Nasalance Scores in Wearers of a Palatal Lift Prosthesis in Comparison with Normative Data for Japanese

2004 ◽  
Vol 41 (3) ◽  
pp. 315-319 ◽  
Author(s):  
Takashi Tachimura ◽  
Yasuko Kotani ◽  
Takeshi Wada
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Normative Data ◽  
Normal Limits ◽  
Velopharyngeal Incompetence ◽  
The Mean ◽  
Velopharyngeal Function ◽  
Normative Score ◽  
Nasal Emission ◽  
Normal Controls

Objective This study was designed to examine whether nasalance score is changed in association with placement of a palatal lift prosthesis (PLP) and whether normative data previously reported are applicable to evaluate the effect of a PLP on velopharyngeal function as it relates to nasality. Design Nasalance scores were obtained as subjects read the Kitsutsuki Passage three times with the PLP in place and then removed. Participants Forty-three children (mean age 9.0 years, SD = 3.6 years) with repaired cleft palate who were treated with a PLP were selected as subjects. Their speech was characterized by nasal emission of air, slight hypernasality without a PLP but within normal limits with a PLP in place, or both. Main Outcome Measures Comparisons were made between normative scores and the average mean nasalance score of subjects with and without the PLP. Results Average values of the mean nasalance score for subjects were 17.3% (SD 7.6%) with the PLP in place and 33.5% (SD 13.3%) without the PLP in place. These scores were greater than the mean score of 9.1% (SD 3.9%) obtained from normal controls previously reported. Conclusion A PLP can decrease nasalance scores for speakers with repaired cleft palate who exhibit velopharyngeal incompetence. It was suggested that the normative score obtained from normal adult speakers is not applicable to evaluate the effect of a PLP to improve velopharyngeal function for children wearing the PLP.

The Correlation between Nasalance and a Differentiated Perceptual Rating of Speech in Dutch Patients with Velopharyngeal Insufficiency

2002 ◽  
Vol 39 (3) ◽  
pp. 277-284 ◽  
Author(s):  
Kornelis H.D.M. Keuning ◽  
George H. Wieneke ◽  
Hans A. Van Wijngaarden ◽  
Philippe H. Dejonckere
Keyword(s):  
Cleft Palate ◽  
Correlation Coefficients ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Visual Analog Scales ◽  
Cleft Palate Speech ◽  
Normal Text ◽  
The Mean ◽  
Lower Correlation ◽  
Nasal Emission

Objective: The correlation between the nasalance score and the perceptual rating of several aspects of speech of speakers with velopharyngeal insufficiency (VPI) by six speech-language pathologists was evaluated. Procedure: The overall grade of severity, hypernasality, audible nasal emission, misarticulations, and intelligibility were rated on visual analog scales. Speech samples with a normal distribution of phonemes (normal text [NT]) and those free of nasal consonants (denasal text [DT]) of 43 patients with VPI were used. Mean nasalance scores were computed for the speech samples, and Spearman correlation coefficients were computed between the mean nasalance score and the five parameters of the differentiated rating. Setting: The Institute of Phoniatrics, Utrecht University Hospital, The Netherlands. Results: The correlation coefficient between the mean nasalance and the perceptual rating of hypernasality ranged among judges from .31 to .56 for NT speech samples and .36 to .60 for DT speech samples. Only small differences were found between speech pathologists with and without expertise in cleft palate speech. The rating of the overall grade of severity appeared to correlate quite well with the rating of the intelligibility (rNT = .77, rDT = .79). Lower correlation coefficients, ranging from .34 to .71, were found between overall grade of severity and hypernasality, audible nasal emission, and mis-articulations. Conclusions: A low correlation between the nasalance and the perceptual rating of hypernasality was found. The parameter overall grade of severity appeared to be determined mainly by the parameter intelligibility. Expertise in rating of cleft palate speech does not guarantee a high correlation between instrumental measurement and perceptual rating.

