Nasal Values Research Articles

Speech Outcome regarding Overall Intelligibility, Articulation, Resonance and Voice in Flemish Children a Year after Pharyngeal Flap Surgery

Objective: The main purpose of this study is to determine the treatment effectiveness of pharyngeal flap surgery by measuring speech outcome 1 year after surgery. The authors hypothesized that flap surgery is an effective technique for velopharyngeal inadequacy resulting in improved intelligibility, decreased hypernasality and nasalance scores and normal voice characteristics. Patients and Methods: Objective (Nasometer, Dysphonia Severity Index) as well as subjective (perceptual evaluations) assessment techniques were performed in 7 subjects. Speech evaluations were performed 1 year after flap surgery and comparison was made between the speech results of the preoperative condition (1 week before surgery) and the first postoperative condition (6 weeks after surgery). Results: After pharyngeal flap surgery there was improved though still slightly impaired intelligibility, with normal nasality, normal nasalance values for standard Flemish speech and normal voice characteristics. The normal nasality and nasalance values were not present in the preoperative condition. Persistence of the incorrect production of the thrill sound /r/ and the fricatives /s/ and /sch/ were observed. Conclusion: It is likely that the slightly impaired speech intelligibility is determined by the presence of persistent articulation disorders.

Sublingual immunotherapy-induced IL-10 production is associated with changed response to the decongestion test: Preliminary results

Sublingual immunotherapy (SLIT) has been shown to be capable of inducing a regulatory T-cell response as evidenced by IL-10 production. Decongestion testing consists of spraying an intranasal vasoconstrictor drug to evaluate the recovery of nasal airflow limitation. The aim of this study was to assess the association of SLIT-induced IL-10 production with nasal airflow recovery after decongestion testing. Nineteen patients with perennial allergic rhinitis (PAR) were studied: 9 patients successfully assumed SLIT for 3 years and 10 patients were considered as control. In vitro IL-10 production was evaluated after SLIT. Rhinomanometry and decongestion testing were performed in all subjects before and after 3 years. After 3 years, SLIT patients showed a significant decrease of nasal resistances (0.048) and reduced response to decongestion testing (p = 0.044 for absolute values and p = 0.0051 for delta). The comparison with nontreated allergic patients shows significant differences concerning both pretest values (p = 0.02) and delta percentages (p = 0.00466). In addition, the decrease of nasal airflow resistance values and the percentages of reversibility were significantly associated with IL-10 levels (p = 0.0016 and p = 0.00294, respectively). This preliminary study provides the first evidence of a changed response to decongestion testing after SLIT that is associated with IL-10 production in patients with PAR.

Die diagnostische Wertigkeit der Nasometrie – eine repräsentative Studie für Patienten mit Lippen-Kiefer-Gaumensegel-Spalten und Gesunde

In the rehabilitation of cleft palate patients the quality of spoken language represents one of the most important aspects of successful social integration. It is therefore necessary to direct special attention to phoniatric care and speech therapy following operative reconstruction. One of the main problems is the comparison of subjective and objective measures of the degree and type of nasal disorder. In an interdisciplinary project at the University of Jena nasometry was assessed. Due to a lack of norm values for German a representative sample for the calibration of cleft palate patients and normal subjects was collected. Speech was elicited using standardized and phonetically validated reading materials. Nasalance measurements were compared with judgements made by a group of trained listeners who were asked to assess voice quality (RBH) and nasality. A database containing nasalance values and acoustic signals from 120 subjects was built up. The results generally exhibited highly significant correlations between instrumental measurements and auditory judgements. Profiles of norm values for a phonetically and statistically reliable standard for German were obtained, which in turn can be used as a comparative basis for further studies.

