Age‐related patterns of nasal resonance in normal Flemish children and young adults

Effect of Adenotonsillectomy on Spectral and Acoustic Characteristics

Acoustic analysis and perceptual analysis has been extensively used to assess the speech and voice among individual with voice disorders. These methods provide objective, quantitative and precise information on the speech and voice characteristics in any given disorder and help in monitoring any recovery, deterioration, or improvement in an individual's speech and also differentiate between normal and abnormal speech and voice characteristics. The present study was carried out to investigate the spectral characteristics (formant frequency parameters and formant centralization ratios) and voice characteristics (Acoustic parameters of voice) changes in individuals following adenotonsillectomy. A total of 34 participants participated in the study with a history of adenotonsillar hypertrophy. Spectral and acoustic voice parameters were analyzed across the three-time domains, before surgery (T0), 30 days (T1), and 90 days (T2) after surgery. Data was analyzed statistically using the SPSS software version-28.0.0.0. Descriptive statistics were used to find the mean and standard deviation. Repeated measures of ANOVA were used to compare the pre and post-experimental measures for spectral and acoustic, voice parameters. The derived parameter of acoustic vowel space (formant centralization ratio 3) was compared across three conditions timelines. The results revealed that acoustic vowel space measure and formant frequency measures were significantly increased in pre and post-operative conditions across the three timelines. A significant difference was obtained across the acoustic parameters across the time domains. Adenotonsillectomy has been proved to be an efficient surgical procedure in treating children with chronic adenotonsillitis. The results obtained have indicated an overall improvement in the spectral and acoustic voice parameters thereby highlighting the need for adenotonsillectomy at the right time and at the right age.

Treatment Outcomes of Interdisciplinary Care on Speech and Health-Related Quality of Life Outcomes in Adults With Cleft Palate

PURPOSE

Individuals born with a cleft palate with or without a cleft lip (CP ± L) often experience functional, aesthetic, and psychosocial consequences well into adulthood. This study aimed to investigate outcomes of speech and health-related quality of life (HRQoL) in adults with a CP ± L who received interdisciplinary cleft care at the Ghent University Hospital using valid, reliable, and condition-specific instruments.

METHOD

Thirteen Belgian Dutch-speaking participants with a CP ± L with a mean age of 25.4 years (SD = 5.1, range: 20-33 years) and an age- and gender-matched control group of 13 participants without a CP ± L with a mean age of 25.2 years (SD = 4.8, range: 20-32 years) were included in this study. Speech characteristics were evaluated perceptually and instrumentally. HRQoL was assessed through standardized patient-reported outcome measures. Outcomes were compared with those of the control group and to normative data where available.

RESULTS

Participants with a CP ± L in this sample demonstrated significantly lower speech acceptability (p < .001) and higher rates of hypernasality (p = .015) and nasal turbulence (p = .005) than the control group. They showed significantly higher satisfaction with appearance of the cleft scar compared with norms of adults with a CP ± L (p = .047). No other differences in speech characteristics, sociodemographics, or HRQoL were found between participants with and without a CP ± L.

CONCLUSIONS

The reduced speech acceptability and the presence of resonance and nasal airflow disorders may indicate the need for standardized long-term outcome measurement and interdisciplinary follow-up for speech characteristics and velopharyngeal insufficiency in young and middle adulthood in future clinical practice. Additional research is necessary to further substantiate these findings and to determine predictors for these continuing complications in adults with a CP ± L.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24243901.

Nasalance Scores as a Function of Skeletal Malocclusion of English-Speaking Adults in the North Indian Population

OBJECTIVE

The objective of this study is quantitative assessment of nasalance for skeletal Class I (normative values), Class II, and III malocclusion in the English language for the North Indian population and to compare the normative values with the nasalance scores obtained from individuals with skeletal Class II and III malocclusion and to evaluate the normative values as a function of gender.

MATERIAL AND METHODS

The study was conducted on a total sample of 200 patients with 100, 50, and 50 in group 1 (control group, Skeletal Class I), group 2 (Skeletal Class II), and group 3 (Skeletal Class III), respectively. ANB angle (anteroposterior angle formed by point A, nasion, and point B) measured on lateral cephalogram was used to categorize the patients into 3 groups. The normative nasalance scores were compared for males and females in the control group. The nasalance scores of skeletal Class II and III subjects were compared to the combined normative scores of the control group. The NasalView was used for the objective assessment of nasalance. Oral syllables (/pa/and/pi/), nasal syllables (/ma/and/mi/), and 3 passages (Zoo passage, Rainbow passage, and Nasal sentences) were used to determine the nasalance scores.

RESULTS

The intragroup comparison of nasalance scores in group 1 showed statistically significant differences for different stimuli. The gender-related comparison showed no statistically significant differences in nasalance scores. The intergroup comparison of nasalance scores for skeletal malocclusion showed no statistically significant differences for different stimuli except statistically significant lower nasalance values for nasal sentences in group 3 compared to the control group.

CONCLUSION

The study concluded that the nasalance scores for nasal sentences in skeletal Class III malocclusion were significantly lower than in the control group and were not statistically significant between the 3 groups for all other stimuli.

Normative nasalance scores in Tamil-speaking Indian children

OBJECTIVE

The aim of this study was to obtain normative nasalance scores for Indian Tamil-speaking children.

METHODS

Mean nasalance scores were obtained from 175 consecutive Tamil-speaking normal children (95 males, 80 females) aged 5-16 years during the repetition of six standardized sentences: two oral, two oronasal, and two nasal sentences. The nasal view was used to obtain nasalance scores for the standardized sentences.

