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Alighieri C, Bettens K, Scheerens C, Allemeersch F, Mouton T, Hens G, Van Lierde K. Diagnosis and Treatment of Speech Disorders in Children With a Cleft (Lip and) Palate: A State-Of-The-Art Overview. J Craniofac Surg 2025:00001665-990000000-02545. [PMID: 40146325 DOI: 10.1097/scs.0000000000011313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Accepted: 03/05/2025] [Indexed: 03/28/2025] Open
Abstract
In children born with a cleft in the palate with or without a cleft in the lip (CP±L), velopharyngeal insufficiency may persist even after successful surgical closure of the palate. This results in speech disorders including both resonance and speech sound disorders. These speech disorders may have a severe impact on the children's speech understandability and speech acceptability which may, in turn, influence psychosocial well-being, quality of life, and inclusion into society. This article provides an overview of the most important speech characteristics per age group (ie, 0-4, 4-6, 6-12, and >12 y). In addition, a state-of-the-art overview of current practices in speech diagnosis and speech intervention is included.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University (Hospital), Gent
| | - Kim Bettens
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University (Hospital), Gent
| | - Charlotte Scheerens
- Multidisciplinary Cleft Palate Team, Department of Otorhinolaryngology-Head and Neck Surgery, Leuven, Belgium
| | - Fien Allemeersch
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University (Hospital), Gent
| | - Tara Mouton
- Multidisciplinary Cleft Palate Team, Department of Otorhinolaryngology-Head and Neck Surgery, Leuven, Belgium
| | - Greet Hens
- Multidisciplinary Cleft Palate Team, Department of Otorhinolaryngology-Head and Neck Surgery, Leuven, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University (Hospital), Gent
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do Carmo GF, Dutka JDCR, Manicardi FT, Geremias BC, Pegoraro-Krook MI, Marino VCDC. Classification of speech nasality of individuals with cleft lip and palate with distinct ordinal scales. Codas 2025; 37:e20240044. [PMID: 39879425 PMCID: PMC11781359 DOI: 10.1590/2317-1782/e20240044pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/27/2024] [Indexed: 01/31/2025] Open
Abstract
PURPOSE To investigate whether there is a difference in the classification of speech hypernasality by inexperienced listeners using different ordinal scales; to verify the agreement of the listeners in the analyses when using these scales; and to verify whether the order in which the scales are presented influences the results. METHODS Twenty Speech-Language Pathology students classified the degrees of hypernasality of 40 (oral) samples from patients with cleft lip and palate. Ten performed the classifications using a 4-point scale (absent, mild, moderate, and severe) and, after two weeks, using a 3-point scale (absent, slightly hypernasal, and very hypernasal). Other ten students performed the same classifications, but in reverse order. The classifications were made remotely and documented on a form. RESULTS The average percentage of correct responses by the students, in relation to the gold standard, was significantly higher for the 3-point scale. There was no significant interaction between the order of presentation and the scale for the percentage of correct classifications. The students' agreement with the gold standard assessment was fair (3-point scale) and moderate (4-point scale). The mean percentage of agreement of the intra-rater analyses was significantly higher for the 3-point scale. There was no significant interaction between presentation order and scale for the percentage of intra-rater classifications. The Kappa coefficient index showed more favorable intra-rater agreement for the reduced scale. CONCLUSION The reduced scale favored the classification of speech hypernasality by listeners and can be considered an important strategy to favor the initial evaluations of students in Speech Therapy during their training.
