacoustics remained unchanged. These results demonstrate the stability of oranasal resonance despite nasal surgery and provide valuable data for patient informed decision-making.

Nasalance scores for normal Korean-speaking adults and children

There are numerous nasometric studies to date, including normative nasalance scores for various languages as well as nasometric differences in age, gender, race and region except the Korean language. In this regard, we sought to establish normative nasalance scores for Koreans. We created speech samples based on the everyday use of phonemes in the Korean language which were syntactically simple for children. In addition, we analysed nasometric features based on age and gender and confirmed test-retest reliability. The study included 108 children (54 girls and 54 boys, aged 7-11 years) and 108 adults (54 women and 54 men, aged 18-29 years) with normal articulation, resonance, voice and hearing. Nasometer II 6400 was used to measure the nasalance scores. The subjects read or repeated three speech stimuli, each consisting of 33, 36 and 24 syllables: (1) an oral passage devoid of nasal consonants, (2) an oro-nasal passage and (3) nasal sentences. For each stimulus, mean nasalance scores were obtained and gender or age dependence was analysed, using two-way analyses of variance. The mean nasalance scores for the oral passage, oro-nasal passage and nasal sentences were 11.69% (standard deviation (SD) 3.68), 34.04% (SD 4.88) and 63.72% (SD 6.07), respectively. Female speakers exhibited significantly higher nasalance scores than male speakers on the oro-nasal passage (p = 0.000) and nasal sentences (p = 0.004). Children exhibited significantly higher nasalance scores than adults on nasal sentences (p = 0.000). The nasalance scores in children and females were a little higher. Korean normative data will provide reference information in the evaluation and treatment of resonance problems.

Nasalance and nasality of tracheoesophageal speech in total laryngectomee

The objective of this study was to determine the rates of nasalance for total laryngectomized users of a tracheoesophageal voice prosthesis and correlate them with the findings of auditory-perceptual assessment of nasality. In this study, 25 total laryngectomized users, including 20 men and five women, with a mean age of 63 years old participated. All the participants had a tracheoesophageal voice prosthesis and underwent treatment for the rehabilitation of tracheoesophageal communication. These patients were submitted to nasalance assessment using nasometry and auditory-perceptual evaluation of nasality and were rated by trained speech therapists. The nasalance values obtained for nasal (59.92%) and oral (18.64%) sentences were within the normal limits for laryngeal speakers of Brazilian Portuguese language. It was possible to observe the presence of nasality in nasal sentences and its absence in oral sentences among most speakers. Specificity was found to be 100% for nasal sentences and sensitivity was 100% for oral sentences. It was not possible to calculate these values for the oral sentences. Total laryngectomized patients with tracheoesophageal voice prostheses have adequate vocal nasality compatible with nasometry rates.

Speech Methodologies in Cleft Palate Assessment: A Pilot Project to Compare Two Phonetically Different Sentence Sets

Objective: To investigate the impact of the phonetic content of two sentence sets on speech outcomes, specifically the effects of nasal phonemes. Method: Audio-video recordings of a consecutive series of 15 participants (age range 4–22 years), with cleft palate (syndromic or non-syndromic), with and without velopharyngeal dysfunction were taken. Participants repeated Sentence Set 1 (with nasals across sentences) and Sentence Set 2 (without nasals except the three nasal target sentences) during a routine speech recording. Two experienced Specialist Speech and Language Therapists, blinded to the study’s purpose, analyzed participants’ speech using the Cleft Audit Protocol for Speech-Augmented (CAPS-A). On day 1, recordings included Sentence Set 1. On day 2, 23 days later, recordings included Sentence Set 2. Main results: The difference between Sentence Set 1 and Sentence Set 2 ‘total scores’ (sum of scores on all CAPS-A parameters) was significant. The Pearson Product Moment showed high correlation. A Wilcoxon test revealed a significant difference between Sets 1 and 2 on the hypernasality parameter, and this alone accounted for the significant difference in total scores. Conclusion: The inclusion or exclusion of nasal consonants in the sentence set significantly affected perceptual ratings of hypernasality but none of the other CAPS-A parameters, highlighting the need for further investigation into perceptual nasality ratings.