RESULTS

Group mean and standard deviation (SD) nasalance scores of children for oral, oronasal, and nasal sentence were 35.65(SD 7.20), 44.42(SD 7.37), and 57.21(SD 8.15), respectively. The mean nasalance values of children aged 9-12 years were greater than children aged 5-8 years and 13-16 years for nasal sentences (p < .001). Males were found to have significantly higher nasalance scores for oral and oronasal sentences (p < .05) although these differences were within the range of normal variation.

CONCLUSIONS

The present study provides normative nasalance scores for Tamil-speaking Indian children.

Measurement of Nasalance Scores Without Touching the Philtrum for Better Comfort During Speech Assessment and Therapy: A Preliminary Study

OBJECTIVE

The Kay Pentax nasometer uses a separator plate that touches the philtrum of a patient to separate the nasal and oral sound energies for nasalance measurement. However, the separator plate can restrict the natural movement of the patient's upper lip and generate unpleasant pressure on the patient's philtrum. The present study was intended to measure nasalance scores without touching the philtrum for better comfort during speech assessment and therapy.

METHODS

Nasalance scores of 10 males and 10 females having no speech disorders were measured under 4 levels (0, 5, 10, and 15 mm) of the gap between the plate and the philtrum (denoted as plate-to-philtrum gap) using Nasometer II 6450 for nasal (Nasal Sentences) and oral (Zoo Passage) stimuli. Regression formulas were established to examine the relationships between nasalance score and plate-to-philtrum gap for the stimuli. To provide nasalance scores equivalent to those measured for the contact condition, compensation factors for the 5 mm plate-to-philtrum gap measurement condition were identified for the stimuli.

RESULTS

The nasalance scores were significantly different between the 4 different plate-to-philtrum gaps for the stimuli. Compensation factors for the Nasal Sentences and the Zoo Passage were identified as 1.17 and 0.71, respectively.

CONCLUSIONS

The 5 mm plate-to-philtrum gap condition after multiplying the compensation factors can provide equivalent nasalance scores to the conventional contact measurement condition which may provide better comfort in speech assessment and therapy.

Speech stimuli and nasalance scores for the assessment of resonance in in Mandarin speaking Malaysian children

This study was designed to develop language-specific stimuli for the assessment of resonance and to obtain nasalance scores using the newly developed speech stimuli in Mandarin. Gender and age influences on nasalance scores for each of the stimulus were also examined. Participants recruited were typically developing Mandarin-speaking ethnic Chinese children aged 6;00-7;11 growing up in Malaysia. Perceptual ratings of nasality were made based on the GOS.SP.ASS.'98 (revised) for children while nasalance scores were recorded for each stimulus using the Nasometer II (Model 6400). Fifty Mandarin-speaking children (24 males and 26 females) were recruited. None of the participants were perceived with abnormal nasality on the three stimuli. The mean nasalance scores for the Mandarin stimuli were 16.08% (SD = 2.57, 95% CI = 15.35-16.81) for the Oral passage, 25.20% (SD = 3.63, 95% CI = 24.17-26.23) for the Oral-Nasal passage and 55.44% (SD = 4.17, 95% CI = 54.25-56.63) for the Nasal passage. No significant age- and gender-related differences were observed for all the three stimuli. This is the first set of Mandarin stimuli and nasalance norms for Mandarin-speaking children in Malaysia. The influence of phonetic content on nasalance is supported. Findings call for language-specific normative nasalance data and careful selection of stimuli for the assessment of resonance.

Nasometric evaluation of resonance disorders: A norm study In Turkish

OBJECTIVE

The aim of this study was to adapt the Simplified Nasometric Assessment Procedures-Revised (SNAP-R) [1] to Turkish, gather norms from Turkish speakers, and test the sensitivity and specificity of the adapted test. Finally, this study was designed to determine if there are any differences in average nasalance scores due to age, gender, and vowel content of the passage.

METHODS

240 children without any known speech, language or hearing disorders and 40 children with cleft palate participated in the study. Participants were divided into three groups according to their age (ages 4-7; 8-12; and 13-18). Data for this descriptive study was collected in the school settings and in a center of speech and language therapy.

RESULTS

This study showed a slight increase in nasalance with age, but no difference in nasalance based on gender. Furthermore, the nasalance score is determined by vowel content of the passage and that high vowels have higher nasalance than the low vowels.

CONCLUSION

This paper offers a new test for nasometric evaluation in the Turkish language, which has relatively high specificity and sensitivity in the evaluation of hypernasality.

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.

Impact of speech rate and mouth opening on hypernasality and speech intelligibility in children with a cleft (lip and) palate

AIM

this study evaluated the effectiveness of different speech techniques (i.e. modification of speech rate and/or mouth opening) for the rehabilitation of hypernasality in children with a cleft palate with or without a cleft lip (CP±L). The impact of speech rate and/or mouth opening was investigated on both hypernasality and speech intelligibility.

METHODS

thirteen patients with CP±L and perceived hypernasality (mean age: 10y5m) and 13 age and gender matched children without CP±L were included. Children were asked to read an oral and oronasal text passage in ten different speaking conditions where speech rate and/or mouth opening was manipulated. Outcome measures included instrumental measurements of hypernasality and perceptual ratings of speech intelligibility and hypernasality.

RESULTS

speaking with a lower speech rate had a statistically significant, positive influence on objective measures of hypernasality in both groups, especially when elicited by a metronome. An increased mouth opening and the combination of both techniques was only effective in the control group. Moreover, it was found that children without CP ±L were less intelligible when speaking with a decreased mouth opening.

CONCLUSION

a metronome-controlled decrease of speech rate had a positive influence on objective measures of hypernasality both in children with and without CP±L. However, present study could not provide any evidence that speaking with increased mouth opening reduces objective and perceptual measures of hypernasality in children with CP±L. Further research investigating the use of these techniques is necessary.