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Affiliation(s)
- Gisele Fonseca do Carmo
- Programa de Pós-Graduação em Fonoaudiologia, Universidade Estadual Paulista “Júlio de Mesquita Filho” – UNESP - Marília (SP), Brasil.
| | - Jeniffer de Cássia Rillo Dutka
- Pós-Graduação em Ciência da Reabilitação, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo – USP - Bauru (SP), Brasil
| | - Flora Taube Manicardi
- Programa de Pós-Graduação em Fonoaudiologia, Universidade Estadual Paulista “Júlio de Mesquita Filho” – UNESP - Marília (SP), Brasil.
| | - Beatriz Campanine Geremias
- Programa de Pós-Graduação em Fonoaudiologia, Universidade Estadual Paulista “Júlio de Mesquita Filho” – UNESP - Marília (SP), Brasil.
| | - Maria Inês Pegoraro-Krook
- Pós-Graduação em Ciência da Reabilitação, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo – USP - Bauru (SP), Brasil
| | - Viviane Cristina de Castro Marino
- Programa de Pós-Graduação em Fonoaudiologia, Universidade Estadual Paulista “Júlio de Mesquita Filho” – UNESP - Marília (SP), Brasil.
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Manicardi FT, Dutka JDCR, Guerra TA, Pegoraro-Krook MI, Chagas EFB, Marino VCDC. Effect of perceptive-auditory training on the classification of speech hypernasality. Codas 2023; 35:e20220069. [PMID: 37729318 PMCID: PMC10723581 DOI: 10.1590/2317-1782/20232022069pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/01/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE To analyze the effect of auditory-perceptual training by inexperienced speech-language pathologists in the classification of hypernasality in individuals with cleft lip and palate and compare their classification of hypernasality individually, with the gold standard evaluation, before and after this training. METHODS Three inexperienced speech-language pathologists used a four-point scale to assess 24 high-pressure speech samples from individuals with cleft lip and palate, before and after auditory-perceptual training. The speech samples corresponded to six samples of each degree of hypernasality. The speech-language pathologists received auditory-perceptual training during the assessments. They had access to anchor samples and immediate feedback of correct answers regarding the degree of hypernasality in training. RESULTS There was no significant difference in the overall percentage of correct answers when comparing before and after the auditory-perceptual training. There was a significant association and agreement of the three evaluators with a gold standard evaluation after training, with an increase in agreement for a single evaluator for absent and mild degrees of hypernasality. The dichotomous analysis of the data showed an increase in the Kappa Index of Agreement of this evaluator. Although there was an increase in the Index of Agreement between evaluators for absent, mild, and severe hypernasality, this increase did not reach statistical significance. CONCLUSION The auditory-perceptual training provided did not result in a significant improvement in the hypernasality classification for the inexperienced speech-language pathologists, even though the individual data analysis showed that the training favored one of the evaluators. Further studies involving gradual and more extensive auditory-perceptual training may favor the classification of hypernasality by inexperienced SLPs.
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Affiliation(s)
- Flora Taube Manicardi
- Programa de Pós-graduação em Fonoaudiologia, Universidade Estadual Paulista Júlio de Mesquita Filho - UNESP - Marília (SP), Brasil.
| | - Jeniffer de Cássia Rillo Dutka
- Pós-graduação em Ciência da Reabilidação, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP -Bauru (SP), Brasil.
| | - Thais Alves Guerra
- Pós-graduação em Ciência da Reabilidação, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP -Bauru (SP), Brasil.
| | - Maria Inês Pegoraro-Krook
- Pós-graduação em Ciência da Reabilidação, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP -Bauru (SP), Brasil.