Modifizierter Edrophonium-Test: Instrumentelle Messungen der Nasalität zur Objektivierung des Edrophonium-Tests

Oropharyngeal myasthenia is characterized by hypernasality which is a consequence of velar dysfunction. In myasthenia gravis the administration of edrophonium is expected to improve velar function by chemically enhancing the signal transmission at the motor end plate. During the edrophonium test hypernasality is analysed only auditorily without the use of objective data. We propose a modified edrophonium test and aim to quantify changes in velar function by measuring oral and nasal airflow with the Rothenberg mask. This mask is divided into an oral and a nasal chamber to register changes of airflow separately. Five patients with myasthenia gravis and a control group of four patients were analysed. After administration of edrophonium we found improvements of velar function in myasthenic patients who exhibited pathological nasality values at baseline. Two myasthenic patients evolved as being sufficiently medicated and showed no effect of the additional edrophonium. A worsening of velar function was measured for the other controls except for one patient with multiple system atrophy. The modified edrophonium test furnishes objective measurements of nasality and allows one to quantify changes in velar movements. It is a complementary diagnostic tool to differentiate myasthenia gravis from other neurogenic aetiologies and also offers the possibility to optimise the dosage of pyridostigmine to optimally treat myasthenia gravis.

Nasalanz- und Nasalitätsmessungen bei Patienten mit Spaltfehlbildungen

The aim of this study was the evaluation of the speech quality of patients with cleft lip or cleft palate after surgical treatment at the Department of Maxillofacial Surgery Freiburg (MKG). Their speech was compared to that of non-affected persons with respect to its acoustic and perceptual quality. Quantitative nasalance measurements were made for the two groups of patients (cleft lip and cleft palate) and the control group using the NasalView ® , an instrument that computes the proportion of nasal to oral energy in the speech signal, and compared. In addition, the perceptual quality of the speech of the cleft palate patients was tested by presenting speech samples of the cleft palate patients to a group of trained and untrained listeners for perceptual assessment which provided nasality values. The obtained nasality data were put into correlation with the nasalance values. In total, 68 persons were investigated: 19 children and adults with repaired cleft lip, 15 children and adults with repaired cleft palate and 34 age and sex matched non-affected persons. The study was carried out at the clinic Freiburg. Measurements of nasalance and nasality were made using the modified Heidelberg Rhinophonia Assessment (HBRB) focusing on differences between the three investigated groups. In addition, the results were separately analysed according to sex and age.The results showed significantly higher nasalance values for the patients with cleft palate as compared to the other two groups but only concerning speech material without nasal sounds. In speech material with nasal sounds this difference could not be detected. In parallel to these results, the cleft palate patients also showed increased nasality values. Both sets of data, i.e. the objectively measured nasalance values and the subjective nasality values, were highly correlated. The results of the nasalance and nasality measurements demonstrated differences in speech for the cleft palate patients compared to the other 2 groups. Due to this investigation, basic reference nasalance values for measurements with the NasalView ® could be set up.

Application of computer aided design and rapid prototyping technology for defected maxilla restoration

To test a new cast-making method based on computer aided design (CAD) and rapid prototyping (RP) technology for defected maxilla. Head CT data of 12 patients with defected maxilla were transmitted into a computer. Three-dimensional digital image of the patient's defected maxilla was then obtained based on Mimics 8.11 and Geomagic 7.0 and the plastic cast of the defected region was manufactured by prototyping. The obturator was made on this plastic cast that duplicated the undercut tissue of defected area. The prominent part of the obturator was made of elastic heat-curing resin and it was helpful to gain the retention through the engagement between the obturator and the tissue undercut. After the obturator was finished, the upper removable partial denture was fabricated in conventional method. The combination of these two parts was achieved using magnetic attachment. Clinical effects of obturator and removable partial denture were evaluated and the nasalance value of 5 patients before and after insertion of the obturator was measured using nanometer. The obturator and removable partial denture could be seated into place separately. They all had good retention and stability. After the obturator was seated in place, the nasalance of non-nasal and vowel text decreased from (46.53 +/- 13.86)% to (22.60 +/- 8.52)% (P < 0.001). The cast-making method based on CAD and RP technology for cast-making of defected maxilla is feasible and practical.