Influence of Altered Auditory Feedback on Oral-Nasal Balance in Speakers of Brazilian Portuguese

Purpose This study explored the role of auditory feedback in the regulation of oral-nasal balance in speakers of Brazilian Portuguese. Method Twenty typical speakers of Brazilian Portuguese (10 male, 10 female) wore a Nasometer headset and headphones while continuously repeating stimuli with oral and nasal sounds. Oral-nasal balance was quantified with nasalance scores. The signals from 2 additional oral and nasal microphones were played back to the participants through the headphones. The relative loudness of the nasal channel in the mix was gradually changed, so that the speakers heard themselves as more or less nasal. Results A repeated-measures analysis of variance of the mean nasalance scores of the stimuli at baseline, minimum, and maximum nasal feedback conditions demonstrated significant effects of nasal feedback condition (p < .0001) and stimuli (p < .0001). Post hoc analyses demonstrated that the mean nasalance scores were lowest for the maximum nasal feedback condition. The scores of the minimum nasal feedback condition were significantly higher than 2 of 3 baseline feedback conditions. The speaking amplitude of the participants did not change between the nasal feedback conditions. Conclusions Increased nasal signal level feedback led to a compensatory adjustment in the opposite direction, confirming that oral-nasal balance is regulated by auditory feedback. However, reduced nasal signal level feedback resulted in a compensatory response that was lower in magnitude. This suggests that, even in Brazilian Portuguese, a language with phonetic and phonological vowel nasalization, decreased nasality was not perceived as critically as increased nasality by the speakers.

Nasality in Homosexual Men: A Comparison with Heterosexual Men and Women

Several studies reported that pitch and articulation may vary according to a person's sexual orientation. The purpose of this study was to investigate whether homosexual males also demonstrate differences in nasal resonance compared to heterosexual males. Speech samples of 30 self-identified homosexual males, 35 heterosexual males, and 34 heterosexual females were compared both instrumentally and perceptually. Nasalance scores were calculated for the sounds /a/, /i/, /u/, and /m/ and for an oronasal, oral, and nasal text. In addition, the Nasality Severity Index was determined. Spontaneous speech samples were used for a perceptual evaluation of nasal resonance. Neither the nasalance scores nor the Nasality Severity Index were significantly different between the homosexual and heterosexual males. Heterosexual females, on the other hand, showed significantly higher nasalance values for the oronasal and oral text and a significantly lower Nasality Severity Index than both the homosexual and the heterosexual males. The perceptual judgment revealed no significant differences between the three groups. The results of this study suggest that, in contrast to pitch and articulation, nasality does not tend to vary with sexual orientation.

Speech Phenotyping in Unaffected Family Members of Individuals With Nonsyndromic Cleft Lip With or Without Palate

OBJECTIVE

Subclinical phenotypes of nonsyndromic cleft lip with or without cleft palate (CL ± P) may be identified from clinically "unaffected" relatives and could be associated with specific cleft-related gene mutations. It has been hypothesized that velopharyngeal insufficiency (VPI) may be a subclinical phenotype of interest in this population, but this has not been explored quantitatively with appropriate control cohorts. The aim of this case-control study was to compare VPI in at-risk clinically unaffected relatives of individuals with nonsyndromic CL ± P with a low-risk matched normative Australian cohort.

PARTICIPANTS

Clinically unaffected (ie, with no overt cleft) first-degree relatives of a proband with nonsyndromic CL ± P (n = 189) and noncleft controls (n = 207).

MAIN OUTCOME MEASURE(S)

Perceptual measures of VPI encompassing resonance, nasal emission, and articulation were evaluated using the Great Ormond Street Speech Assessment. Quantitative measures of VPI were obtained from the Nasometer II using standardized adult and pediatric speech stimuli.

RESULTS

Both perceptual and instrumental measures showed no significant difference (P > .01) between the VPI in unaffected relatives and the noncleft comparison group. Mean nasalance scores for both groups were calculated and reported according to speech stimuli, age, and sex.

CONCLUSIONS

Results suggest that VPI, measured through speech, is not a significant subclinical phenotype of nonsyndromic CL ± P. Therefore, further familial genetic investigations exploring VPI may not yield meaningful results. Exploration across multiple subclinical phenotypes in larger cohorts may enable researchers to better understand the multifaceted nature of this complex and heterogeneous anomaly.

Nasality Changes With Age in Normal Korean-Speaking Adults

Objectives

This study was performed to investigate the effects of aging on nasality and the influence of age-related changes in nasal cavity volume and nasal patency on nasality.

Methods

A total of 180 healthy Korean-speaking adult volunteers, who had no nasal or voice-related complaints, were enrolled in this study. Nasometry, acoustic rhinometry, and rhinomanometry were performed to obtain the nasalance score, nasal cavity volume, and nasal resistance, respectively. Changes in these parameters with age were analyzed.

Results

Nasal cavity volume increased significantly, and nasal resistance decreased significantly, with age. The nasalance scores for the nasal passage and oronasal passage decreased significantly with age, while there were no age-related changes in nasalance scores for the oral passage.

Conclusion

Nasalance scores for the passages containing nasal consonants decreased with age although significant increases were observed in nasal cavity volume and nasal patency with age. Therefore, the age-related decreases in nasalance scores may result from factors other than changes in the nasal cavity.

Clinical Application of a New Approach to Identify Oral-Nasal Balance Disorders Based on Nasalance Scores

OBJECTIVE

A new approach to classify oral-nasal balance disorders based on instrumental measurements was developed based on linear discriminant analysis (LDA) of nasalance scores of simulated oral-nasal balance disorders by de Boer and Bressmann. The current study aimed to apply the newly developed functions to clinical data to investigate the applicability of this new approach.

