Nasalance score variation in normal adult Japanese speakers of Mid-West Japanese dialect

Normative nasalance scores in Chilean adults

PURPOSE

The present study is aimed towards determining and comparing normative nasalance scores in Chilean Spanish-speaking adult men and women.

METHODS

40 women (age range 18 to 35, X = 25.79, SD = 5.83) and 36 men (age range 18 to 35, X = 26.45, SD = 4.08) were invited to participate, all of them without any previous speech therapy, neurological pathologies, intellectual deficits, hearing loss, syndromes, or other diagnosed pathologies that could impact speech production.A study of proper velopharyngeal function was performed, using a perceptual resonance evaluation. Nasalance was determined using a model 6450 Nasometer, during the reading of three standardized speech samples in Spanish: a nasal passage (NP), an oronasal passage (ONP), and an oral passage (OP). Also, the nasalance distance was calculated. Genders were compared using Wilcoxon tests for independent samples.

RESULTS

The NP presented the highest percentage of nasalance, with 52.13% (± 4.73), followed by the ONP with 25.38% (± 3.7), and finally the OP, which presented the lowest value of 14.15% (± 5.03). Meanwhile, nasalance distance was 37.98% (± 5.32). Finally, no significant differences were observed when comparing the nasalance between genders (p >0.05).

CONCLUSION

The nasalance values obtained were similar to those observed for other Spanish speakers. Also, male and women showed similar scores. The results of this study are a contribution to the indirect assessment of velopharyngeal function in Chilean adults.

Nutritional assessment in a maxillectomy patient from the preoperative period to definitive obturator insertion: A case report

PATIENT

A 69-year-old Japanese male with squamous cell carcinoma of the right maxilla (T4M0N0) was referred to our department for a preoperative examination. An immediate surgical obturator was fabricated before surgery. He underwent surgical treatment, which included right subtotal maxillectomy and reconstruction with a split skin graft. One week postoperatively, the immediate surgical obturator was modified to expand the nasal cavity for obturator prosthesis. Oral intake was started 12 days postoperatively with an immediate surgical obturator in situ. The definitive obturator was fabricated after the wound surface had healed 8 months postoperatively. Assessment of the nutritional status included body mass index, serum albumin level, resting energy expenditure (REE) measured using indirect calorimetry, and predicted REE using the Harris-Benedict equation. These assessments were performed several times, from the time of admission until the definitive obturator was applied.

DISCUSSION

Malnutrition occurs frequently in patients with head and neck cancer because this region is vital for swallowing and mastication. Maxillectomy patients require a maxillofacial prosthesis to improve their nutritional status from the preoperative period to recovery. This case report describes maxillofacial prosthetic treatment from the perspective of nutrition. The patient wore the immediate surgical obturator postoperatively, which was followed by marked weight loss after restoration, and then weight gain returned to the normal range when wearing the definitive obturator.

CONCLUSION

Maxillofacial prosthetic treatments should make efforts to maintain nutritional status and achieve optimal function and quality of life in patients with head and neck cancers.

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.

Normative data on nasalance scores for Farsi speaking children: Influence of age, gender and phonetic context

BACKGROUND

Normative nasalance scores are essential for treatment and assessment purposes for clinicians. The purpose of the current study is to determine the normative data on nasalance scores for Farsi speaking children. Comparing to the obtained normative data, hypernasal or hyponasal speech (i.e. the higher or lower nasalance score) can be evaluated.

METHODS

Ninety-six Farsi speakers ranging from 4 years to 11 years old with typically developing speech were included in this study. Mean nasalance scores were obtained using the Universal Parameters System sentences with nasometer II (model 6450). The nasalance data was also analyzed for any gender, age and phonetic context dependence.

RESULTS

Normative nasalance values were determined, Nno differences were found for gender and age for the school-aged children. With an increasing in age, the nasalance score also increased in oral passages but not in nasal passages. Furthermore, amongst the nasalance scores there was a significant difference between these four categories of sentences: 7 sentences loaded with oral stop consonants, 5 sentences loaded with oral fricative consonants, 2 sentences loaded with oral affricatives and 3 sentences loaded with nasal consonants.

CONCLUSIONS

The absence of age and gender differences led to a computation of an overall mean nasalance score for different types of phonetic context (Nasal, oral and oronasal). These normative nasalance data for Farsi speaking children will provide important reference information during speech assessments of children with velopharyngeal insufficiency.

