Perceptual Speech Assessment Research Articles

Cognitive and Physiological Measures of Listening Effort During Degraded Speech Perception: Relating Dual-Task and Pupillometry Paradigms.

Purpose Listening effort is quickly becoming an important metric for assessing speech perception in less-than-ideal situations. However, the relationship between the construct of listening effort and the measures used to assess it remains unclear. We compared two measures of listening effort: a cognitive dual task and a physiological pupillometry task. We sought to investigate the relationship between these measures of effort and whether engaging effort impacts speech accuracy. Method In Experiment 1, 30 participants completed a dual task and a pupillometry task that were carefully matched in stimuli and design. The dual task consisted of a spoken word recognition task and a visual match-to-sample task. In the pupillometry task, pupil size was monitored while participants completed a spoken word recognition task. Both tasks presented words at three levels of listening difficulty (unmodified, eight-channel vocoding, and four-channel vocoding) and provided response feedback on every trial. We refined the pupillometry task in Experiment 2 (n = 31); crucially, participants no longer received response feedback. Finally, we ran a new group of subjects on both tasks in Experiment 3 (n = 30). Results In Experiment 1, accuracy in the visual task decreased with increased signal degradation in the dual task, but pupil size was sensitive to accuracy and not vocoding condition. After removing feedback in Experiment 2, changes in pupil size were predicted by listening condition, suggesting the task was now sensitive to engaged effort. Both tasks were sensitive to listening difficulty in Experiment 3, but there was no relationship between the tasks and neither task predicted speech accuracy. Conclusions Consistent with previous work, we found little evidence for a relationship between different measures of listening effort. We also found no evidence that effort predicts speech accuracy, suggesting that engaging more effort does not lead to improved speech recognition. Cognitive and physiological measures of listening effort are likely sensitive to different aspects of the construct of listening effort. Supplemental Material https://doi.org/10.23641/asha.16455900.

Predictors of Success After Furlow Palatoplasty for Repair of Cleft Palate: Does Syndrome Matter?

To determine predictors of success following Veau 1 and 2 cleft palate repair in patients with and without syndromes. Retrospective review of prospectively collected data. Tertiary care children's hospital. All children <18 months of age undergoing Furlow palatoplasty for Veau 1 and 2 cleft repair between 2000 and 2014 with postoperative perceptual speech assessment (PSA). In total, 368 consecutive patients were identified; 95 were excluded, resulting in 273 patients. Median age at surgery was 13.0 months (interquartile range [IQR], 11-15 months) with postoperative PSA at a median of 32.3 months (IQR, 26.3-44.5 months). Fifty patients (18.3%) had syndrome diagnosis; 59 patients (21.6%) had nonsyndromic Robin sequence. Velopharyngeal insufficiency (VPI) occurred in 27 patients (10.5%); 13 underwent secondary speech surgery. Cleft-related speech errors occurred in 46 patients (17.6%). Non-cleft-related speech errors occurred in 155 patients (59.6%) and reduced intelligibility in 127 patients (47.9%). Oronasal fistula occurred in 23 patients (8.8%) and was exclusive to Veau 2 clefts. In multivariate analysis, age >13 months at palatoplasty demonstrated a 6-fold higher rate of VPI (hazard ratio [HR], 6.64; P < .01), worse speech outcomes (HR, 6.04; P < .01; HR, 1.60; P < .01; HR, 1.57; P = .02), and greater speech therapy utilization (HR, 2.18; P < .01). VPI occurred in 10% of patients undergoing Furlow palatoplasty repair of Veau 1 or 2 clefts. Age <13 months at palatoplasty was associated with improved speech outcomes and lower VPI incidence (2.8% vs 16.2%). Syndromic diagnosis was associated with noncleft speech errors and reduced intelligibility on univariate analysis but not velopharyngeal function after palatoplasty.

