Nasality In Patients 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.

Nasality outcome in unilateral chronic rhinosinusitis following functional endoscopic sinus surgery

In this study we aimed to investigate the prevalence of abnormal nasality in patients with unilateral rhinosinusitis and their nasality outcomes following functional endoscopic sinus surgery (FESS). A total of 42 patients with unilateral chronic rhinosinusitis who underwent unilateral FESS between April 2016 and November 2017 were enrolled. Questionnaires on sinonasal symptoms and nasality were recorded. The change in the nasalance score of vowels [a], [i] [u], nasal consonant [m], 2 nasal syllable repetitions, and 2 Chinese sentences were measured. The patients were evaluated preoperatively, 6 months, and 12 months after the operation. The patients were divided into two groups, wide opening surgery and limited surgery, according to the severity of the disease. Among 42 patients, the subjective reports showed that one-third of unilateral chronic rhinosinusitis (CRS) patients had abnormal nasality preoperatively and significant improvement following FESS. The Lund-Mackay score was significantly negatively correlated with preoperative nasalance of [i] and positively correlated with change of nasalance of [i]. The increase in the value of [i] is statistically significant (p=0.01) following FESS. In the further subgroup analysis, the change in nasalance was significant in the wide opening surgery group, but not in the limited surgery group. Although only one side of the nasal airway was involved, one-third of the patients reported abnormal nasality. In patients with more disease severity who underwent wide opening surgery, the nasalance significantly increased 1 year after FESS. The increase in the objective nasalance score was corresponded to a significant improvement of subjective self-reported nasality assessment postoperatively.

Assessment of nasalance and nasality in patients with a repaired cleft palate

In patients with a repaired cleft palate, nasality is typically diagnosed by speech language pathologists. In addition, there are various instruments to objectively diagnose nasalance. To explore the potential of nasalance measurements after cleft palate repair by NasalView®, we correlated perceptual nasality and instrumentally measured nasalance of eight speech items and determined the relationship between sensitivity and specificity of the nasalance measures by receiver-operating characteristics (ROC) analyses and AUC (area under the curve) computation for each single test item and specific item groups. We recruited patients with a primarily repaired cleft palate receiving speech therapy during follow-up. During a single day visit, perceptive and instrumental assessments were obtained in 36 patients and analyzed. The individual perceptual nasality was assigned to one of four categories; the corresponding instrumental nasalance measures for the eight specific speech items were expressed on a metric scale (1–100). With reference to the perceptual diagnoses, we observed 3 nasal and one oral test item with high sensitivity. However, the specificity of the nasality indicating measures was rather low. The four best speech items with the highest sensitivity provided scores ranging from 96.43 to 100%, while the averaged sensitivity of all eight items was below 90%. We conclude that perceptive evaluation of nasality remains state of the art. For clinical follow-up, instrumental nasalance assessment can objectively document subtle changes by analysis of four speech items only. Further studies are warranted to determine the applicability of instrumental nasalance measures in the clinical routine, using discriminative items only.

Analysis of Nasalance in Patients with Chronic Rhinosinusitis

Background and Objectives: This study was designed to compare the nasalance between chronic rhinosinusitis (CRS) patients and normal controls and to determine the correlation of nasalance with nasal volume, nasal resistance, CT score, and polyp score in CRS patients. Materials and Methods: This study enrolled 150 CRS patients and 154 normal adults. All subjects underwent acoustic rhinometry and rhinomanometry. Nasalance scores were measured with the nasometer. All CRS patients were graded according to the Lund-Mackay CT staging system and the degree of nasal polyp. Results: Nasal volume was decreased and nasal resistance was increased in CRS patients compared with normal controls. However, the nasalance scores for oro-nasal and nasal passages were significantly higher in CRS patients compared with normal controls. In CRS patients, the nasalance score for the nasal passage showed positive correlation with nasal volume and negative correlation with nasal resistance and Lund-Mackay CT score. However, no significant correlation was found between nasalance score and endoscopic polyp score. Conclusion: Contrary to expectations, nasalance was increased in CRS patients despite decreased nasal volume and increased nasal resistance. Thus, nasal resonance likely depends on a multitude of factors other than changes in the sinonasal cavity.

Nasalance in patients with maxillary defects – Reconstruction versus obturation

An important question remains on how to obtain good quality of speech for patients needing maxillectomy. Oral and nasal spaces must be separated either by surgical means or by using an obturator-prosthesis. An objective measure of oronasal closure is nasalance. Different rehabilitative strategies should be compared. Between 1990 and 2000, 88 patients underwent maxillectomy of which 28 (32%) were available for examination. Ten patients had obturators (group l) and in 18 patients the maxilla was biologically reconstructed with different techniques (group 2). Sound pressure of nasal and oral airways were assessed seperately using a computerized sampling system (NasalView) and standardized German texts. Nasalance was calculated and compared with an uncompromised sample of patients. There were no significant differences between group 1 and group 2 concerning nasalance. Furthermore, the achieved values of nasalance were similar to healthy individuals. Nasalance after maxillectomy can be normal after sufficient rehabilitation.

