Relationships between nasalance scores and nasopharyngeal shapes in cleft palate patients.
ABSTRACT The aim of the present study is to clarify the relationship between nasalance scores and nasopharyngeal shapes obtained by lateral cephalograms.
Eight patients who underwent a Wardill-Kilner push-back palatoplasty were included in this study. Perceptual judgment by a speech pathologist indicated that these patients had no hypernasality and no nasal emission at blowing. As normal controls, 33 non-cleft individuals, 4 boys and 10 girls aged 6 years old and 5 boys and 14 girls aged 7 years old, were investigated.
Lateral cephalograms at rest were taken for both groups. For the cleft (palate) patients, lateral cephalograms at phonation /a/ and blowing were analyzed and nasometries were also performed using a kitsutsuki passage.
There was no significant difference in the velar length, the pharyngeal depth, the ratio of the velar length to the pharyngeal depth and the velar angle between the cleft patients and the non-cleft individuals. Multiple regression analyses indicated that standardized regression coefficients of ratios for the velar length to the pharyngeal depth and the velar ascent at blowing had higher nasalance scores for sentences 1 and 3, which had high coefficients of determination, respectively.
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ABSTRACT: A new integrated videoendoscopic/photodetection system, including an endoscope with an internal instrument channel used for photodetection, was applied to the evaluation of velopharyngeal closure in a subject with marginal velopharyngeal insufficiency (VPI) and in a subject with no speech disorder. Acoustic and aerodynamic speech assessments were used to establish the severity of velopharyngeal impairment in the marginal VPI patient. A light-out condition was used to establish the photodetector criterion for closure. The new system was effective for providing detailed phonetic assessment of velopharyngeal closure. Variations in degree of closure during select oral and nasal consonant productions were identified in the VPI subject but not in the normal speaking subject. The data show that important details of velopharyngeal insufficiency can be identified using the integrated endoscopic/photodetection system.The Cleft Palate-Craniofacial Journal 06/1993; 30(3):337-42. · 1.24 Impact Factor
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ABSTRACT: This two-part project was designed to test a pressure-sensitive theory of marginal velopharyngeal inadequacy (MPVI). Specifically, are select subgroups of children with MPVI perceived as hypernasal because they fail to achieve consistent closure during vowels and semivowels while demonstrating adequate closure during pressure consonants? In part one, 36 children with cleft palate and other craniofacial anomalies were examined using a clinical assessment protocol that included nasometry and perceived ratings of hypernasal resonance. Children with nasalance percentages above threshold during low-pressure (LP) productions and below threshold for high-pressure (HP) productions were placed in one group (group 1), while children with nasalance percentages below threshold for both LP and HP sentences were placed in another (group 2). Children in the two groups were age- and sex-matched. In part two, endoscopic data were examined for 10 additional children who received nasometry, perceived hypernasal resonance scores, and videoendoscopy on the same day and who received higher mean nasalance measures during production of LP sentences than during production of HP sentences. The results of part one confirmed that children in group 1 were perceived as being significantly more hypernasal than children in group 2 (mean(group 1) = 2.17, mean(group 2) = 1.50; t = 2.75, p =.01). However, results of endoscopic testing failed to demonstrate a consistent observable physiologic pattern of velopharyngeal inadequacy that would confirm the theory that some patients with MVPI are perceived as being hypernasal because of difficulty achieving velopharyngeal closure during vowels and semivowels. CONCLUSIONS; The findings provide partial support for a pressure-sensitive theory of MVPI and demonstrate the value of using both HP and LP sentences to evaluate patients with MVPI.The Cleft Palate-Craniofacial Journal 08/2001; 38(4):346-57. · 1.24 Impact Factor
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ABSTRACT: (1) To adopt the nasometry for the Hungarian language and to obtain normative nasalance scores. (2) To compare our results with the data of other languages and to evaluate the correlation between nasalance scores and perceptual ratings of nasality. (3) To use the nasometry in various fields of the otolaryngological, phoniatric, and logopedic diagnostics, therapy and documentation. (1) To determine the normative nasalance scores regarding the Hungarian language, we included 30 children aged 5-7 years and 45 adults in the 20-25 years age group. In the latter group 15 subjects were speech therapists and 30 phonetically untrained people-15 males and 15 females. Study design: phonation of isolated vowels, articulation of spirants, cyclical repetition of affricates, pronunciation of various (oral, nasal, mixed type) sentences and evaluation of the nasalance score in continuous speech. (2) Thirty-six persons (12 speech pathologists, 12 logopedic students, 12 phonetically uneducated individuals) evaluated the children's physiological and nasal speech recordings with a 3-point scale. (3) Two hundred and forty-eight children of kindergarten age were examined, 20 infants and 6 adult singers in the following fields: evaluation of hypernasality due to cleft palate or velopharyngeal insufficiency (VPI), and of the success of the therapy; examination of hyponasality in cases of enlarged adenoid and allergic rhinitis; evaluation of the speech of hard-of-hearing people; differentiation between nasal sigmatism and hyperrhinophony; testing of the resonance in professional singers; examination of infant cry; application of nasometry in the therapy. The mean value of the nasalance score using the oral sentence: "Zsuzsi kutyája ugat" is 11-13%, in the nasal sentence ("A majom banánt enne") 56%, while that of the mixed sentence representing the Hungarian language ("Jó napot kívánok!") falls in the 30-40% range. The resonance grows with aging and there is no significant difference between genders. The nasalance score is greater with phonetically trained people. Our data correlate with the values of other languages. The correlation is significant between the nasalance scores and perceived nasality (r=0.901). Practical results: Values above 40% in cases of VPI using mixed sentences may support the indication of velopharyngoplasty, together with the subjective evaluation of nasality and other tests. In cases with rhinitis and adenoid vegetation the nasalance score remains below 20%. The nasality value is increased in sensorineural hearing loss, and is decreased in cases with conducting hearing impairment. In nasal sigmatism not the vowels' but the nasality of consonants grow. The difference between the nasalance score of the cry in clefted and non-cleft infants is significant (26% versus 36%): this observation could give possibility in the future to screen babies with congenital hearing problems or hidden VPI. Alterations in nasalance can be documented with nasometry in professional singers when they increase the nasal resonance to grow the power capacity of their voice. The nasometry procedure is a significant help also in speech therapy through the real time visual and auditive control. The otolaryngological, phoniatric and logopedic diagnostics and therapy is significantly widened with nasometry which is a quick, non-invasive and objective procedure, measuring the nasal resonance of the speech.International Journal of Pediatric Otorhinolaryngology 06/2006; 70(5):785-98. · 1.35 Impact Factor