İşitme cihazı kullanan çocuklarda gürültüde konuşmayı anlama becerisinin değerlendirilmesi: Preliminer sonuçlar

Assessment of speech perception in noise in children with hearing aids: Preliminary results* Objective: Noisy environments are a part of the daily life of children, just like adults. Children with hearing loss who wear hearing aids are more susceptible to the negative effects of noise than their normal-hearing peers. This study aims to evaluate the speech recognition in noise performance of hearing aid users and compare them with their normal-hearing peers. Material and Method: Five children aged 6-12 years with bilateral moderate to severe symmetrical sensorineural hearing loss and using bilateral behind-the-ear hearing aids were included in the study. 4 different conditions of the Turkish HINT-C were applied, and a speech recognition threshold (SRT) is determined for each condition. Results: Regardless of their age, the SRT needed by children with hearing aids to achieve equal performance with their normal-hearing peers was found to be higher for all test conditions. As seen in children with normal hearing in general, the mean noise front score of the children with hearing loss was higher than the mean noise right and noise left scores. Conclusion: The results of this study revealed that children with bilaterally symmetrical moderate to severe hearing loss achieved poor speech recognition scores in environments similar to the classroom environment, compared to their normal-hearing peers. Our results guided appropriate rehabilitation and follow-up. Keywords: noise, speech recognition in noise, hearing loss, hearing aid, pediatric audiology, HINT, HINT-C

Teaching Children With Hearing Loss to Recognize Speech: Gains Made With Computer-Based Auditory and/or Speechreading Training.

Transfer appropriate processing (TAP) refers to a general finding that training gains are maximized when training and testing are conducted under the same conditions. The present study tested the extent to which TAP applies to speech perception training in children with hearing loss. Specifically, we assessed the benefits of computer-based speech perception training games for enhancing children's speech recognition by comparing three training groups: auditory training (AT), audiovisual training (AVT), and a combination of these two (AT/AVT). We also determined whether talker-specific training, as might occur when children train with the speech of a next year's classroom teacher, leads to better recognition of that talker's speech and if so, the extent to which training benefits generalize to untrained talkers. Consistent with TAP theory, we predicted that children would improve their ability to recognize the speech of the trained talker more than that of three untrained talkers and, depending on their training group, would improve more on an auditory-only (listening) or audiovisual (speechreading) speech perception assessment, that matched the type of training they received. We also hypothesized that benefit would generalize to untrained talkers and to test modalities in which they did not train, albeit to a lesser extent. Ninety-nine elementary school aged children with hearing loss were enrolled into a randomized control trial with a repeated measures A-A-B experimental mixed design in which children served as their own control for the assessment of overall benefit of a particular training type and three different groups of children yielded data for comparing the three types of training. We also assessed talker-specific learning and transfer of learning by including speech perception tests with stimuli spoken by the talker with whom a child trained and stimuli spoken by three talkers with whom the child did not train and by including speech perception tests that presented both auditory (listening) and audiovisual (speechreading) stimuli. Children received 16 hr of gamified training. The games provided word identification and connected speech comprehension training activities. Overall, children showed significant improvement in both their listening and speechreading performance. Consistent with TAP theory, children improved more on their trained talker than on the untrained talkers. Also consistent with TAP theory, the children who received AT improved more on the listening than the speechreading. However, children who received AVT improved on both types of assessment equally, which is not consistent with our predictions derived from a TAP perspective. Age, language level, and phonological awareness were either not predictive of training benefits or only negligibly so. The findings provide support for the practice of providing children who have hearing loss with structured speech perception training and suggest that future aural rehabilitation programs might include teacher-specific speech perception training to prepare children for an upcoming school year, especially since training will generalize to other talkers. The results also suggest that benefits of speech perception training were not significantly related to age, language level, or degree of phonological awareness. The findings are largely consistent with TAP theory, suggesting that the more aligned a training task is with the desired outcome, the more likely benefit will accrue.

Benefit of Musical Training for Speech Perception and Cognition Later in Life.