DESIGN

Retrospective diagnostic accuracy study.

SETTING

Tertiary university hospital.

PARTICIPANTS

Fifty-five Dutch-speaking Flemish children (age 4-12 years) with normal (n = 20), hypernasal (n = 18), hyponasal (n = 12), or mixed nasality (n = 5).

INTERVENTIONS

Nasalance scores of an oral and a nasal text were used to calculate 3 sets of LDA function scores. Predicted classification was consecutively based on the function values of the group centroids originally determined by de Boer and Bressmann and adapted LDA functions and group centroids based on clinical data.

MAIN OUTCOME MEASURES

Discriminatory power of the linear discriminant formulas.

RESULTS

Based on the original LDA functions, 56% of the speech samples matched the perceptual classification. Applying a correction factor for age and language differences resulted in a 67% correct classification, although 83% of the hyponasal samples were ranked as "normal resonance." Rederivation of the LDA functions based on current clinical data resulted in an 80% correct classification.

CONCLUSIONS

The new approach of classifying oral-nasal balance disorders based on a combination of nasalance scores was promising. However, further clinical research is needed to refine the LDA functions and group centroids before clinical application is possible.

Normative nasalance scores for Estonian children

Normative nasalance scores are essential for the treatment and assessment purposes for clinicians. Till date, no studies have been done on nasalance in Estonia. This research was conducted to develop Estonia-specific optimized speech stimuli for Nasometer II and establish the normative nasalance scores. Ninety-two randomly selected healthy and 14 cleft palate Estonian monolingual children, aged four to seven years, were included as participants. Estonian language-specific test material was developed. The Estonian test material consisted of 24 speech stimuli. Based on the phoneme content, the stimuli were divided into three groups: (1) sentences that included oral and nasal phonemes and targeted the same phoneme distribution as in spontaneous speech, (2) sentences that included only oral phonemes and (3) sentences that were loaded with nasal phonemes. Nasometer II software was used to calculate the nasalance scores for each child and each sentence. Results indicated that there were significant differences in nasalance scores for oronasal and oral stimuli scores, and no significant differences were found in nasal stimuli scores between the study and control group. The threshold for oronasal stimuli was 42.1-18.9, oral stimuli was 27.9-3.9 and nasal stimuli was 69.4-46.2. In conclusion, Estonia-specific optimized speech stimuli were developed and normative nasalance scores were established. These normative scores can be used for the diagnosis and follow-up treatment of patients with resonance disorders, especially for patients with cleft palate.

Acoustic Characteristics in Epiglottic Cyst

OBJECTIVE

The purpose of this study was to analyze the acoustic characteristics associated with alternation deformation of the vocal tract due to large epiglottic cyst, and to confirm the relation between the anatomical change and resonant function of the vocal tract.

METHODS

Eight men with epiglottic cyst were enrolled in this study. The jitter, shimmer, noise-to-harmonic ratio, and first two formants were analyzed in vowels /a:/, /e:/, /i:/, /o:/, and /u:/. These values were analyzed before and after laryngeal microsurgery.

RESULTS

The F1 value of /a:/ was significantly raised after surgery. Significant differences of formant frequencies in other vowels, jitter, shimmer, and noise-to-harmonic ratio were not presented.

CONCLUSION

The results of this study could be used to analyze changes in the resonance of vocal tracts due to the epiglottic cysts.

Delayed primary palatal closure in resource-poor countries: Speech results in Ugandan older children and young adults with cleft (lip and) palate

AIMS

Unrepaired clefts still regularly occur in resource-poor countries as a result of limited health-care access. The purpose of the present study was to report resonance, airflow and articulation characteristics following delayed (≥8years) primary palatal closure.

METHODS

Fifteen Ugandan participants with cleft (lip and) palate (CP±L) were included as well as 15 age- and gender-matched Ugandan subjects without clefts. Palatal closure was performed at a mean age of 15;10 years using the Sommerlad technique. Speech evaluations were carried out on a single occasion postoperatively (mean age: 18;10 years). Resonance and nasal airflow were perceptually evaluated and detailed phonetic and phonological assessments were carried out. Additionally, nasalance values were determined.

RESULTS

Nasal emission occurred postoperatively in only 27% (4/15) of the patients, whereas resonance disorders and articulation errors were prevalent in 87% (13/15) of the patient group. Compared with the control group, a significantly higher prevalence of hypernasality and significantly higher nasalance values for all oral and oronasal speech samples were obtained in the CP±L group. Moreover, significantly smaller consonant inventories and significantly more phonetic and phonological disorders were observed.

CONCLUSIONS

Delayed palatal repair (≥8years) seems to be insufficient to eliminate nasal airflow errors, resonance abnormalities, and articulation disorders. In order to prevent patients' late presentation at specialized centers, the availability of high quality surgical cleft palate treatment should increase as well as people's awareness of the possibility and importance of early surgical intervention. Moreover, speech therapy following delayed palatal closure would be beneficial. Furthermore, a standardized and validated protocol for speech assessment in future studies is advocated.

Nasalance of Brazilian Portuguese-speaking populations from two different states

Purpose

To measure the nasalance scores of Brazilian Portuguese-speaking young adults from the states of Sao Paulo and Minas Gerais in order to investigate whether dialect variations and gender affect these scores.

Methods

Nasalance was assessed in 36 individuals: 20 native residents of Sao Paulo state (mean age=23 y.o.) and 16 native residents of Minas Gerais state (mean age=24 y.o.), following the same criteria. Nasalance measures were taken using the Nasometer II 6400 (KayPentax) device based on the reading of three texts (nasal-1, nasal-2, and oral). Intergroup nasalance scores were compared using the unpaired Student's t test considering two experimental groups.