The Effects of Frequency Range, Vowel, Dynamic Loudness Level, and Gender on Nasalance in Amateur and Classically Trained Singers

This study addresses two questions: (1) How much nasality is present in classical Western singing? (2) What are the effects of frequency range, vowel, dynamic level, and gender on nasality in amateur and classically trained singers? The Nasometer II 6400 by KayPENTAX (Lincoln Park, NJ) was used to obtain nasalance values from 21 amateur singers and 25 classically trained singers while singing an ascending five-tone scalar passage in low, mid, and high frequency ranges. Each subject sang the scalar passage at both piano and mezzo-forte dynamic loudness levels on each of the five cardinal vowels (/a/, /e/, /i/, /o/, /u/). A repeated mixed-model analysis indicated a significant main effect for the amateur/classically trained distinction, dynamic loudness level, and vowel, but not for frequency range or gender. The amateur singers had significantly higher nasalance scores than classically trained singers in all ranges and on all vowels except /o/. Dynamic loudness level had a significant effect on nasalance for all subject groups except for female majors in the mid- and high-frequency ranges. The vowel, /i/, received significantly higher nasalance than all of the other vowels. Although results of this study show that dynamic loudness level, vowel, and level of training in classical singing have a significant effect on nasality, nasalance scores for most subjects were relatively low. Only six of the subjects, all of whom were amateur singers, had average nasalance scores that could be considered hypernasal (ie, a nasalance average of 22 or above).

Response of the Female Vocal Quality and Resonance in Professional Voice Users Taking Oral Contraceptive Pills: A Multiparameter Approach

The purpose of this study was to analyze the vocal quality and resonance (nasality and nasalance values) during the menstrual cycle in professional voice users using oral contraceptive pills (OCPs). Although professional voice users are more sensitive and aware of their vocal quality, no changes of voice and resonance characteristics were expected because OCPs create a stable hormonal balance throughout the menstrual cycle. The authors conducted a comparative study of 24 healthy, young professional voice users using OCPs. One assessment was performed between the 10th and 17th day of pill intake, when hormonal levels reached a steady state. The second assessment was performed during the first 3 days of menses, when no pills were taken and hormonal levels were minimized. Subjective (perceptual evaluation of voice and nasality) and objective (aerodynamic, voice range, acoustic, Dysphonia Severity Index [DSI], nasometer) assessment techniques were used. : The Mann-Whitney U test showed no significant difference between the perceptual evaluation of the voice and the nasality in the two assessments. The paired Student t test showed no significant difference regarding the maximum phonation time, the vocal performance, the acoustic parameters, and the DSI. These findings indicate that OCPs do not have an impact on the objective and subjective voice and resonance parameters in young professional voice users. This information is specifically relevant to professional voice users who are more aware of vocal quality changes and ear, nose and throat specialists/voice therapists who treat professional voice users with voice problems/disorders. Further research regarding the impact of increased vocal load during the premenstrual or menstrual phase in professional voice users using OCPs should be considered.

Noninvasive methods for the detection of upper and lower airway inflammation in atopic children

Exhaled nitric oxide (FE(NO)) and exhaled breath condensate (EBC) are noninvasive methods to assess inflammation. To investigate the role of the FE(NO) and of the EBC pH and IL-5 levels in atopic children. We evaluated oral and nasal FE(NO) and the pH and IL-5 of oral and nasal EBC in children with atopic dermatitis (AD; n = 18), allergic rhinitis (AR; n = 18), intermittent asthma (n = 21), moderate persistent asthma (n = 18), and healthy controls (HCs; n = 16). Oral FE(NO) was significantly increased in asthma, whereas the nasal values were increased in AR and asthma in comparison with HCs. The pH of oral EBC was lower in AD and asthma than in AR and HCs, whereas the nasal levels were lower in AD, AR, and asthma than in HCs. The oral IL-5 was higher in AD, AR, and asthma in comparison with HCs, whereas the nasal IL-5 concentrations were higher in asthma and AR than in HCs. In AR, the nasal FE(NO) correlated with the IL-5 values and with the disease duration. In intermittent asthma, oral and nasal pH inversely correlated with the exacerbations, whereas in moderate asthma, the nasal IL-5 positively correlated with exacerbations. In AD, the oral and nasal IL-5 positively correlated with the serum IgE. These markers of nasal and bronchial inflammation, accessible with noninvasive techniques, might be useful to identify patients with uncontrolled diseases and to verify the usefulness of new therapeutic approaches. These markers are useful tools to monitor the upper and lower airway inflammation in atopic children.