Purpose The aim of this study was to determine the long-term associations of musical training with speech perception in adverse conditions and cognition in a longitudinal cohort study of middle-age to older adults. Method This study is based on Epidemiology of Hearing Loss Study participants. We asked participants at baseline (1993-1995) about their musical training. Speech perception (word recognition in competing message; Northwestern University Auditory Test Number 6), cognitive function (cognitive test battery), and impairment (self-report or surrogate report of Alzheimer's disease or dementia, and/or a Mini-Mental State Examination score ≤ 24) were assessed up to 5 times over the 20-year follow-up. We included 2,938 Epidemiology of Hearing Loss Study participants who had musical training data and at least one follow-up of speech perception and/or cognitive assessment. We used linear mixed-effects models to determine associations between musicianship and decline in speech perception and cognitive function over time and Cox regression models to evaluate associations of musical training with 20-year cumulative incidence of speech perception and cognitive impairment. Models were adjusted for age, sex, and occupation and repeated with additional adjustment for health-related confounders and education. Results Musicians showed less speech perception decline over time with stronger effects in women (0.16% difference, 95% confidence interval [CI] [0.05, 0.26]). Among men, musicians had, on average, better speech perception than nonmusicians (3.41% difference, 95% CI [0.62, 6.20]) and were less likely to develop a cognitive impairment than nonmusicians (hazard ratio = 0.58, 95% CI [0.37, 0.91]). Conclusions Musicians showed an advantage in speech perception abilities and cognition later in life and less decline over time with different magnitudes of effect sizes in men and women. Associations remained with further adjustment, indicating that some degree of the advantage of musical training is independent of socioeconomic or health differences. If confirmed, these findings could have implications for developing speech perception intervention and prevention strategies. Supplemental Material https://doi.org/10.23641/asha.14825454.

Through-and-Through Dissection of the Soft Palate for Pharyngeal Flap Inset: A "Good-Fast-Cheap" Technique for Any Etiology of Velopharyngeal Incompetence.

Objective:To determine the efficacy and resource utilization of through-and-through dissection of the soft palate for pharyngeal flap inset for velopharyngeal incompetence (VPI) of any indication.Design:Retrospective review.Setting:Tertiary care center.Patients:Thirty patients were included. Inclusion criteria were diagnosis of severe VPI based on perceptual speech assessment, confirmed by nasoendoscopy or videofluoroscopy; VPI managed surgically with modified pharyngeal flap with through-and-through dissection of the soft palate; and minimum 6 months follow-up. Patients with 22q11.2 deletion syndrome were excluded.Intervention:Modified pharyngeal flap with through-and-through dissection of the soft palate.Main Outcome Measure(s):Velopharyngeal competence and speech assessed using the Speech-Language Pathologist 3 scale.Results:The median preoperative speech score was 11 of 13 (range, 7 to 13), which improved significantly to a median postoperative score of 1 of 13 (range 0-7; P < .001). Velopharyngeal competence was restored in 25 (83%) patients, borderline competence in 3 (10%), and VPI persisted in 2 (7%) patients. Complications included 1 palatal fistula that required elective revision and 1 mild obstructive sleep apnea that did not require flap takedown. Median skin-to-skin operative time was 73.5 minutes, and median length of stay (LOS) was 50.3 hours.Conclusions:This technique allows direct visualization of flap placement and largely restores velopharyngeal competence irrespective of VPI etiology, with low complication rates. Short operative time and LOS extend the value proposition, making this technique not only efficacious but also a resource-efficient option for surgical management of severe VPI.

Is High-Intensity Speech Intervention Better? A Comparison of High-Intensity Intervention Versus Low-Intensity Intervention in Children With a Cleft Palate.

Purpose The purpose of this study was to compare the effect of speech intervention provided with a low intensity with speech intervention provided with a high intensity on the speech and health-related quality of life (HRQoL) in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years. Method A longitudinal, prospective, randomized controlled trial with a multiple baseline design was used. Twelve children with a CP ± L (M age = 8.0 years, SD = 1.54) were divided into two groups using block randomization stratified by age and gender: One group received low-intensity speech intervention (LISI; n = 6) and one group received high-intensity speech intervention (HISI; n = 6). Children in the LISI group received intervention with a session duration of 1 hr, a dose frequency of 1 session per week, and a total intervention duration of 10 weeks. Children in the HISI group received intervention with a session duration of 1 hr, a dose frequency of 5 sessions per week, and a total intervention duration of 2 weeks. The cumulative intervention intensity was kept constant. Both groups received identical therapy programs provided by the same experienced speech therapist. Perceptual speech assessments were performed on baseline and posttreatment data points. Changes in HRQoL were assessed using the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) questionnaire. Both groups were compared over time using (generalized) linear mixed models. Results No significant Time × Group interactions were observed for the percentage of correctly produced consonants at the word and sentence levels, indicating no differences in evolution over time among the two groups. The variables speech understandability, speech acceptability, and the total VELO scores significantly improved following HISI, but not following LISI. Conclusions Children in the HISI group made equal and, for some variables, even superior progress in only 2 weeks of therapy compared to children in the LISI group who received 10 weeks of therapy. HISI is a promising strategy to improve speech outcomes and HRQoL in a shorter time period.