Results

The nasalance scores in individuals from the states of Sao Paulo and Minas Gerais were 52.7% and 48.8% for the nasal-1 text, 49.6% and 49.9% for the nasal-2 text, and 14.3% and 9.8% for the oral text, respectively. Statistical analysis comparing the mean nasalance scores in both groups showed significant difference (p=0.03) only for the oral text, in which individuals from Sao Paulo state presented higher scores.

Conclusion

Although nasalance scores were lower in individuals from Minas Gerais state compared with those of individuals from Sao Paulo state, both groups presented values within the normal range. The variable gender was not relevant in the nasalance assessment; however, a tendency for higher scores was observed in women compared with men from Minas Gerais state in the same group in the reading of the nasal-2 text. This study contributes to the knowledge of nasalance reference scores for two different populations of Brazilian Portuguese speakers; however, the results herein reported should be interpreted with caution due to the small study sample size.

Nasalance Changes Following Various Endonasal Surgeries

Introduction There is change in nasalance post endonasal surgery which is not permanent.

Objectives The objective of this study is to evaluate the long-term nasalance changes following different types of endonasal surgeries.

Methods We included in this study patients who underwent sinonasal surgery at the Otorhinolaryngology Department in Zagazig University Hospitals from February 2015 until March 2016. We divided the patients into two groups according to the surgeries they underwent: Group (A) was the FESS group and group (B), the septoturbinoplasty group. We checked nasalance using a nasometer before and after the sinonasal surgery.

Results Nasalance increased at one month after the operation in both groups. However, it returned to nearly original levels within three months postoperatively.

Conclusion FESS, septoplasty, and turbinate surgery may lead to hypernasal speech. This hypernasal speech can be a result of change in the shape and diameter of the resonating vocal tract. Hypernasal speech in these circumstances may be a temporary finding that can decrease with time. Surgeons should inform their patients about the possibility of hypernasality after such types of surgery, especially if they are professional voice users.

Influence of gender and age on the Nasality Severity Index 2.0 in Dutch-speaking Flemish children and adults

This study aimed to explore the influence of gender and age on the Nasality Severity Index 2.0 (NSI 2.0), an instrumental multiparametric index to determine hypernasality. Additionally, reference values will be established for this new index. Influence of gender and age on the NSI 2.0 was explored in 80 Flemish-speaking children (4-12 years; 40 boys, 40 girls) and 60 Flemish-speaking adults (18-60 years, 30 men, 30 women) without resonance disorders by determining its incorporated acoustic parameters: nasalance of the vowel/u/and an oral text, determined by a Nasometer, and voice low tone to high tone ratio (VLHR) of the vowel/i/. The equation yields NSI 2.0 = 13.20 - (0.0824 × nasalance/u/(%)) - (0.26 × nasalance oral text (%)) - (0.242 × VLHR/i/4.47*F0 Hz (dB)). No effect of gender or age was found on the NSI 2.0 in children. However, significant differences were found for the NSI 2.0, nasalance of/u/and an oral text between adult men and women. Additionally, an interaction effect between gender and age was found for these parameters. Consequently, separate reference values for the NSI 2.0 in children, adult men and adult women were established. Based on these reference scores, deviation of the NSI 2.0 score in patients with resonance disorders can be defined, which can determine the need for (additional) intervention. Further research can explore the possible influence of language on the index.

Short-term and long-term test-retest reliability of the Nasality Severity Index 2.0

PURPOSE

The Nasality Severity Index 2.0 (NSI 2.0) forms a new, multiparametric approach in the assessment of hypernasality. To enable clinical implementation of this index, the short- and long-term test-retest reliability of this index was explored.

METHODS

In 40 normal-speaking adults (mean age 32y, SD 11, 18-56y) and 29 normal-speaking children (mean age 8y, SD 2, 4-12y), the acoustic parameters included in the NSI 2.0 (i.e. nasalance of the vowel /u/ and an oral text, and the voice low tone to high tone ratio (VLHR) of the vowel /i/) were obtained twice at the same test moment and during a second assessment two weeks later. After determination of the NSI 2.0, a comprehensive set of statistical measures was applied to determine its reliability.

RESULTS

Long-term variability of the NSI 2.0 and its parameters was slightly higher compared to the short-term variability, both in adults and in children. Overall, a difference of 2.82 for adults and 2.68 for children between the results of two consecutive measurements can be interpreted as a genuine change. With an ICC of 0.84 in adults and 0.77 in children, the NSI 2.0 additionally shows an excellent relative consistency. No statistically significant difference was withheld in the reliability of test-retest measurements between adults and children.

CONCLUSION

Reliable test-retest measurements of the NSI 2.0 can be performed. Consequently, the NSI 2.0 can be applied in clinical practice, in which successive NSI 2.0 scores can be reliably compared and interpreted.

LEARNING OUTCOMES

The reader will be able to describe and discuss both the short-term and long-term test-retest reliability of the Nasality Severity Index 2.0, a new multiparametric approach to hypernasality, and its parameters. Based on this information, the NSI 2.0 can be applied in clinical practice, in which successive NSI 2.0 scores, e.g. before and after surgery or speech therapy, can be compared and interpreted.

Nasalance and nasality in children with cochlear implants and children with hearing aids

OBJECTIVES

In prelingually deaf children, many speech production aspects including resonance, are known to be problematic. This study aimed to investigate nasality and nasalance in two groups of prelingually hearing impaired children, namely deaf children with a cochlear implant (CI) and moderate-to-severely hearing impaired hearing aid (HA) users. The results of both groups are compared with the results of normal hearing children. Besides, the impact of the degree of hearing loss was determined.