Enhanced Imaging Algorithm for Scanning Laser Polarimetry with Variable Corneal Compensation

To describe and investigate a method of improving assessment of retinal nerve fiber layer (RNFL) morphology with scanning laser polarimetry (SLP) with variable corneal compensation (VCC). By neutralizing anterior segment birefringence with a variable compensator, the current VCC method allows direct measurement of RNFL retardation. In the new method, enhanced corneal compensation (ECC), the variable compensator was set to introduce a "bias" birefringence. This bias was removed mathematically for each individual pixel to produce the RNFL image. In 177 eyes of healthy subjects, patients with glaucoma, and subjects with ocular hypertension, retardation images were obtained with both VCC and ECC. In the tested eyes, images obtained with ECC showed the expected RNFL appearance better than those obtained with VCC. In addition, the typical scan score, which quantifies the amount of atypia, was higher with ECC than with VCC. The amount of residual anterior segment birefringence dropped significantly with ECC in the various groups. Measurements of peripapillary RNFL retardation showed reduced temporal and nasal values with ECC, whereas superior and inferior values were not significantly different between VCC and ECC. The dynamic range appeared to have increased with ECC. The accuracy of the TSNIT (temporal, superior, nasal, inferior, temporal) average and inferior average for detecting glaucoma was higher with ECC than with VCC. RNFL morphology may be better assessed with the presented ECC method than with standard VCC. ECC may be implemented in the current VCC systems by means of a software upgrade. It may enhance the clinical utility of the GDx VCC in glaucoma management.

Changes in Nasal Resonance after Functional Endoscopic Sinus Surgery

Hyponasality may be present in patients with chronic rhinosinusitis because of decreased resonance of nasal cavities. Nasalance is a parameter of nasality measured by a nasometer. This study investigated the influence of functional endoscopic sinus surgery (FESS) on nasalance and determined the correlation of the nasalance change with nasal volume change. When patients with chronic rhinosinusitis underwent FESS, nasalance was measured by nasometry and nasal volume was measured by acoustic rhinometry before and at least 6 months after surgery. There were 81 eligible patients enrolled in the study. Nasalance scores and nasal volumes were significantly increased after FESS. The increased nasalance value was moderately correlated with the increased midnasal and postnasal volumes. The correlation between postoperative changes in nasalance scores and nasal volumes was more remarkable in patients without nasal polyps than in those with nasal polyps and it was also higher in patients with allergic rhinitis than in those without allergic rhinitis. This study showed that the FESS effectively increased nasalance scores and nasal volumes in patients with chronic rhinosinusitis, but the increase in nasalance scores did not appear to be achieved largely through the increased nasal volumes.

The impact of mandibular advancement on articulation, resonance and voice characteristics in Flemish speaking adults: a pilot study

Bilateral saggital split osteotomy (BSSO) of the mandible is a frequently performed mandibular orthognathic procedure, used to resolve mandibular disharmonies. Literature review showed contradictory findings regarding the effect of the orthognathic surgery on speech characteristics. The purpose of the present study was to determine a detailed analysis of the articulation, resonance and voice characteristics after BSSO with mandibular advancement for the treatment of Class II malocclusions using objective and subjective assessment techniques (perceptual evaluations, Dysphonia Severity Index, nasalance scores) in eight subjects. The findings of the present study indicate that before and after BSSO with mandibular advancement three types of articulation disorders may predominate in the Flemish language: the incorrect production of the trill sound /r/ and the /s/ sound and devoicing of the /z/. After orthognathic surgery most patients showed an identical articulation pattern (normal or disturbed pattern) as in the presurgical condition. In this study the BSSO with mandibular advancement had no significant impact on the nasality characteristics and the nasalance values probably due to the competent velopharyngeal valving in the presurgical condition. And, as expected the vocal quality revealed no significant difference. The maxillofacial surgeon and the speech language pathologist must be aware of the persistency of these preoperative articulation errors in the postsurgical condition.