Assessment of speech perception in deaf or hard of hearing children who received auditory-verbal therapy with hearing aids or cochlear implants

ObjectivesTo reframe the criteria for pediatric cochlear implants (CIs) in Japan, we investigated monosyllabic and word speech perception at the time of school entry in deaf or hard of hearing (D/HH) children who underwent auditory-verbal therapy (AVT) with hearing aids (HAs) or CIs in early childhood. MethodsD/HH children who started AVT at Fujimidai Auditory Center for Hearing-Impaired Children before the age of 1 year and who underwent auditory assessment in the previous year of schooling (at the age of 5 or 6) from 2010 to 2020 were enrolled in this study. The results of hearing level tests with or without amplification and monosyllabic and word speech discrimination were assessed. ResultsThe children with profound hearing impairment (>90 dB HL) had worse speech perception than children with CIs. The children with severe hearing impairment (>70–90 dB HL) did not show any significant differences in speech perception compared with the children with CIs. The children with HAs with a wearing threshold <40 dB HL did not show any significant differences in speech perception from the children with CIs. ConclusionD/HH children with audiologic thresholds greater than 90 dB HL or aided thresholds greater than 40 dB HL should be considered for CIs to ensure development of appropriate listening and spoken language.

Evaluation of working memory in relation to cochlear implant consonant speech discrimination

BackgroundSpeech perception in cochlear implants (CI) is affected by frequency resolution, exposure time, and working memory. Frequency discrimination is especially difficult in CI. Working memory is important for speech and language development and is expected to contribute to the vast variability in CI speech reception and expression outcome. The aim of this study is to evaluate CI patients’ consonants discrimination that varies in voicing, manner, and place of articulation imparting differences in pitch, time, and intensity, and also to evaluate working memory status and its possible effect on consonant discrimination.ResultsFifty-five CI patients were included in this study. Their aided thresholds were less than 40 dBHL. Consonant speech discrimination was assessed using Arabic consonant discrimination words. Working memory was assessed using Test of Memory and Learning-2 (TOMAL-2). Subjects were divided according to the onset of hearing loss into prelingual children and postlingual adults and teenagers. Consonant classes studied were fricatives, stops, nasals, and laterals. Performance on the high frequency CVC words was 64.23% ± 17.41 for prelinguals and 61.70% ± 14.47 for postlinguals. These scores were significantly lower than scores on phonetically balanced word list (PBWL) of 79.94% ± 12.69 for prelinguals and 80.80% ± 11.36 for postlinguals. The lowest scores were for the fricatives. Working memory scores were strongly and positively correlated with speech discrimination scores.ConclusionsConsonant discrimination using high frequency weighted words can provide a realistic tool for assessment of CI speech perception. Working memory skills showed a strong positive relationship with speech discrimination abilities in CI.

The Feasibility and Reliability of a Digits-in-Noise Test in the Clinical Follow-Up of Children With Mild to Profound Hearing Loss.

Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss. We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs. The average speech reception threshold (SRT) was -3.6 dB (SD 3.6) for the first list and significantly improved to -4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child's hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list. The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.

Interleaved Acoustic Environments: Impact of an Auditory Scene Classification Procedure on Speech Perception in Cochlear Implant Users.