Nasometer 6200 versus Nasometer II 6400: Effect on Measures of Nasalance

Objective : This study compared measures of nasalance obtained using the Nasometer 6200 versus the Nasometer II 6400 in typically speaking young adult males and females for the nonnasal Zoo Passage, the phonetically balanced Rainbow Passage, and the Nasal Sentences. Design : Participants read passages at a comfortable pitch and loudness twice while wearing Nasometer 6200 or Nasometer II 6400 headgear. The order of Nasometer system was counterbalanced across participants, and the order of the reading passage was randomized. Participants : Participants consisted of 25 males (mean age = 21.22 years) and 25 females (mean age = 23.83 years). Main Outcome Measures : The main outcomes measures were nasalance scores (%) obtained for each system × passage per participant. Results : Results showed that the Nasometer 6200 and the Nasometer II 6400 differed significantly on mean nasalance for the Zoo Passage (mean difference = 7.15%) and the Rainbow Passage (mean difference = 3.05%) but not for the Nasal Sentences (mean difference = 0.77%). Intersystem correlations and measures of predictive accuracy indicated that the ability to predict Nasometer 6200 nasalance scores from Nasometer II 6400 scores was relatively weak. Conclusions : In addition to such factors as age, gender, and regional dialect, normative nasalance expectations and normal versus disordered nasalance cutoff scores must be considered with full knowledge of the specific system that was used to acquire the nasalance data. Intrasubject changes in nasalance can only be validly assessed when test versus retest measurements have been acquired using the same nasalance system.

Voice Low Tone to High Tone Ratio, Nasalance, and Nasality Ratings in Connected Speech of Native Mandarin Speakers: A Pilot Study

Voice low tone to high tone ratio (VLHR) is defined as the power ratio of a voice spectrum with a specific cut-off frequency. Previous studies have shown that there are significant correlations between VLHR and nasalance and hypernasality ratings in vowels. The correlation was investigated in this study using connected speech material. The Zoo Passage, the Rainbow Passage, the English Nasal Sentences, the Mandarin Nonnasal Sentences, and the Mandarin Nasal Sentences were used to acquire VLHRs, nasalance scores, and perceptual judgments of nasality. Each passage was recorded twice for averaging, and the cut-off frequencies from 200 Hz to 1200 Hz were used to survey for the presence of optimal correlations with VLHR. Participants : Ten native Mandarin speakers with an English learning history of over 8 years were enrolled. Main outcome measures : VLHRs, nasalance scores, and hypernasality ratings. The correlations of VLHR with nasalance (rho = .76, p < .001, Spearman rank correlation) and nasality ratings (rho = .81, p < .001) were significant using a cut-off frequency of 300 Hz for the English passages. For the Mandarin Sentences, the optimal correlations of VLHR with nasalance (rho = .83, p < .001) and nasality ratings (rho = .79, p < .001) were identified using a cut-off frequency of 500-Hz. The significant correlations of VLHR with nasalance and perceptual ratings of nasality using connected speech show that these approaches have a potential value in terms of basic and clinical application.

Normative Nasalance Data in Ugandan English-Speaking Children

Aims: The aim of this study was to obtain normative nasalance values for typically developing Ugandan English-speaking children as a reference point for clinical practice and further research. Methods: Sixty-nine typically developing Ugandan children (35 males and 34 females, 2.7–13.5 years of age) participated in the study. Nasalance scores were obtained with the Nasometer while children repeated 4 sustained sounds, 14 repeated syllables, 15 sentences (12 oral, 3 nasal) and 2 texts (‘Rainbow Passage’ and ‘Zoo Passage’). Data were analyzed for gender and age dependence. Results: No significant effects of age or gender on nasalance values were obtained; hence, normative values for the overall group were reported. The average nasalance scores for Ugandan English-speaking children were 17 and 64% for the oral and nasal sentences and 33 and 14% for the oronasal and oral text, respectively. Conclusion: The normative values are important as a reference point to assess the impact of several surgical procedures and several surgical timing strategies on speech in Uganda.

Nasalance norms in Greek adults

The purposes of this study were to derive nasalance norms for monolingual Greek speakers, to examine nasalance scores as a function of gender and to draw cross-linguistic comparisons based on normative data.Participants read aloud a corpus of linguistic material, consisting of (1) a nasal text, an oral text and a balanced text; (2) a set of nasal sentences and four sets of oral sentences and (3) repetitions of each of 12 syllable types (8 oral and 4 nasal). The last two sets of material corpus were based on an adaptation of the Simplified Nasometric Assessment Procedures Test (SNAP test) test () in Greek, called the G-SNAP test. Eighty monolingual healthy young adult speakers of Greek, 40 males (mean age = 21 years) and 40 females (mean age = 20.5 years), with normal hearing and speech characteristics and unremarkable history were included in the study.The Nasometer (model 6200-3) was used to derive nasalance scores. Mean normative nasalance for spoken Greek was 25.50%, based on the G-oronasal text (with 8.6% nasals). Nasalance scores did not differ significantly with respect to gender. Finally, spoken Greek consistently yielded lower nasalance scores than other languages examined in past work.The aforementioned normative data on nasalance of young adult speakers of Greek are valid across gender and have direct clinical utility as they provide valuable reference information for the diagnosis and management of Greek adults with resonance disorders caused by velar dysfunction.