Olfactometric and rhinomanometric outcomes in post-menopausal women treated with hormone therapy: a prospective study

BACKGROUND: The aim of this prospective study was to evaluate the effects of hormone therapy (HT) on olfactory sensitivity in post-menopausal women. METHODS: Forty-six naturally post-menopausal women underwent rhinomanometric and olfactometric measurements to compare nasal airflow resistance values and olfactometric thresholds during the eighth month of HT treatment with baseline levels prior to starting HT. Eighteen women used an oral HT regimen, and twenty-eight women used transdermal patch HT. RESULTS: Rhinomanometric values during HT were statistically different from those at baseline (P < 0.001). Olfactometric threshold data indicated a higher sensitivity during the HT treatment than at baseline (P < 0.001). Finally, no statistically significant difference was observed among women using oral or patch HT administration on rhinomanometric and olfactometric values. CONCLUSIONS: Our study demonstrates that 8 months of treatment with estrogen and progestogens in HT preparations has an effect on nasal airflow resistance and the olfactory thresholds to odours. We believe that estrogens could influence neuronal plasticity, and the neuronal conduction time into the olfactory system. Our findings confirm that gonadal steroids such as estrogen have an influence on non-genital targets; this relationship might have a beneficial impact on sensorineural communication and emotional behaviour.

Evaluation of Oral and Nasal Odor in Patients with and without Cleft Lip and Palate: Preliminary Report

To evaluate oral and nasal halitosis parameters in patients with and without clefts. Randomized and prospective study. Patients with and without clefts were evaluated as to oral and nasal halitosis. University of São Paulo, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Brazil. Twelve patients with clefts and 12 without clefts were evaluated, and no exclusion criteria were followed. Nasal and oral halitosis were measured with the use of a portable sulfide monitor during a single visit. One hundred percent of the patients with clefts had altered values for volatile sulfur compounds. Only 33.3% of the patients without clefts had at least one strong value for nasal halimeter measurements, and 58.3% of these patients showed alteration in the nasal values. Statistical evaluation, made using the Mann-Whitney U test, classifying the nasal halimeter values as normal, weak, and strong, showing a statistical significant group difference (p = .003). There was no significant difference in the oral halimeter values between the two groups. Patients with cleft lip and palate had a tendency to present higher values for the nasal halimeter measurements, when compared with patients without clefts.

Objectivating nasality in healthy and velopharyngeal insufficient children with the Nasalance Acquisition System (NasalView ®) : Defining minimal required speech tasks assessing normative values for Dutch language

Objectives: (1) To define normative nasalance data for Dutch language with “the NasalView System”, and obtain a reference for normality when nasality is evaluated in children. (2) To investigate the minimal number of required speech tasks for a reliable nasalance measurement. Methods: 55 children (30 normal and 25 velopharyngeal insufficient), aged between 4 and 11 were included. All children had to read or repeat two Dutch passages ((one with a normal amount of nasal consonants (normal passage) and one with none (nonnasal passage)). Further, one normal and one velopharyngeal insufficient subject read a passage in repetition to test the NasalViews reproducibility: (1) For both passages, group means (GM) and standard deviations (S.D.) were used to compute “pathological nasalance boundaries” [GM ± (2×S.D.)], in combination with the coefficient of variation (CV), sensitivity, specificity and positive predictive values. (2) With ANOVA all sentences within each passage were tested for significant differences in nasalance. Results: (1) The pathological boundaries were 28.6–41.4% (GM: 35.0) and 21.4–34.7% (GM: 28.1), for the normal and nonnasal passage, respectively. For the normal passage a sensitivity of 96%, a specificity of 93% and a positive predictive value of 92% was computed. For the nonnasal passage these parameters were 96, 95 and 96%, respectively. Intra subject CVs of 3.6% (normal subject) and 1.5% (VI subject) showed good reproducibility of measurements. (2) Within the normal passage only the third sentence was significantly different in nasalance, compared to the entire passage (31.2% versus 35.0%). Within the nonnasal passage the second and fifth sentences were significantly different (23.8 and 24.8% versus 28.1%). However, the individual nonsignificantly different sentences showed a higher variation in nasalance compared to the entire passages. Conclusions: The NasalView System seems to be reliable and quantifies valid nasalance values when nasality is evaluated. Within both passages high levels of sensitivity, specificity and positive predictive values were obtained. The nonnasal passage discriminates slightly better for hypernasal speech. For the most reliable nasalance measurements, the entire passage should be used.