Clinical speech perception tests with simple presentation conditions often overestimate the impact of signal preprocessing on speech perception in complex listening environments. A new procedure was developed to assess speech perception in interleaved acoustic environments of different complexity that allows investigation of the impact of an automatic scene classification (ASC) algorithm on speech perception. The procedure was applied in cohorts of normal hearing (NH) controls and uni- and bilateral cochlear implant (CI) users. Speech reception thresholds (SRTs) were measured by means of a matrix sentence test in five acoustic environments that included different noise conditions (amplitude modulated and continuous), two spatial configurations, and reverberation. The acoustic environments were encapsulated in a randomized, mixed order single experimental run. Acoustic room simulation was played back with a loudspeaker auralization setup with 128 loudspeakers. 18 NH, 16 unilateral, and 16 bilateral CI users participated. SRTs were evaluated for each individual acoustic environment and as mean-SRT. Mean-SRTs improved by 2.4 dB signal-to-noise ratio for unilateral and 1.3 dB signal-to-noise ratio for bilateral CI users with activated ASC. Without ASC, the mean-SRT of bilateral CI users was 3.7 dB better than the SRT of unilateral CI users. The mean-SRT indicated significant differences, with NH group performing best and unilateral CI users performing worse with a difference of up to 13 dB compared to NH. The proposed speech test procedure successfully demonstrated that speech perception and benefit with ASC depend on the acoustic environment.

Development of Minimal Pair Test in Tamil (MPT-T)

Introduction: Speech perception testing provides an accurate measurement of the child’s ability to perceive and distinguish the various phonetic segments and patterns of the sounds. From among the many types of speech stimuli used, minimal pairs can also be used to assess the phoneme recognition skills. Thus, the study focused on developing Minimal Pair Test in Tamil (MPT-T). Aim: The aim of the present study was to develop and validate the MPT in Tamil on Normal Hearing (NH) children and paediatric cochlear implantees (CI). Materials and Methods: It was an experimental study which included school going children in the age range of six to eight years and the duration of the study was 12 months. The test was developed in two phases. The first phase focussed on the construction of the word list, recording of the word pairs and the preparation of the test. The second phase was administration of the test on NH children and paediatric cochlear implantees. The test scores were analysed using Mann Whitney U test, Kruskal Wallis and Wilcoxon signed-rank test. The results showed a statistical significance between the NH group and the paediatric cochlear implantees. Results: The present study included 40 NH children and 15 paediatric cochlear implantees through purposive sampling method. The specific speech feature analysis of the paediatric cochlear implantees revealed that there was difficulty identifying the word pairs differing in Vowel Length (VL) and the best performed feature was Place of Articulation (POA). The results showed statistical significance between the NH group and the paediatric cochlear implantees. Conclusion: The developed test can be effectively used in clinic for assessing speech perception abilities of pediatric Cochlear Implantees and also in planning the rehabilitative goals.

Auditory-perceptual performance in children with and without phonological disorder in the stops class.

To compare the auditory-perceptual performance of children with and without phonological disorder (PD) in the identification task of contrasts between stops phonemes. Information was selected from a database regarding the auditory-perceptual performance of 46 children (23 with a diagnosis of PD with involvement in the stops (G1) and 23 with typical speech development (G2)), aged 4 and eight years old, in an identification task of the class of stops consonants in Brazilian Portuguese, using the speech perception assessment instrument (PERCEFAL). The reaction time, the number of errors and correctness, as well as the pattern of perceptual error were considered in the analysis. Regarding the auditory-perceptual accuracy, T-Test showed a statistically significant difference, in which typical children had a higher average of correctness than children with PD and shorter reaction time for correct answers. Regarding the error pattern, repeated measures ANOVA showed a significant effect for the group and error pattern, but not for the interaction between group and error pattern. Tukey's Post Hoc test showed for both groups that errors involving place of articulation were superior to voicing and voicing + place of articulation errors. children with phonological disorders have worse accuracy in relation to children without disorders and, also, longer response time for correctness. Errors involving the place of articulation between the stops were the most frequent for both groups.