METHODOLOGY

36 CI children (mean age: 9;0y), 25 HA children (mean age: 9;1y) and 26 NH children (mean age: 9;3y) were assessed using objective assessment techniques and perceptual evaluations in order to investigate the nasal resonance of the three groups. Ten HA children had thresholds above 70dB (range: 91dB-105dB) and fifteen below 70dB (range: 58dB-68dB). The Nasometer was used for registration of the nasalance values and nasality was perceptually evaluated by two experienced speech therapists using a nominal rating scale (consensus evaluation).

RESULTS

For nasal stimuli, both CI children and HA children showed lower nasalance values in comparison with NH children. The opposite was observed for the oral stimuli. In both hearing impaired groups, cul-de-sac-resonance was observed on a significantly larger scale than in the NH group, and the HA children were judged to be significantly more hypernasal in comparison with NH children.

CONCLUSIONS

Despite the fact that a substantial number of the CI and HA children demonstrate normal (nasal) resonance quality, this aspect of speech production is still at risk for hearing impaired children.

The Nasality Severity Index 2.0: Revision of an Objective Multiparametric Approach to Hypernasality

OBJECTIVE

Due to the multidimensional nature of resonance disorders, multivariate diagnostic assessment is advisable. The nasality severity index (NSI) is based on this point of view. Because of the influence of personal and environmental variables on the current NSI, this study aims to refine this index.

DESIGN

Prospective case-control study.

SETTING

Tertiary university hospital.

PATIENTS

Forty-two patients with cleft lip and palate and 50 children without resonance disorders were tested.

INTERVENTIONS

Resonance was investigated by perceptual as well as objective measurements. A Nasometer was used to score nasalance, and spectral speech characteristics of a sustained sound /i:/ were determined, among which the voice low tone to high tone ratio (VLHR). Binary logistic regression analysis was performed to calculate the optimal index to discriminate patients from control children. Additionally, the validity of the index was determined based on data from an independent patient and control group.

RESULTS

The NSI 2.0, a weighted linear combination of three variables, can be obtained using the equation NSI 2.0 = 13.20 - (.0824 × nasalance /u:/ [%]) - (.260 × nasalance oral text [%]) - (.242 × VLHR 4.47*F0 [dB]). The NSI has a sensitivity of 92% and a specificity of 100%. Moreover, it has excellent validity (sensitivity 88%, specificity 89%).

CONCLUSIONS

The NSI 2.0 discriminates patients from control children with high sensitivity, specificity, and validity. This multiparametric method can offer a more powerful approach in the assessment and treatment planning of individuals with hypernasality.

Instrumental assessment of velopharyngeal function and resonance: a review

The purpose of this literature review is to describe and discuss instrumental assessment techniques of the velopharyngeal function in order to diagnose velopharyngeal disorders and resonance characteristics. Both direct and indirect assessment techniques are addressed, in which successively nasopharyngoscopy, videofluoroscopy, magnetic resonance imaging (MRI), cephalometric radiographic analysis, computed tomography (CT), ultrasound, acoustic and aerodynamic measurements are considered. Despite the multiple instrumental assessments available to detect and define velopharyngeal dysfunction, the ideal technique is not yet accessible. Therefore, a combination of different quantitative parameters can possibly form a solution for a more reliable determination of resonance disorders. These multi-dimensional approaches will be described and discussed. The combination of quantitative measurement techniques and perceptual evaluation of nasality will probably remain necessary to provide sufficient information to make appropriate decisions concerning the diagnosis and treatment of resonance disorders.

LEARNING OUTCOMES

The reader will be able to describe and discuss currently available instrumental techniques to assess the velopharyngeal mechanism and its functioning in order to diagnose velopharyngeal disorders. Additionally, he will be able to explain the possible advantages of the combination of several types of complementary measurement techniques.

Comparison of nasal acceleration and nasalance across vowels

PURPOSE

The purpose of this study was to determine the performance of normalized nasal acceleration (NNA) relative to nasalance as estimates of nasalized versus nonnasalized vowel and sentence productions.

METHOD

Participants were 18 healthy speakers of American English. NNA was measured using a custom sensor, and nasalance was measured using the KayPentax Nasometer II. Speech stimuli consisted of CVC syllables with the vowels (//, /æ/, /i/, /u/) and sentences loaded with high front, high back, low front, and low back vowels in both nasal and nonnasal contexts.

RESULTS

NNA showed a small but significant effect of the vowel produced during syllable stimuli but no significant effect of vowel loading during sentence stimuli. Nasalance was significantly affected by the vowel being produced during both syllables and sentences with large effect sizes. Both NNA and nasalance were highly sensitive and specific to nasalization.

CONCLUSIONS

NNA was less affected by vowel than nasalance. Discrimination of nasal versus nonnasal stimuli using NNA and nasalance was comparable, suggesting potential for use of NNA for biofeedback applications. Future work to improve calibration of NNA is needed to lower intersubject variability.

Nasalance scores for typical Irish English-speaking adults

The aim was to establish normative nasalance values for Irish English-speaking adults. Thirty men and 30 women with normal resonance read aloud 16 sentences from the Irish nasality assessment protocol, the Zoo passage, and the Rainbow passage. The speech samples were recorded using the Nasometer II 6400. Results of a mixed between-within subjects ANOVA indicated no significant gender effect on nasalance scores. The speakers showed significantly higher nasalance scores for high-pressure consonant sentences than low-pressure consonant sentences, and for the Rainbow passage than total test sentences. There was no significant difference between high-pressure consonant sentences and the Zoo passage. Compared to previous studies, the Irish young adults had lower nasalance scores than Irish children and than young adults with North American dialects.