The long-term speech outcome in Flemish young adults after two different types of palatoplasty

Objective: The success of cleft palate surgery is specifically determined by the subsequent speech characteristics. There are several types of surgical techniques to repair the palate. The surgeon chooses his or her own technique according to the principles (s)he have established based on experience. The main purpose of this study is to determine and to compare the long-term speech outcome (18 years after surgery) regarding overall intelligibility, articulation, resonance, and voice after one-stage Wardill–Kilner palatoplasty or two-stage Furlow palatoplasty. The authors hypothesized that a decreased overall intelligibility, more compensatory articulation disorders, higher nasalance values and more nasality disorders would occur in the two-stage Furlow palatoplasty. Moreover, an increased risk for dysphonic symptoms, caused by the more intensive vocal tract activities, were expected in subjects with higher nasalance scores. An additional objective of this study was to compare the speech and voice characteristics with the age related normative data. Significant differences between the resonance and voice characteristics of the two techniques of palatoplasty and the normative data were hypothesized. Methods: Objective as well as subjective assessment techniques were used. The evaluation of the articulation included a phonetic inventory and a relational analysis in which the consonant and vowel productions were compared with target productions and analyzed for error types at the segmental level. The speech samples were perceptually judged for intelligibility and nasality. The Nasometer was used for the objective measurement of the nasalance values. The assessment of the voice included a perceptual evaluation and a determination of the Dysphonia Severity Index. Results: The subjects who received a two-stage Furlow palatoplasty showed statistically more hypernasality and higher nasalance scores in comparison with the one-stage Wardill–Kilner palatoplasty. No major differences regarding articulation and voice characteristics were found. As expected, significant differences were found between the speech intelligibility and resonance characteristics in subjects who received a palatoplasty and the normative data. Conclusion: Since the subjects who received a one-stage Wardill–Kilner palatoplasty had a significantly better speech outcome it was decided in the craniofacial team of the University Hospital of Ghent that a two-stage palatoplasty would no longer be performed.

Nasalance scores for normal-speaking Irish children.

To obtain normal nasalance values during the production of a standardized speech sample for Irish children and determine whether significantly different scores exist for different speech stimuli for female and male speakers. Mean nasalance scores were obtained for normal-speaking children during the repetition of 16 test sentences that were categorized according to consonant type within the sentences (high-pressure consonants, low-pressure consonants, nasal consonants). Seventy children (36 girls and 34 boys, aged 4 years 11 months to 13 years) with normal articulation, resonance, and voice were included. Children repeated each of the 16 test sentences individually. The sentences were presented in groups according to consonant type, referred to as sentence categories. Data were collected and analyzed using the Kay nasometer (model 6200.3). Nasalance scores were obtained for the total speech sample and each sentence category. Data were statistically analyzed to investigate the effects of gender, sentence category, and gender by sentence category. Normative nasalance scores were obtained for the total speech sample (26%), high-pressure consonant sentences (14%), low-pressure consonant sentences (16%), and a nasal consonant sentence (51%). There was no significant difference in nasalance scores between male and female speakers. Significant differences were found between each sentence category (p </=.001), except between the high-pressure and low-pressure consonant sentence categories (p =.09). The present study provides normative nasalance data for English-speaking Irish children. There was a significant difference between nasalance scores for different speech stimuli.