Change in Levator Veli Palatini Muscle Activity for Patients with Cleft Palate in Association with Placement of a Speech-Aid Prosthesis

2002 ◽  
Vol 39 (5) ◽  
pp. 503-508 ◽  
Author(s):  
Takashi Tachimura ◽  
Kanji Nohara ◽  
Yoshinori Fujita ◽  
Takeshi Wada
Keyword(s):  
Cleft Palate ◽  
Pressure Change ◽  
Mean Value ◽  
Emg Activity ◽  
Reserve Capacity ◽  
Activity Levels ◽  
Levator Veli Palatini ◽  
Velopharyngeal Incompetence ◽  
Velopharyngeal Closure ◽  
The Mean

Objective: The purpose of this study was to examine whether a speech-aid prosthesis normalizes the activity of the levator veli palatini muscle for patients with cleft palate who exhibit velopharyngeal incompetence. Design: Each subject was instructed to produce repetitions of /mu/, /u/, /pu/, /su/, and /tsu/ and to blow with maximum possible effort. Electromyographic (EMG) activity of the levator veli palatini muscle was recorded with and without a hybrid speech-aid prosthesis in place. Participants: The participants were five patients with repaired cleft palate who were routinely wearing a hybrid speech-aid prosthesis. Results: With the prosthesis in place, the mean value of levator activity changed positively in relation to oral air-pressure change during blowing. Differences in levator activity in relation to speech samples were similar to those in normal speakers. With the prosthesis in place, levator activity for speech tasks was less than 50% of the maximum levator activity for all subjects. The findings were similar to those reported previously for normal speakers. Conclusion: Placement of the prosthesis changed EMG activity levels of the levator veli palatini muscle to levels that are similar to normal speakers. It is possible that, with the increase in the differential levator activity between speech and a maximum force task, the velopharyngeal mechanism has a greater reserve capacity to maintain velopharyngeal closure compared with the noprosthesis condition.

Speech in 5-Year-Olds With Cleft Palate With or Without Cleft Lip Treated With Primary Palatal Surgery With Muscle Reconstruction According to Sommerlad

2018 ◽  
Vol 55 (10) ◽  
pp. 1399-1408 ◽  
Author(s):  
Kristina Klintö ◽  
Evelina Falk ◽  
Sara Wilhelmsson ◽  
Björn Schönmeyr ◽  
Magnus Becker
Keyword(s):  
Cleft Palate ◽  
Normative Data ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Air Leakage ◽  
Fistula Surgery ◽  
Audio Recordings ◽  
Velopharyngeal Function ◽  
Palatal Surgery

Objective: To evaluate speech in 5-year-olds with cleft palate with or without cleft lip (CP±L) treated with primary palatal surgery in 1 stage with muscle reconstruction according to Sommerlad at about 12 months of age. Design: Retrospective study. Setting: Primary care university hospital. Participants: Eight 5-year-olds with cleft soft palate (SP), 22 with cleft soft/hard palate (SHP), 33 with unilateral cleft lip and palate, and 17 with bilateral CLP (BCLP). Main Outcome Measures: Percent oral consonants correct (POCC), percent consonants correct adjusted for age (PCC-A), percent oral errors, percent nonoral errors, and variables related to velopharyngeal function were analyzed from assessments of audio recordings by 3 independent speech-language pathologists. Results: The median POCC was 75.4% (range: 22.7%-98.9%), median PCC-A 96.9% (range: 36.9%-100%), median percent oral errors 3.4% (range: 0%-40.7%), and median percent nonoral errors 0% (range: 0%-20%), with significantly poorer results in children with more extensive clefts. The SP group had significantly less occurrence of audible nasal air leakage than the SHP and the BCLP groups. Before age 5 years, 1.3% of the children underwent fistula surgery and 6.3% secondary speech improving surgery. At age 5 years, 15% of the total group was perceived as having incompetent velopharyngeal function. Conclusions: Speech was poorer in many children with more extensive clefts. Children with CP±L had poorer speech compared to normative data of peers without CP±L, but the results indicated relatively good speech compared to speech of children with CP±L in previous studies.