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Marino VCDC, Dutka JDCR, Manicardi FT, Gifalli G, Silva PP, Pegoraro-Krook MI. Influence of speech stimuli in the auditory perceptual identification of hypernasality in individuals with cleft lip and palate. Codas 2020; 32:e20190269. [PMID: 33331425 DOI: 10.1590/2317-1782/20202019269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/11/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the influence of speech stimuli in the auditory perceptual identification of hypernasality in individuals with Cleft Lip and Palate (CLP). METHODS Speech samples from 80 individuals with operated unilateral CLP, ages ranged from nine to 17 years (the mean age of: 12y7m), both genders, were edited for this study. Samples were recorded over the production of nine different speech stimuli, including counting and short sentences characterized by oral sounds, one loaded with low pressure consonants and seven loaded with high pressure consonants. Three speech-language pathologists rated the presence or absence of hypernasality while analyzing 864 recordings (80 individuals X 9 stimuli + 144 repeated recordings, for measuring the intra-rater agreement). Intra-rater and inter-rater indexes of agreement were established for all nine stimulus conditions. The indexes of inter-rater agreement were compared using the Z test (p<0.005), with samples comprising significant indexes of agreement interpreted as better stimuli for identifying the hypernasality in these individuals. RESULTS Intra-rater agreement for high pressure stimuli with voiced consonants were significantly lower than indexes for other stimuli. Inter-rater agreement between each pair of SLPs ranged from 0.11 (plosive voicing stimuli) to 0.57 (12 short sentences, one of each high pressure consonant). The values of mean inter-rater agreement between all SLPs was 0.47 indicating moderate agreement for identifying hypernasal speech. CONCLUSION Speech recordings obtained over the production of longer speech samples including 12 short sentences, for instance one for each high pressure consonant, may favor inter-rater agreement for identifying hypernasality.
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Affiliation(s)
| | - Jeniffer de Cássia Rillo Dutka
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP - Bauru (SP), Brasil.,Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Flora Taube Manicardi
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP - Marília (SP), Brasil
| | - Giovana Gifalli
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Patrick Pedreira Silva
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Maria Inês Pegoraro-Krook
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP - Bauru (SP), Brasil.,Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru, Universidade de São Paulo - USP - Bauru (SP), Brasil
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Walden PR, Khayumov J. The Use of Auditory-Perceptual Training as a Research Method: A Summary Review. J Voice 2020; 36:322-334. [PMID: 32747174 DOI: 10.1016/j.jvoice.2020.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this descriptive review was to document the current state of training to perform auditory-perceptual analysis as reported in the voice literature. METHODS A review of the literature was performed. RESULTS Thirty-six articles were included in the review. The theoretical basis of training, specific training methods employed, duration of training, stimuli used to train, vocal qualities trained, and the type of listeners used are reported. CONCLUSION There is wide variation to training procedures used in research including auditory-perceptual evaluation of voice quality. In order to begin to discover how to best train listeners for research and clinical settings, attention to the training methods used in research is necessary. Further, these training methods must be explicitly acknowledged and described to allow for adequate evaluation of research findings, comparison across studies, and to determine for which populations results might be applicable. The conceptual framework outlined in this study is a starting point to review voice quality research and to design future studies for which auditory-perceptual evaluation is taught to listeners.
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de Boer G, Marino VCDC, Dutka JDCR, Pegoraro-Krook MI, Bressmann T. Nasalance-Based Preclassification of Oral-Nasal Balance Disorders Results in Higher Agreement of Expert Listeners' Auditory-Perceptual Assessments: Results of a Retrospective Listening Study. Cleft Palate Craniofac J 2019; 57:448-457. [PMID: 31537110 DOI: 10.1177/1055665619873506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Reliable perceptual and instrumental assessment of oral-nasal balance disorders is a persistent problem in speech-language pathology. The goal of the study was to evaluate whether nasalance-based preclassification of oral-nasal balance disorders improves listener agreement. DESIGN Retrospective listening study. SETTING Tertiary university hospital. PARTICIPANTS Fifty-four randomly selected recordings of patients with repaired unilateral cleft lip and palate (UCLP). Three experienced speech-language pathologists participated as expert listeners. INTERVENTIONS Two listening experiments were based on nasalance scores and audio recordings of speakers with repaired UCLP. The speakers were preclassified as normal, hypernasal, hyponasal, or mixed based on their nasalance scores. Initially, the listeners determined the diagnostic category of the oral-nasal balance for 62 audio recordings (8 repeats). Six months later, they listened to 38 of the recordings (6 repeats) along with a spreadsheet indicating the nasalance-based categories for the oral-nasal balance. The listeners confirmed, or rejected and corrected, the nasalance-based preclassification. MAIN OUTCOME MEASURES Intralistener, interlistener agreement, and agreement between listener categories and nasalance-based oral-nasal balance categories. RESULTS In the first study, the agreement between the listeners' diagnostic category and the nasalance-based category was 45.1% and the interlistener agreement was 36.7%. In the second study, the agreement between the listeners' category and the nasalance-based category was 67.1% (75% agreement for the correct nasalance-based categories and 41.7% for the misclassifications), and the interlistener agreement was 85.4%. CONCLUSIONS Preclassification of oral-nasal balance disorders based on nasalance scores may help listeners achieve better diagnostic accuracy and higher agreement.
