The Use of the Nasometer and Interpretation of Nasalance Scores

Purpose The acoustic characteristics of oral–nasal coupling (nasalization) have clinical implications for speech-language pathologists because excessive oral–nasal coupling results in a resonance disorder referred to as hypernasality . Nasometry is a tool that allows clinicians to measure the effect of oral–nasal coupling in the clinical setting. This clinical focus article summarizes the large volume of research on nasometry and clarifies its clinical application. Conclusion Although the precise relationship between the acoustics of oral–nasal coupling and the perception of hypernasality remains unclear, measuring the acoustic effects of oral–nasal coupling is useful in the evaluation and treatment of resonance disorders.

A perceptual evaluation of resonance disorders in children with repaired unilateral cleft lip and palate in Hospital UniversitiSains Malaysia

Background: In most literature regarding speech outcomes in children with repaired cleft lip and palate (CLP), exhibited resonance disorders despite having surgical repair. However, the types and severity of the resonance disorders vary from one individual to another. Thus, perceptual evaluation is important to determine the speech outcomes in individuals with repaired cleft lip and palate.Aim: The aim of this cross sectional study was to determine the types and severity of resonance disorders of children with repaired unilateral cleft lip and palate (UCLP) and describe the inter- and intra-rater reliability of perceptual evaluation of resonance disorders using GOS. SP.PASS’98. Four children with repaired UCLP in Hospital USM with ages ranging from 8 years old to 12 years old was included in this study. During data collection, history taking was first conducted, then participants’ speech sample was collected and lastly oral motor examination was conducted.Results: 50% of the speech sample was then duplicated for inter- and intraexaminer reliability investigations. Exact agreement and kappa values were used for reliability measures. Seventy five percent (75%) (3/4) participants exhibited hypernasality as the type of resonance disorder and 25% (1/4) participant had no evidence of hypernasality or any other types of resonance disorder. No other types of resonance disorders such as hyponasality, mixed resonance or cul-de-saq was noted in the participants. The severity of hypernasality ranged from mild to severe in the participants. Inter-rater reliability showed fair to almost perfect agreement and intra-rater reliability revealed almost perfect agreement.Conclusion: The results obtained from this study was more or less similar to our other studies conducted on the speech outcome of individuals with repaired UCLP. Although surgical intervention has been provided to these individuals, it is important that referrals be made to SLPs to evaluate their speech outcomes. This is to determine a proper management for the individual.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.282-289

Original article. Articulation disorders and patterns in children with a cleft

Background: Compensatory articulation disorders (CAD) are the most common speech defects in patients with a cleft. Early prevention programs are needed to avoid CAD.Objectives: To examine articulation disorders, patterns, and related speech outcomes in children with a cleft palate with or without lip defects.Methods: Articulation test record forms and clinical records of 42 children were accessed retrospectively to provide the data of speech outcomes related to cleft palate. Double data entries and incorrect completion type errors were corrected.Results: Prevalence of articulatory defects was 88% (functional articulation disorders, 12%; compensatory articulation disorders, 10%; functional articulation disorders and CAD, 67%), resonance disorder was 50%, and voice abnormalities was 19%. Abnormal backing of oral consonants, particularly glottal substitution was the most common pattern of CAD (40%), follow by velar substitution (36%), and nasal consonant for oral pressure consonant (21%). There was high incidence of functional articulation disorder in patients with a cleft (76%). Younger children (≤7 years old) had more articulation defects than older children (>7 years old) (mean difference = 3.308, P = 0.002, 95% confident interval 1.683-6.971). Levene’s test for equal variance found that resonance disorder seems unaffected by the number of articulation errors (mean difference = 0.253, P = 0.897, 95% confident interval -3.736-4.241).Conclusion: CAD, particularly abnormal backing of oral consonants and hypernasality were the most common speech defects in children with cleft. Refinement and revision of timing for referring for early speech intervention should be reconsidered.

Cleft Palate and/or Velopharyngeal Dysfunction: Assessment and Treatment

Children with cleft palate and/or velopharyngeal dysfunction often exhibit complicated clinical findings. In order to differentiate a resonance disorder from an articulatory/phonological disorder, the speech-language pathologist must be able to evaluate the function of the velopharyngeal mechanism and have knowledge of aberrant articulatory postures that create compensatory articulations. This paper will address current assessment techniques and treatment strategies for this clinical population. Methods for collaborating with the transdisciplinary cleft palate/craniofacial team will be provided.

Evaluation and Treatment of Resonance Disorders

Resonance disorders can be caused by a variety of structural abnormalities in the resonating chambers for speech, or by velopharyngeal dysfunction. These abnormalities may result in hypernasality, hypo- or denasality, or cul-de-sac resonance. Resonance disorders are commonly seen in patients with craniofacial anomalies, particularly a history of cleft palate. The appropriate evaluation of a resonance disorder includes a speech pathology evaluation, and may require a video-fluoroscopic speech study or nasopharyngoscopy assessment. Treatment may include surgery or the use of prosthetic devices, and usually speech therapy. Given the complexity of these disorders in regard to evaluation and treatment, the patient is best served by an interdisciplinary craniofacial anomaly team.