Surgical Management of Velopharyngeal Incompetence in Velocardiofacial Syndrome

2004 ◽  
Vol 41 (2) ◽  
pp. 124-135 ◽  
Author(s):  
Felicity V. Mehendale ◽  
Malcolm J. Birch ◽  
Louise Birkett ◽  
Debbie Sell ◽  
Brian C. Sommerlad
Keyword(s):  
Posterior Pharyngeal Wall ◽  
Velocardiofacial Syndrome ◽  
Prospective Data ◽  
Pharyngeal Wall ◽  
Velopharyngeal Incompetence ◽  
Staged Approach ◽  
Velopharyngeal Function ◽  
And Function ◽  
Nasal Emission ◽  
Results Of Surgery

Objective To analyze the results of surgery for velopharyngeal incompetence (VPI) in velocardiofacial syndrome. Design Prospective data collection, with randomized, blind assessment of speech and velopharyngeal function on lateral videofluoroscopy and nasendoscopy. Setting Two-site, tertiary referral cleft unit. Patients Forty-two consecutive patients with the 22q11 deletion underwent surgery for symptomatic VPI by a single surgeon. Interventions Intraoral examinations, lateral videofluoroscopy (± nasendoscopy) and intraoperative evaluation of the position of the velar muscles through the operating microscope. Based on these findings, either a radical dissection and retropositioning of the velar muscles (submucous cleft palate [SMCP repair]) or a Hynes pharyngoplasty (posterior pharyngeal wall augmentation pharyngoplasty) was performed. As anticipated, a proportion of patients undergoing SMCP repair subsequently required a Hynes. The aim of this staged approach was to maximize velar function, thereby enabling a less obstructive pharyngoplasty to be performed. Thus, there were three surgical groups for analysis: SMCP alone, Hynes alone, and SMCP+Hynes. Main Outcome Measures Blind perceptual rating of resonance and nasal airflow; blind assessment of velopharyngeal function on lateral videofluoroscopy and nasendoscopy; and identification of predictive factors. Results Significant improvement in hypernasality in all three groups. The SMCP+Hynes group also showed significant improvement in nasal emission. There were significant improvements in the extended and resting velar lengths following SMCP repair and a trend toward increased velocity of closure. Conclusions Depending on velopharyngeal anatomy and function, there is a role for SMCP repair, Hynes pharyngoplasty, and a staged combination of SMCP+Hynes, all of which are procedures with a low morbidity.

Speech Outcome and Velopharyngeal Function in Cleft Palate: Comparison of Le Fort I Maxillary Osteotomy and Distraction Osteogenesis—Early Results

2007 ◽  
Vol 44 (1) ◽  
pp. 23-32 ◽  
Author(s):  
Nattharee Chanchareonsook ◽  
Tara L. Whitehill ◽  
Nabil Samman
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Gap Size ◽  
Le Fort I Osteotomy ◽  
Chi Square ◽  
Le Fort ◽  
Le Fort I ◽  
Nasal Emission ◽  
Maxillary Distraction