Spectral analysis of english fricatives /s/ and /ʃ/ produced by people with profound hearing loss

Purpose Hearing loss not only causes restricted speech understanding, but also alters speech production resulting in poor intelligibility. This study investigated whether English fricatives /s/ and /ʃ/ spoken by people with severe-to-profound hearing loss acoustically differ from those spoken by normal hearing (NH) individuals. Methods For hearing impaired (HI) group, we analyzed a part of deaf speech corpus collected at the Speech Perception Assessment Lab (SPAL) at the University of Memphis. From the big dataset, /aSa/ and /aSha/ recordings spoken by eight females were selected. For NH control group, Shannon’s consonant set (1999) spoken by eight females was used. A set of spectral moment analysis (Mean, Variance, Skewness, Kurtosis) along with spectral peak (SP) and wiener entropy (WE) were used as measures of spectral properties of /s/ and /ʃ/. Results Variance and WE for HI were significantly higher than those for NH group (p<0.05). Mean and SP for /s/ were significantly greater in NH group, while Mean and SP for /ʃ/ were significantly greater in HI group (p<0.05). This trends suggest greater Mean and SP differences between /s/ and /ʃ/ for NH group than HI group. Conclusions Based on our finding, Variance and WE are spectral measures that are different between NH and HI individuals’ spoken /s/ and /ʃ/. We assume that HI individuals likely pronounce /s/ and /ʃ/ without making clear distinction substituting by each other due probably to lack of auditory feedback or failure of motor control. Keywords: Fricatives; Spectral moment analysis; Hearing loss; Deaf speech

Listening to a Dysphonic Speaker in Noise May Impede Children's Spoken Language Processing in a Realistic Classroom Setting.

Purpose The aim of this study was to investigate children's processing of dysphonic speech in a realistic classroom setting, under the influence of added classroom noise. Method Typically developing 6-year-old primary school children performed two listening tasks in their regular classrooms: a phoneme discrimination task to assess speech perception and a sentence-picture matching task to assess listening comprehension. Speech stimuli were played back in either a typical or an impaired voice quality. Children performed the tasks in the presence of induced classroom noise at signal-to-noise ratios between +2 and +9 dB. Results Children's performance in the phoneme discrimination task decreased significantly when the speaker's voice was impaired. The effect of voice quality on sentence-picture matching depended on task demands: Easy sentences were processed more accurately in the impaired-voice condition than in the typical-voice condition. Signal-to-noise ratio effects are discussed in light of methodological constraints. Conclusions Listening to a dysphonic teacher in a noisy classroom may impede children's perception of speech, particularly when phonological discrimination is needed to disambiguate the speech input. Future research regarding the interaction of voice quality and task demands is necessary.

Development and structure of the VariaNTS corpus: A spoken Dutch corpus containing talker and linguistic variability

Speech perception and spoken word recognition are not only affected by what is being said, but also by who is speaking. Currently, publicly available corpora of spoken Dutch do not offer a wide variety of linguistic materials produced by multiple talkers. The VariaNTS (Variatie in Nederlandse Taal en Sprekers) corpus is a Dutch spoken corpus that was developed to maximize both linguistic and talker variability. It contains 1000 items from 11 linguistic subcategories, recorded by 8 male and 8 female native speakers of standard Dutch. The corpus contains audio recordings, orthographic transcriptions, item-specific details such as word frequencies, neighborhood densities and phonotactic probabilities, and talker details. The VariaNTS corpus aims to provide new materials to be used for broad assessment of speech perception and word recognition in Dutch clinical and academic settings.

Management of submucous cleft palate.

Submucous cleft palate (SMCP) represents an uncommon congenital palatal anomaly with a variable rate of velopharyngeal dysfunction or resulting speech abnormality. Classic teaching regarding management of this entity involves delayed repair until a perceptual speech assessment by a skilled speech-language pathologist can be performed, typically at age 3-5 years. An assessment of timing of intervention, surgical techniques, and patient comorbidities is critical for optimized outcomes. Early diagnosis and surgical intervention for SMCP are associated with improved speech outcomes. Expanding indications for surgery are being actively investigated. Timing of intervention and surgical technique may be influenced by a syndromic diagnosis, specifically 22q11.2 deletion syndrome. Diagnosis of classic SMCP and occult SMCP may be difficult based on provider experience. Variable surgical techniques may be used with good outcomes; patient comorbidities including syndromic diagnoses may determine best surgical technique. Expanding indications for surgery and timing of repair continue to evolve and warrant additional study.

Effectiveness of Speech Intervention in Patients With a Cleft Palate: Comparison of Motor-Phonetic Versus Linguistic-Phonological Speech Approaches.