The assessment of nasality with a nasometer and sound spectrography in patients with nasal polyposis

With the development of computerized acoustic analysis systems, an objective measure of nasal speech has become readily available by means of a simple, noninvasive technique. In this study, we assessed the nasality in patients with multiple nasal polyposis before and after endoscopic sinus surgery. With the nasometer, we measured nasalance, which reflects the ratio of acoustic energy output of nasal sounds from the nasal and oral cavities, and the slope score of the nasogram curve. The nasalance scores of nasal sentences and the slope scores of the nasogram curves for all nasal consonants were significantly lower in patients with nasal polyposis than in healthy subjects. After surgery, however, the nasalance and slope scores increased significantly to the normal range. On the sound spectrographic analysis, the frequencies of the first nasal formant decreased slightly and the sound intensity increased slightly for all nasal consonants after surgery. However, no significant change was noticed in the frequencies of the second nasal formant. In conclusion, nasometric and sound spectrographic analyses are considered to be useful tools for objectively assessing the extent of nasality in patients with nasal airway obstruction. (Otolaryngol Head Neck Surg 1997;117:343-8.)

A radiographic technique for demonstrating the causes of persistent nasality in patients with pharyngeal flaps

A radiographic technique for demonstrating the causes of persistent nasality in patients with pharyngeal flaps

The lateral velo-pharyngoplasty: A new method for the correction of open nasality

Summary After a short review of the most important surgical measures for the correction of open nasality in patients with cleft palate, our personal surgical technique is described. Using a Z-plasty, the lateral base of the pharyngopalatine arch is swung over upwardly and inwardly in exchange for a mucosal flap from the posterior pharyngeal wall. The palatopharyngeal muscle is thus transformed into an oval muscle sphincter, which actively closes the nasopharynx. The basic idea of the technique corresponds to the Orticochea Procedure in the construction of a dynamic muscle sphincter, but differs from it in its indication as well as in essential technical details. The application of the principles of Z-plasty ensures that no raw surfaces remain postoperatively, and that healing occurs fast and without complication. The indication for operation is limited to secondary treatment of the unfavourably preoperated cicatricial palate with poorly developed muscles. This method has, up to date, been utilised with success in 3 patients. It is being suggested as an alternative for the existing, more exhaustive and complicated procedures which, however, are often less effective.

A radiographic technique for demonstrating the causes of persistent nasality in patients with pharyngeal flaps

Summary Videofluoroscopy in multiple views was employed in a study of the nasopharynx in a series of patients with persistent velopharyngeal incompetence following pharyngeal flap surgery. This technique permits the visualisation of specific anatomical and physiological defects in the closure mechanism accounting for velopharyngeal incompetence. Incompetent closure mechanisms were observed to result from a variety of abnormalities of flap width, horizontal position and vertical level in relationship to the region of greatest lateral nasopharyngeal wall movement.

Radiological Evaluation Of Velopharyngeal Closure

<h3>To the Editor.—</h3> We wish to add some remarks to the reports (<b>216</b>:2075, 1971) of papers presented by Hogan and Zaborsky at the plastic surgery meeting in Williamsburg, Va, concerned with the success and failure of pharyngeal flaps in eliminating nasality in patients with cleft palate. To achieve velopharyngeal closure, a pharyngeal flap must occupy the space between the lateral pharyngeal walls at their maximum medial movement during phonation. Flap width must be related to the degree of movement of the lateral pharyngeal walls and, therefore, should be individually tailored to the patient. A patient with very active lateral walls and a mobile palate needs a narrow flap, while a subject with poor lateral wall movement needs a wide flap. If the lateral walls exhibit no motion a flap may not be the best treatment. Instead, methods of mechanically stimulating the lateral walls should first be used in an

Secondary lengthening of the soft palate using Millard's island flap technique

Summary A number of patients with nasality in speech after a cleft palate repair were treated by secondary lengthening of the palate with Millard's island flap method. The lengthening achieved was found to be permanent in the majority of cases, but the effective lengthening was limited to a maximum of approximately io mm. The cause of this phenomenon is discussed. It is thought that lengthening procedures ought to be included in the treatment of nasality in patients with a repaired cleft. The importance of preoperative radiographs of these patients, as being the only accurate and universally recordable assessment of the condition, is stressed.