Objective: To compare speech outcome and velopharyngeal (VP) status of subjects with repaired cleft palate who underwent either conventional Le Fort I osteotomy or maxillary distraction osteogenesis to correct maxillary hypoplasia. Design: Prospective randomized study with blind assessment of speech outcome and VP status. Subjects: Twenty-two subjects were randomized into conventional Le Fort I osteotomy and Le Fort I distraction groups. All were native Chinese (Cantonese) speakers. Method: Perceptual judgment of resonance and nasal emission, study of VP structures by nasoendoscopy, and instrumental measurement by nasometry. Assessments were performed preoperatively and at 3 months postoperatively. Main Outcome Measures: Assessment of VP closure, perceptual rating of hypernasality and nasal emission, nasalance, and amount of maxillary advancement. Results: There was no statistical difference in any of the outcome measures between the 10 subjects with conventional Le Fort I osteotomy and the 12 subjects with maxillary distraction: hypernasality (chi-square = 3.850, p = 0.221), nasal emission (chi-square = 0.687, p = 0.774), VP gap size (chi-square = 1.527, p = 0.635, and nasalance (t = −0.145, p = 0.886). There was no correlation between amount of maxillary advancement and any of the outcome measures (p = .05 for all). Changes in VP gap size and resonance are described. Conclusion: Results need to be interpreted with caution because of the small sample size and early follow-up. However, this study utilized an assessment protocol involving a variety of outcome measures and careful consideration of reliability factors, which can be a model for further and follow-up studies.

Speech in Children with an Isolated Cleft Palate: A Longitudinal Perspective

2006 ◽  
Vol 43 (3) ◽  
pp. 295-309 ◽  
Author(s):  
Christina Persson ◽  
Anette Lohmander ◽  
Anna Elander
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Soft Palate ◽  
Hard Palate ◽  
Surgical Intervention ◽  
University Hospital ◽  
Speech Sounds ◽  
Velopharyngeal Function ◽  
Isolated Cleft Palate

Objective To describe articulation and speech symptoms related to velopharyngeal impairment in children born with an isolated cleft palate. Design Blind assessment of speech at 3, 5, 7, and 10 years of age was performed. Two subgroups were formed based on the results at age 5 years, the no-VPI group and the VPI group, and they were compared with controls. Setting A university hospital. Patients Twenty-six children born with isolated cleft palate. Seventeen children served as controls. Interventions Soft palate closure at 7 months and hard palate closure at a mean age of 3 years and 11 months if the cleft extended into the hard palate. Main Outcome Measures Perceptual assessments of four variables related to velopharyngeal function and of articulation errors were performed at all ages. Phonetic transcriptions of target speech sounds were obtained at 5, 7, and 10 years and nasalance scores were obtained at age 10 years. Results The no-VPI group continued to have no or minor difficulties. The VPI group improved but continued to have moderate velopharyngeal impairment. Both groups differed significantly from the controls at age 10 years. Persistent velopharyngeal impairment, as well as glottal misarticulation, were mostly found in children with the cleft as a part of a syndrome or together with multiple malformations. Conclusion Small changes in velopharyngeal impairment were found across ages. Improvement seemed to be related to surgical intervention, and persistent problems seemed to be related to the presence of additional multiple malformations or syndromes.

scholarly journals Preliminary Studies on Efficacy of Prolonged Nasal Cul-De-Sac with High Pressure Speech Acts (P.i.N.C.H.) on Hypernasality

2004 ◽  
Author(s):  
Helene Fisher
Keyword(s):  
High Pressure ◽  
Cleft Palate ◽  
Clinical Studies ◽  
Speech Acts ◽  
Velopharyngeal Incompetence ◽  
Velopharyngeal Function

Prolonged Nasal Cul-De-Sac with High Pressure Speech Acts (P.i.N.C.H.), a technique to treat hypernasality, was developed upon the basis of four physiological principles of velopharyngeal function. Preliminary experimental and clinical studies were conducted to determine the efficacy of P.i.N.C.H. in decreasing nasalance in 5 non-cleft palate subjects with velopharyngeal incompetence over a 3-week to 22 month period of time. Results revealed statistically significant decreases in nasalance for posttreatment measures immediately after treatment as well as over several months. It was concluded that P.i.N.C.H. warrants further investigation.