The impact of menopause and hormone therapy on nasal resonance

The purpose of this study was to investigate the impact of menopause and hormone therapy on nasal resonance by comparing premenopausal women and postmenopausal women with and without hormone therapy. A total of 147 middle-aged Flemish (Dutch)-speaking women participated in the study and were divided into three groups: premenopausal women (n =42), and postmenopausal women with (n =63) and without (n =42) hormone therapy. Nasal resonance scores of isolated sounds and connected speech were measured using the Nasometer. For the isolated sounds as well as for the reading texts, no differences were found in nasal resonance scores between the three groups (ANCOVA). The results of this study indicate that menopause and hormone therapy do not have an impact on the nasal resonance in middle-aged women.

Nasal resonance in middle-aged women: a multiparameter approach

OBJECTIVES

Aging influences several speech characteristics in middle-aged women. However, the effect of aging on nasal resonance has not been widely investigated, and findings are contradictory. The purpose of this study was to investigate the effect of aging on nasal resonance by comparing young women (between 20 and 28 years of age) with middle-aged women (between 45 and 55 years of age).

METHODS

Thirty-one middle-aged women with a mean age of 48 years participated in the subject group. The control group consisted of 22 young women with a mean age of 23 years. To investigate nasal resonance, we used a multiparameter approach by means of the Nasal Severity Index (NSI). Objective acoustic (nasal resonance scores of sounds and connected speech measured with the Nasometer) and aerodynamic measurements (maximum duration time of /s/, vital capacity, and mirror fogging test), as well as perceptual evaluations (Gutzmann /a/-i/test), were performed.

RESULTS

The results of this study showed no differences in aerodynamic measurements and nasal resonance scores of connected speech and the sounds /i/, /u/, and /m/. Only the mean nasal resonance score of /a/ and the Gutzmann /a/ test were significantly different between the young and middle-aged women. The mean (+/- SD) NSI scores of the young women (12.93 +/- 17.9) and the middle-aged women (-1.49 +/- 14.4) both corresponded to normal nasal resonance.

CONCLUSIONS

The results of this study indicate that both young and middle-aged women show a normal nasal resonance. Differences in objective and subjective measurements of nasal resonance were only found in isolated vowels, and not in connected speech.

Nasality evaluation of Turkish phonemes in vowel-consonant combinations

OBJECTIVES

The purpose of this study is to find average nasalance values of Turkish syllables with the nasometer.

METHODS

This study is done at Hacettepe University Department of Otolaryngology Audiology and Speech Pathology Unit with 50 participating children.

RESULTS

The normative nasalance values of Turkish phonemes are determined. It is found that nasalance scores of syllables that is combined with/i/phoneme is statistically have higher nasalance scores than/a/and/e/phonemes (p<0.05). There is no difference find statistically between age and nasalance value (p>0.05). Statistical difference between age and nasalance score is found in "iki, şe, eşe, işi, aç, eç, çi, içi, iç, al, yi, iy, iyi, yiy, ana, ne" syllables (p<0.05). These phonemes have positive relation with the age. There is no statistical difference between sex and nasalance scores (p<0.05). Statistical difference is only found in "tat- te- li- lil- aya" syllables (p<0.05). On these phonemes it is found that girls have higher nasalance score than boys.

CONCLUSION

As a result, it is thought that gathered nasalance values of Turkish phonemes will be useful for resonance disorder diagnosis and follow ups on treatment.

Nasometry cooperation in children 4-6 years of age

OBJECTIVE

Hypernasality is a common problem in cleft care. It should be treated before the age of six, because of the impact it can have on speech sound development in young children. An objective method of nasalance evaluation is nasometry. Cooperation of young children, by nature, differs over time and situations. First aim of this study is to indicate a minimum age for cooperation with the nasometer. Second aim is to compare the cooperation of children in the most used research setting (school) with the cooperation of children in the most used setting in daily practice (ENT outpatient clinic).

METHOD

Children from four to six years of age were recruited from schools. Outpatient clinic children were recruited from the Groningen ENT clinic. Both groups were tested with the nasometer. The cooperation with installation and repetition of speech stimuli were noted.

RESULTS

118 school children and 41 outpatient clinic children were recruited. Six years old children cooperated significantly better than the five years old. The five years old cooperated better than the four years old. Moreover, school children cooperated significantly better than the outpatient children.

CONCLUSION

Most children of 6 years of age and older, will show good cooperation with nasometry. In children aged 5, cooperation depends on the situation in which the nasometer is used. In a school setting the cooperation is better than in an outpatient clinic setting. In the 4 years old children the cooperation with the nasometer often is insufficient, probably due to normal, unpredictable cooperative behavior belonging to this age.

Nasometry normative data for young Dutch children

OBJECTIVE

Hypernasality is a common problem in cleft care. It should be treated before the age of six, because of the impact it can have on speech sound development in young children. An objective method of nasalance evaluation is nasometry. To decide whether a nasometer test result is normal or abnormal, normative data and cut off points are needed. Normative data for children are not available for every language and age. For Dutch children two sets of Dutch speech stimuli, the Van Zundert sentences or the Moolenaar-Bijl, sentences, are often used in the diagnostic process for hypernasality. Primary goal of this study is to determine normative data and cut off points for two sets of Dutch speech stimuli for Dutch children from four to six years of age. Secondary is to compare those two sets of oral sentences.

METHOD

Children without clefts were recruited from schools. According to their teachers their speech was normal. They were tested with the nasometer with the two sets of speech stimuli. The set from Van Zundert has oral and oronasal sentences, the Moolenaar-Bijl set only has oral sentences.