Functional outcomes after primary oropharyngeal cancer resection and reconstruction with the radial forearm free flap.

To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes, as well as preliminary swallowing data, in patients having reconstruction with radial forearm free flaps after primary resection for oropharyngeal cancer. Prospective cohort study. Acoustical, aeromechanical, and perceptual speech data and swallowing data were gathered at three evaluation times (preoperatively and before and after radiation therapy) for patients treated for oropharyngeal cancer by means of primary resection and reconstruction with a radial forearm free flap. Degree of involvement of the soft palate and base of tongue, along with reconstructive techniques, were entered as between-group factors in the analysis. There were no significant differences in speech intelligibility between the patient groups based on the degree of palate and tongue resected. However, patients with resections of half or more than half of the soft palate had significantly higher nasalance values and larger velopharyngeal orifice areas than individuals who had less than half of the soft palate resected. Significant within-subject differences were revealed across evaluation times for the dependent variables nasalance, velopharyngeal orifice area, and word intelligibility. Ninety-four percent of the patients were able to resume a normal or soft diet. There was a 6% incidence of aspiration in 128 swallows that were analyzed. The amount of base of tongue resected did not significantly affect any of the speech or swallowing parameters. Radial forearm free flaps are a good reconstructive option after oropharyngeal cancer extirpation. Our acoustic and aeromechanical results indicated that issues related to quality of the speech signal require further study for resections of half or more than half of the soft palate.

Outcome of Treatment regarding Articulation, Resonance and Voice in Flemish Adults with Unilateral and Bilateral Cleft Palate

The purpose of this study was to evaluate the outcome regarding speech intelligibility, articulation, nasalance, nasality and voice in adult cleft palate patients. An additional objective of this study was to delineate the impact of a unilateral versus bilateral cleft lip and palate on speech outcome and to compare the nasalance and nasality patterns of cleft palate adults with data from non-cleft subjects. Objective (nasalance values obtained by the Nasometer, mirror-fogging test according to Glatzel and the determination of the dysphonia severity index, DSI) and subjective assessment techniques (perceptual evaluation of speech, nasality and voice, the Bzoch tests and the Gutzmann test) were used. All 14 subjects with a complete unilateral or bilateral cleft lip and palate consulted the same craniofacial team, followed an identical surgical protocol, completed the surgical cleft palate treatments and followed speech therapy. Most of the patients had a fairly satisfactory outcome with normal speech intelligibility, but three types of articulation errors seemed to predominate. More than one half of the subjects demonstrated hypernasality. In comparison with the non-cleft normative data, statistically higher nasalance values were obtained in the cleft group. The subjects had a DSI score that corresponds with a normal or slightly impaired voice quality. No significant differences regarding speech outcome were found between subjects with a unilateral or bilateral cleft lip and palate. The results provide important information for speech-language pathologists to evaluate and improve speech outcome in cleft palate patients.

Nasalance Changes After Functional Endoscopic Sinus Surgery

Forty adult patients diagnosed with chronic rhinosinusitis who underwent functional endoscopic sinus surgery (FESS), were analyzed with respect to postoperative resonatory voice changes. For evaluation the patients were asked about their subjective impression of voice changes using a questionnaire. An objective assessment was performed by determining the so-called nasalance using the Nasometer® (Kay Elemetrics), preoperatively, on the immediate postoperative follow-up (2 days after surgery), and approximately 1 month after surgery. The mean nasalance values increased significantly one month after FESS whereas the immediate postoperative control (2 days after surgery) showed a decrease of nasalance. Although FESS is a minimally invasive procedure, it can change the acoustic characteristics of the vocal tract in the long term and produce a significant increase in nasality. The authors strongly recommend that clinicians inform all patients, in particular voice professionals, about the possible effects of endonasal sinus surgery on voice quality.