ASSESSMENT OF THE EFFECT OF PUSHBACK Z-PLASTY METHOD ON THE FUNCTION OF VELOPHARYNGEAL AND ARTICULATION IN POST-RECONSTRUCTION CLEFT PALATE PATIENTS IN HARAPAN KITA CHILDREN AND MATERNITY HOSPITAL JAKARTA

2017 ◽  
Vol 20 (1) ◽  
pp. 1-7
Author(s):  
Olivia Avriyanti Hanafiah ◽  
Kasman Manullang ◽  
Mantra Firman ◽  
Muhammad Syafrudin Hak
Keyword(s):  
Cleft Palate ◽  
Nasal Mucosa ◽  
Speech Intelligibility ◽  
Maternity Hospital ◽  
Speech Articulation ◽  
Articulation Disorder ◽  
Cephalometric Radiograph ◽  
Velopharyngeal Function ◽  
Patients Experience ◽  
Nasal Emission

Cleft palate patients experience various problems, especially those affecting their speech intelligibility, such as speech articulation disorder. The aim of this research was to prove the effect of cleft palate reconstruction with modified pushback z–plasty technique at the nasal mucosa on velopharyngeal function and articulation function in speaking. A research has been conducted on post-reconstruction cleft palate patients by using modified pushback z-plasty technique at the nasal mucosa. The methods were examining velopharyngeal components with cephalometric radiograph, assessing airflow released from the nose when the patients pronounce vowel ‘a’ using nasal emission device and assessing speech articulation results through Sehati Program at Harapan Kita Children and Maternity Hospital, Jakarta. The research results showed that there was a statistically significant effect of cleft palate reconstruction with pushback z-plasty technique at the nasal mucosa on velopharyngeal function, and there was a statistically significant effect of cleft palate reconstruction with pushback z-plasty technique at the nasal mucosa on articulation function in speaking. In addition, there was also a statistically significant correlation between velopharyngeal function and speech articulation function of post-reconstruction cleft palate patients with pushback z-plasty technique at the nasal mucosa based on the cephalometric radiograph, but the result was not significant statistically based on nasal emission assessment.

Submucous Cleft Palate: A Grading System and Review of 40 Consecutive Submucous Cleft Palate Repairs

2004 ◽  
Vol 41 (2) ◽  
pp. 114-123 ◽  
Author(s):  
Brian C. Sommerlad ◽  
Christopher Fenn ◽  
Kim Harland ◽  
Debbie Sell ◽  
Malcolm J. Birch ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Consecutive Series ◽  
Gap Size ◽  
Velopharyngeal Closure ◽  
Submucous Cleft Palate ◽  
A Prospective Study ◽  
Nasal Emission ◽  
Outcome Of Surgery

Objective This study was designed to determine whether velar surgery was worthwhile for submucous cleft palate (SMCP) and evaluate whether results were dependent on the degree of the anatomical abnormality. Design A prospective study of a consecutive series of patients fulfilling the entry criteria, assessed blindly from records arranged randomly. Patients Fifty-eight patients diagnosed with SMCP and operated on by a single surgeon between June 1991 and April 1997 were reviewed. Forty patients fulfilled the entry criteria. Minimum follow-up was 6 years. Interventions Radical reconstruction of the soft palate musculature was performed by one surgeon using the operating microscope. A scoring system was devised for grading the anatomical severity of submucous cleft (SMCP score). Main Outcome Measures Postoperative hypernasality and nasal emission scores and the degrees of improvement were considered the primary outcome measures, and the degree of velopharyngeal closure was also assessed. Results There were highly significant improvements in hypernasality, nasal emission, and velopharyngeal closure. A preoperative gap size of more than 13 mm was associated with less satisfactory outcomes, but gap size was not predictive of improvement. Severity of the SMCP did not correlate with the degree of preoperative speech abnormality but was a significant predictor of outcome of surgery, with the less severe (total SMCP score of 0 to 3) having less satisfactory end results and lesser degrees of improvement. Patients with less abnormal muscle anatomy had lesser degrees of improvement. Conclusion Repair of the muscle abnormality in SMCP is recommended as the first line of treatment in most cases.

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