RESULTS

118 children were recruited. Out of these children, 55 produced recording samples which were suitable for analysis. There were no significant differences between age groups or gender. The two different sets of speech stimuli used were significantly different, but the confidence intervals overlapped.

CONCLUSIONS

Normal nasalance scores of the tested sentences are between 3 and 19% for oral sentences and between 17 and 37% for oronasal sentences. The Moolenaar-Bijl speech sentences are preferred to evaluate hypernasality in young Dutch children, because of the shortness and intelligibility. Normative nasalance scores are applicable to the whole group of children from four to six years of age.

Normative data on nasalance scores for Swedish as measured on the Nasometer: influence of dialect, gender, and age

This study was conducted to establish normative nasalance values for Swedish speaking children as measured with the Nasometer(trade mark) II, and to investigate differences due to regional dialect, gender, and age. Two hundred and twenty healthy children aged 4-5, 6-7, and 9-11 years were included. Group mean nasalance scores for four speech stimuli were calculated and compared. There were no significant differences due to dialect or gender for children in the study. For age there was a significant difference on nasal sentences between the youngest group of children and the other two groups, age 4-5 vs age 6-7 (t = -2.844, p = .006) and for age 4-5 vs age 9-11 (t = -2.888, p = .005). The results from this study have both clinical significance for Swedish SLPs working with resonance disorders, and theoretical significance for linguists studying features of dialects and languages.

The impact of tonsillectomy with or without adenoidectomy on speech and voice

OBJECTIVES

The aim of this study was to evaluate changes in acoustic features of speech and voice after tonsillectomy with or without adenoidectomy.

METHODS

Before and 1 month after surgery the following parameters were estimated: average of fundamental frequency (Fo), Jitter percent (Jitt), Shimmer, noise-to-harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voiceless (DUV), degree of voice breaks (DVB) and peak amplitude variation (vAm); as an evaluation of nasal resonance, speech articulation and voice handicap index (VHI).

RESULTS

The results were statistically evaluated using the unpaired t-test. Probability values below 0.05 were regarded as significant. One month after surgery, our data showed significant (P<0.05) improvements of the acoustic and other parameters in the children submitted to adenotonsillectomy: Fo (176Hz vs. 206Hz, after sustained vowels: 206Hz vs. 192Hz; 148Hz vs. 168Hz; 171Hz vs. 161Hz after balanced sentences), Jitt (0.85% vs. 1.81% to 0.82% vs. 1.81%), Shimmer (3.41% vs. 5.81% to 4.89% vs. 5.73%), NHR (0.16 vs. 0.42 to 0.29 vs. 0.39), VTI (0.05 vs. 0.38 to 0.28 vs. 0.37), SPI (14.78 vs. 21.14-19.89 vs. 21.89), DUV (0% vs. 0.44% to 0% vs. 0.48%), DVB (0% vs. 0.42% to 0% vs. 0.42%) and vAm (8.93% vs. 23.89% to 8.89% vs. 24.25%).

CONCLUSIONS

The results suggest the role of adenotonsillectomy in the improvement of voice and speech quality and of objective evaluation of speech and voice in the correct management of these children.

Effects of adenotonsillectomy on speech spectrum in children

OBJECTIVE

The vocal tract, which starts from the glottis and extends to the lips is considered to be a resonator for speech production. Enlarged palatine tonsils may cause hypernasal speech, oral breathing or muffled voice. Changes in the structure of this resonator are assumed to modify the speech characteristics. The aim of this study was to evaluate changes in acoustic feature of speech after adenotonsillectomy in children and to establish concepts of management and rational therapeutic approach.

METHODS

Before and after surgery, an acoustic analysis was made to 40 children, aged between 5 and 14 years old, with enlarged palatine tonsils and hypetrophic adenoids. Phonetically balanced sentences were carried out and digitalized with Multi Dimensional Voice Program (MDVP, Kay Elemetrics). As a control group, 40 healthy children were identified. These parameters were estimated: average of fundamental frequency (Fo), Jitt, Shim, noise to harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voiceless (DUV) and degree of voice breaks (DVB).

RESULTS

After adenotonsillectomy, our data showed an improvement in all the parameters: the analysis of Fo, Jitt, Shim, NHR, VTI, SPI, DUV and DVB showed a postoperative decrease; comparison with healthy children highlighted a postoperative normalization of NHR, VTI and DVB.

CONCLUSIONS

The postoperative improvement of the parameters suggests a reduction of the nasal resonance and the improvement of voice quality. MDVP method may be useful for analyzing speech characteristics, evaluating the effects of surgical excision and therapeutic approach: in selected cases of patients with enlarged tonsils, the decision to perform tonsillectomy depends on its potential positive effect on speech too.

Comparison of the overall intelligibility, articulation, resonance, and voice characteristics between children using cochlear implants and those using bilateral hearing aids: a pilot study

The purpose of this study was to determine and to compare the overall intelligibility, articulation, resonance, and voice characteristics in children using cochlear implants (CI) and children using conventional hearing aids (HA). Nine prelingually deaf children using CI and six children with a prelingual severe hearing loss using HA, were selected to participate. Objective (DSI, nasalance scores) as well as subjective assessment techniques (perceptual evaluations) were used. Both the CI and HA children demonstrated normal vocal quality and resonance but showed the presence of articulation disorders. In the CI children, intelligibility was significantly better compared to the HA children. Significantly more phonetic and phonological disorders were present in the HA children. The results of this study show a poorer intelligibility of the HA children in comparison with the CI children which is probably due to the occurrence of significantly more phonetic and phonological disorders. Future detailed analysis in a larger sample of CI and HA children may help further clarify the issue of speech and voice characteristics and may demonstrate an important prognostic value.