Purpose The purpose of this study was to compare the effect of two different speech therapy approaches, a traditional motor-phonetic approach and a linguistic-phonological approach, on the speech and health-related quality of life in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years old. Method A block-randomized, sham-controlled design was used. Fourteen children with a CP ± L (M age = 7.71 years) were divided into two groups using block randomization stratified by age and gender: one receiving motor-phonetic intervention (n = 7) and one receiving linguistic-phonological intervention (n = 7). Each group received 10 hr of speech therapy divided over 2 weeks. Perceptual speech assessments were performed on several baseline and posttreatment data points. The psychosocial effects of the intervention were assessed using the patient-reported Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire. Both groups were compared over time using (generalized) linear mixed models. Within-group effects of time were determined using pairwise comparisons with post hoc Bonferroni correction. Results Significant Time × Group interactions with large effect sizes were revealed in terms of consonant proficiency, indicating significant differences in evolution over time among the two groups. Only in the group receiving linguistic-phonological intervention, percentage of correctly produced consonants and places significantly improved after the treatment. Total Velopharyngeal Insufficiency Effects on Life Outcomes scores of the parents significantly improved in both groups after the intervention. Conclusions Both motor-phonetic and linguistic-phonological speech interventions can have a positive impact on the occurrence of cleft speech characteristics and consonant proficiency in children with a CP ± L. A linguistic-phonological approach, however, was observed to be more effective in terms of improving these speech outcomes compared with a motor-phonetic approach. Speech intervention, irrespective of the used approach, significantly improved the participant's health-related quality of life.

Assessment of speech perception and quality of life after cochlear implant in postlingual deaf adults

Objective:The study is aimed to evaluate impacts of cochlear implantation on speech perception and quality of life in postlingual deaf adults, and to explore the correlation between speech perception and quality of life using Nijimegen Cochlear Implantation Questionnaire and Mandarin version of Minimum Speech Test Battery. Method:Thirty-six postlingual deafpatients were recruited, including 20 males and 16 females. Patient age was 20 to 72 years old（52±16） when CI was implanted, and the hearing loss duration was 2 to 25 years（14±6） before cochlear implantation. The single syllable recognition rate score were tested by using Mandarin version of Minimum Speech Test Battery, and the quantify quality of life was tested by using Nijimegen Cochlear Implantation Questionnaire. Result:Speech recognition and quality of life have significantly improved in patients with CI after cochlear implantiont. The scores of basic sound perception, advanced sound perception, speech ability, self-confidence, social activity ability, and social ability have improved, but the differences were not statistically significant. The Mandrin single-syllable recognition rate scores were related to basic sound perception（r=-0.36; P=0.004）, advanced sound perception（r=-0.41; P=0.002）, and speech ability（r=-0.67; P=0.001）, and the differences are statistically significant. Conclusion:The postlingual deafnesses ability of auditory, speech perception and the quality of life have improved significantly in patients with CI after cochlear implantiont.

Speech perception in deaf and hard of hearing Arabic-speaking children

The rate of Deaf and Hard of Hearing (DHH) people is relatively large in native Arabic speakers in Israel. However, Arabic assessment tools are scarce. The present study reports the procedure of developing two speech perception assessment tools, which are used for hearing loss diagnosis, hearing aids fitting, cochlear implant mapping, and evaluation of progress following rehabilitation intervention. Our closed set test “Arabic Picture Speech Pattern Contrast” (ArPiSPAC), and word perception open-set test, “Arabic AB” (ArAB), were administered to 34 children with moderate to profound sensorineural hearing loss, hearing aids users, aged between 4;5—8;11. In addition, the ArPiSPaC was administered to 38 hearing children, aged between 2;6-5;5 in order to obtain a developmental hierarchy. For DHH participants, the findings showed that vowel contrasts were better perceived than consonants, and articulation manner was better perceived than articulation place. The hearing participants' phonological perception hierarchy differed in some interesting features from that of the DHH children. The mean percent of phoneme perception by DHH was M = 60.53%, (SD = 23.87), and the mean percent of word perception was M = 18.5%, (SD = 15.68). Voicing and pharyngealization contrasts revealed the largest Pearson correlation for phoneme and word perception.