A pilot study shows the positive effects of continuous airway pressure for treating hypernasal speech in children with infantile-onset Pompe disease

Children with infantile-onset Pompe disease (IOPD) demonstrate hypernasality. This study aimed to evaluate whether continuous positive airway pressure (CPAP) training may reduce hypernasality in children with IOPD. Five children with IOPD were enrolled in a single-subject experimental design of type A-B-A′. The intervention comprised an 8-week, 6-day-per-week regimen of CPAP training at home. Participants continued traditional speech therapy once per week throughout the 24-week study duration. The outcome measurements included the degree of hypernasality (DH), the percentage of consonants correct (PCC), and the speech intelligibility score (SIS). C-statistic analysis with an α of 0.05 was used along with visual analysis to assess speech changes. Three patients completed the study. During the CPAP training phase, the DH, PCC, and SIS were significantly improved compared with the baseline (p < 0.05). At the follow-up phase, both DH and SIS were improved compared with the baseline (p < 0.05), but the PCC had returned to the baseline level. CPAP training demonstrated effectiveness in reducing nasal sounds in IOPD patients. Further studies training younger children with normal hearing may help elucidate the persistence of the effects in children with IOPD.

Cocaine-Induced Midline Destructive Lesions: A Real Challenge in Oral Rehabilitation

Cocaine abuse is associated with severe local effects on mucosal and osteocartilaginous structures, with a centrifugal spreading pattern from the nose, a condition known as cocaine-induced midline destructive lesions (CIMDL). When the soft or hard palate is affected, a perforation may occur, with subsequent oro-nasal reflux and hypernasal speech. Both diagnosis and therapy (surgical or prosthetic) constitute a serious challenge for the physician. The cases of three patients affected by cocaine-induced palatal perforation and treated with a palatal obturator at San Raffaele Dentistry department between 2016 and 2019 are presented. In addition, the literature was reviewed in search of papers reporting the therapeutic management in patients affected by cocaine-induced palatal perforation. All the patients in our sample suffered from oro-nasal reflux and hypernasal speech, and reported a significant impact on interpersonal relationships. The results at the delivery of the obturator were satisfactory, but the duration of such results was limited in two cases, as the progression of the disease necessitated continuous modifications of the product, with a consequent increase in costs and a reduction in patient satisfaction. In conclusion, the therapy for palatal defects in CIMDL includes both reconstructive surgery and prosthetic obturators, the latter being the only possibility in the event of active disease. It successfully relieves symptoms, but the long-term efficacy is strongly related to the level of disease activity.

Transpalatal Approaches to the Skull Base and Reconstruction: Indications, Technique, and Associated Morbidity

Multiple anterior surgical approaches are available to obtain access to the nasopharynx, clivus, and craniocervical junction. These include the direct and transoral robotic surgery transpalatal, maxillary swing, and endoscopic endonasal approaches. In this article, we describe the indications for these techniques, surgical steps, and associated morbidities. This article is a PubMed literature review. A review of the literature was conducted to assess the techniques, surgical steps, and associated morbidities with transpalatal approaches to the skull base and nasopharynx. The transpalatal approach has been traditionally utilized to obtain surgical access to the nasopharynx, clivus, and craniocervical junction. Morbidity includes velopalatine insufficiency due to shortening of the soft palate from scar contraction or neuromuscular damage, thus leading to hypernasal speech and dysphagia. Middle ear effusion and oronasal or oronasopharyngeal palatal fistula are additional potential morbidities. The choice of surgical approach depends on a variety of factors including the disease location and extent, surgeon experience, and available resources.

Velopharyngeal insufficiency in patients without a cleft palate: important considerations for the ENT surgeon

BackgroundVelopharyngeal insufficiency is the inability to close the velopharyngeal port during speech and swallowing, leading to hypernasal speech and food regurgitation.ObjectiveThis study aimed to explore the aetiological factors contributing to the development of velopharyngeal insufficiency in a non-cleft paediatric population, especially following adenoidectomy.MethodsA retrospective case review was conducted of all children without a known cleft palate, born between 2000 and 2013, who were referred to a tertiary cleft centre with possible velopharyngeal insufficiency.ResultsThe data for 139 children diagnosed with velopharyngeal insufficiency following referral to the cleft centre were analysed. Thirteen patients developed the condition following adenoidectomy; only 3 of these 13 had a contributing aetiological factor.ConclusionVelopharyngeal insufficiency is a rare but significant complication of adenoidectomy. The majority of patients who developed velopharyngeal insufficiency following adenoidectomy did not have an identifiable predisposing factor. This has important implications for the consent process and when planning adenoidectomy.

Automatic hypernasality grade assessment in cleft palate speech based on the spectral envelope method

Due to velopharyngeal incompetence, airflow overflows from the oral cavity to the nasal cavity, which results in hypernasality. Hypernasality greatly reduces speech intelligibility and affects the daily communication of patients with cleft palate. Accurate assessment of hypernasality grades can provide assisted diagnosis for speech-language pathologists (SLPs) in clinical settings. Utilizing a support vector machine (SVM), this paper classifies speech recordings into four grades (normal, mild, moderate and severe hypernasality) based on vocal tract characteristics. Linear prediction (LP) analysis is widely used to model the vocal tract. Glottal source information may be included in the LP-based spectrum. The stabilized weighted linear prediction (SWLP) method, which imposes the temporal weights on the closed-phase interval of the glottal cycle, is a more robust approach for modeling the vocal tract. The extended weighted linear prediction (XLP) method weights each lagged speech signal separately, which achieves a finer time scale on the spectral envelope than the SWLP method. Tested speech recordings were collected from 60 subjects with cleft palate and 20 control subjects, and included a total of 4640 Mandarin syllables. The experimental results showed that the spectral envelope of normal speech decreases faster than that of hypernasal speech in the high-frequency part. The experimental results also indicate that the SWLP- and XLP-based methods have smaller correlation coefficients between normal and hypernasal speech than the LP method. Thus, the SWLP and XLP methods have better ability to distinguish hypernasal from normal speech than the LP method. The classification accuracies of the four hypernasality grades using the SWLP and XLP methods range from 83.86% to 97.47%. The selection of the model order and the size of the weight function are also discussed in this paper.

Resonance Effects and the Vocalization of Speech

Purpose Studies of the respiratory and laryngeal actions required for phonation are central to our understanding of both voice and voice disorders. The purpose of this tutorial is to highlight complementary insights about voice that have come from the study of vocal tract resonance effects. Conclusion This tutorial overviews the following areas: (a) special resonance effects that have been found to occur in the vocal productions of professional performers; (b) resonance and antiresonance effects associated with nasalization, together with clinical considerations associated with the diagnosis and/or treatment of hyponasal and hypernasal speech; and (c) studies of resonant voice and what they tell us about both normal and disordered speech production.

Intranasal abuse of prescription hydrocodone/acetaminophen results in oronasal fistula: A case report

Opioids are becoming more common in the treatment of chronic nonmalignant pain. With increased availability of opioids for chronic pain we may expect an increased misuse of these as analgesics as well. The authors describe the case report of a young woman with chronic back pain and intranasal abuse of prescribed hydrocodone/acetaminophen who was diagnosed after presenting for hypernasal speech and foreign body in the nose. This case report highlights the need for vigilance on the part of the physician for any aberrant drug-related behaviors. Any unusual symptoms or signs such as hypernasal speech, chronic nasal infection, or unexplained foreign body sensation in the nose should be thoroughly investigated.