Comparative study between V-Y pushback technique and Furlow technique in cleft soft palate repair

Many methods of cleft palate repair have been described. Two effective methods are commonly used for repair of soft palate clefts: the Wardill-Kilner V-Y push back and the Furlow double opposing Z-plasty; each has advantages and disadvantages. The aim of this study was to compare between the V-Y push back technique and the Furlow Z-plasty technique regarding effectiveness in palatal reconstruction and improvement of velopharyngeal closure in cases of cleft soft palate. Also, operative duration time and blood loss were considered. This study was conducted on 60 patients diagnosed to have cleft soft palate. The patients were randomly classified into two equal groups A and B. In group A, the cleft palate was repaired using V-Y push back technique while in group B the cleft palate was repaired using Furlow double opposing Z-plasty technique. Flexible nasopharyngoscopy and perceptual speech resonance evaluation were used to assess the velopharyngeal closure and speech outcome, respectively. Nasalance score was measured for nasal and oral sentences in both groups. The average operative duration time and blood loss were lesser in Z-plasty than in V-Y pushback technique. Two of the cases subjected to V-Y pushback technique developed fistula while none of the cases subjected to Z-plasty showed this complication. Velopharyngeal closure and speech outcome was better after Z-plasty than after V-Y pushback technique with significant nasometric data. The Furlow Z-plasty is better than the V-Y pushback technique in the repair of clefts involving the soft palate as it has a higher success rate regarding speech outcome and velopharyngeal closure; also, it has a lower operative time and blood loss.

Objective Assessment of Internal Nasal Dimensions and Speech Resonance in Individuals With Repaired Unilateral Cleft Lip and Palate After Rhinoseptoplasty

The objective of the current study was to analyze the effects of rhinoseptoplasty on internal nasal dimensions and speech resonance of individuals with unilateral cleft lip and palate, estimated by acoustic rhinometry and nasometry, respectively. Twenty-one individuals (aged 15-46 years) with previously repaired unilateral cleft lip and palate were analyzed before (PRE), and 6 to 9 (POST1) and 12 to 18 months (POST2) after surgery. Acoustic rhinometry was used to measure the cross-sectional areas (CSAs) of segments corresponding to the nasal valve (CSA1), anterior portion (CSA2), and posterior portion (CSA3) of the lower turbinate, and the volumes at the nasal valve (V1) and turbinate (V2) regions at cleft and noncleft sides, before and after nasal decongestion with a topical vasoconstrictor. Nasometry was used to evaluate speech nasalance during the reading of a set of sentences containing nasal sounds and other devoid of nasal sounds. At the cleft side, before nasal decongestion, there was a significant increase (P < 0.05) in mean CSA1 and V1 values at POST1 and POST2 compared with PRE. After decongestion, increased values were also observed for CSA2 and V2 at POST2. No significant changes were observed at the noncleft side. Mean nasalance values at PRE, POST1, and POST2 were not different from each other in both oral and nasal sentences. The measurement of CSAs and volumes by acoustic rhinometry revealed that rhinoseptoplasty provided, in most cases analyzed, a significant increase in nasal patency, without concomitant changes in speech resonance, as estimated by nasalance assessment.

Normative data on nasalance scores for Swedish as measured on the Nasometer: Influence of dialect, gender, and age

This study was conducted to establish normative nasalance values for Swedish speaking children as measured with the Nasometer™ II, and to investigate differences due to regional dialect, gender, and age. Two hundred and twenty healthy children aged 4–5, 6–7, and 9–11 years were included. Group mean nasalance scores for four speech stimuli were calculated and compared. There were no significant differences due to dialect or gender for children in the study. For age there was a significant difference on nasal sentences between the youngest group of children and the other two groups, age 4–5 vs age 6–7 (t = −2.844, p = .006) and for age 4–5 vs age 9–11 (t = −2.888, p = .005). The results from this study have both clinical significance for Swedish SLPs working with resonance disorders, and theoretical significance for linguists studying features of dialects and languages.

Same noses, different nasalance scores: Data from normal subjects and cleft palate speakers for three systems for nasalance analysis

Nasalance scores from the Nasometer, the NasalView and the OroNasal System were compared. The data was collected from 50 normal participants and 19 hypernasal patients with cleft palate. The Nasometer had the lowest nasalance scores for the non‐nasal Zoo Passage and that the OroNasal System had the lowest nasalance scores for the Nasal Sentences. The nasalance distance was largest for the Nasometer and smallest for the OroNasal System. When the calculation was based on nasalance magnitudes, results for sensitivity ranged from 57.9% to 81.8% and results for specificity ranged from 62.0% to 76.0%. When the calculation was based on nasalance distances, results for sensitivity ranged from 84.2% to 100.0% and results for specificity ranged from 82.0% to 100.0%. Results suggest that nasalance scores from the three systems are not interchangeable. Diagnostic efficacy improved when the calculations were based on nasalance distances rather than magnitudes, but further research is warranted to corroborate these findings.