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Affiliation(s)
- Gillian de Boer
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | | | - Jeniffer de Cassia Rillo Dutka
- Department of Speech-Language and Audiology, College of Dentistry of Bauru, and Graduate Programs, Hospital de Reabilitação de Anomalias Craniofaciais, and College of Dentistry of Bauru, University of São Paulo, Bauru, Brazil
| | - Maria Inês Pegoraro-Krook
- Department of Speech-Language and Audiology, College of Dentistry of Bauru, and Graduate Programs, Hospital de Reabilitação de Anomalias Craniofaciais, and College of Dentistry of Bauru, University of São Paulo, Bauru, Brazil
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
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Bettens K, Bruneel L, Maryn Y, De Bodt M, Luyten A, Van Lierde KM. Perceptual evaluation of hypernasality, audible nasal airflow and speech understandability using ordinal and visual analogue scaling and their relation with nasalance scores. JOURNAL OF COMMUNICATION DISORDERS 2018; 76:11-20. [PMID: 30071470 DOI: 10.1016/j.jcomdis.2018.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/04/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Perceptual assessments remain the most commonly utilized procedure to diagnose and evaluate resonance disorders. However, the discussion continues about which rating scale has to be applied. Therefore, this study aimed to compare the reliability and validity of ordinal and visual analogue scales to rate hypernasality, audible nasal airflow and speech understandability. METHODS Four experienced speech-language pathologists rated 35 speech samples of children with a range of hypernasality, audible nasal airflow and speech understandability, using an ordinal scale and a visual analogue scale. Intraclass correlations coefficients determined intra- and inter-rater reliability. The model of best fit was determined by plotting both rating scales against each other. A Pearson correlation coefficient verified the relationship between both rating scales and nasalance scores determined by a Nasometer. RESULTS Good intra- and inter-rater reliability was found for both rating scales. A multiple regression analysis revealed a curvilinear relationship between both rating scales, indicating a slight preference to rate all parameters by a visual analogue scale. Comparable correlations with nasalance scores were found. CONCLUSIONS This study confirms that visual analogue scale ratings form a reliable and valid alternative for ordinal ratings in the perceptual judgments of hypernasality, audible nasal airflow and speech understandability. A combination of both rating scales may even combine the advantages and eliminate their limitations. However, further research is necessary to verify how this new approach can be implemented in available protocols for clinical practice, audits and research.
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Affiliation(s)
- Kim Bettens
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Laura Bruneel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Youri Maryn
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Speech-Language Pathology, Sint-Augustinus General Hospital, Wilrijk, Antwerp, Belgium; Department of Speech-Language Therapy and Audiology, Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marc De Bodt
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Wilrijk, Belgium
| | - Anke Luyten
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Kristiane M Van Lierde
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Therapy and Audiology, University of Pretoria, Pretoria, South Africa
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The Exploration of an Objective Model for Roughness With Several Acoustic Markers. J Voice 2018; 32:149-161. [DOI: 10.1016/j.jvoice.2017.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/19/2017] [Indexed: 11/18/2022]
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The Acoustic Breathiness Index (ABI): A Multivariate Acoustic Model for Breathiness. J Voice 2017; 31:511.e11-511.e27. [DOI: 10.1016/j.jvoice.2016.11.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 11/24/2022]
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