Nasometric Comparison Between Spanish–English Bilingual and English Monolingual Children

Objective:

It is well established in the literature that English diagnostic tests should not be directly applied to speakers whose primary language is Spanish. Normative nasalance data across word and sentence-level stimuli among Spanish–English bilingual children living in the United States have not been provided. The present study aims to (1) compare differences in nasalance between typically developing Spanish–English bilingual children and English-speaking monolingual children and (2) determine whether within-speaker nasalance differences exist in Spanish–English bilingual children when presented with English and Spanish speech stimuli.

Design:

Thirty-four typically developing children including 17 monolingual English speakers and 17 Spanish–English bilingual speakers with normal velopharyngeal anatomy between 5 and 7 years of age participated in the study. Speakers were recorded using a nasometer producing sets of stimulus items at the word and sentence level in English (English monolinguals) and in both Spanish and English for bilingual children.

Results:

Results indicated no statistically significant difference between nasalance values across the different stimuli between monolingual and bilingual participants. However, within-subject effects showed statistical significance between English and Spanish word stimuli among the bilingual group.

Conclusions:

These findings emphasize the importance of using language-specific diagnostic materials for nasalance testing, which would be of importance in the treatment of individuals with cleft palate.

Comparison of Nasalance Scores Obtained with the Nasometer, the NasalView, and the OroNasal System

Objective

To compare nasalance scores obtained with the Nasometer, the NasalView, and the OroNasal System; evaluate test-retest reliability of the three systems; and explore whether three common text passages used for nasalance analysis could be shortened to a sentence each.

Subjects

Seventy-six adults with normal speech and hearing (mean age 26.5 years).

Procedures

Subjects read the complete Zoo Passage, Rainbow Passage, and Nasal Sentences.

Main Outcome Measures

Mean nasalance magnitudes and mean nasalance distances were obtained with the three devices.

Results

The Nasometer had the lowest nasalance scores for the nonnasal Zoo Passage. The NasalView had the highest nasalance scores for the phonetically balanced Rainbow Passage. The OroNasal System had the lowest nasalance scores for the Nasal Sentences. The nasalance distance was largest for the Nasometer and smallest for the OroNasal System. Over 90% of the recordings were within 4% to 6% nasalance for most materials recorded with the Nasometer and the NasalView and within 7% to 9% for materials recorded with the OroNasal System. There were significant differences between the complete Zoo Passage and the Nasal Sentences and the individual sentences from these passages for the Nasometer and the OroNasal System.

Conclusions

The three systems measure nasalance in different ways and provide nasalance scores that are not interchangeable. Test-retest variability for the Nasometer and the NasalView may be higher than previously reported. Individual sentences from the Zoo Passage and the Nasal Sentences do not provide nasalance scores that are equivalent to the complete passages.

Nasalance Scores in Wearers of a Palatal Lift Prosthesis in Comparison with Normative Data for Japanese

Objective

This study was designed to examine whether nasalance score is changed in association with placement of a palatal lift prosthesis (PLP) and whether normative data previously reported are applicable to evaluate the effect of a PLP on velopharyngeal function as it relates to nasality.

Design

Nasalance scores were obtained as subjects read the Kitsutsuki Passage three times with the PLP in place and then removed.

Participants

Forty-three children (mean age 9.0 years, SD = 3.6 years) with repaired cleft palate who were treated with a PLP were selected as subjects. Their speech was characterized by nasal emission of air, slight hypernasality without a PLP but within normal limits with a PLP in place, or both.

Main Outcome Measures

Comparisons were made between normative scores and the average mean nasalance score of subjects with and without the PLP.

Results

Average values of the mean nasalance score for subjects were 17.3% (SD 7.6%) with the PLP in place and 33.5% (SD 13.3%) without the PLP in place. These scores were greater than the mean score of 9.1% (SD 3.9%) obtained from normal controls previously reported.

Conclusion

A PLP can decrease nasalance scores for speakers with repaired cleft palate who exhibit velopharyngeal incompetence. It was suggested that the normative score obtained from normal adult speakers is not applicable to evaluate the effect of a PLP to improve velopharyngeal function for children wearing the PLP.

The comparative study of resonance disorders for Vietnamese and Korean cleft palate speakers using nasometer

BACKGROUND

Nasalance is used to evaluate the velopharyngeal incompetence in clinical diagnoses using a nasometer. The aim of this study is to find the nasalance differences between Vietnamese cleft palate children and Korean cleft palate children by measuring the nasalance of five oral vowels.

METHODS

Ten Vietnamese cleft palate children after surgery, three Vietnamese children for the control group, and ten Korean cleft palate children after surgery with the same age participated in this experimentation. Instead of Korean control, the standard value of Korean version of the simplified nasometric assessment procedures (kSNAP) was used.

RESULT

The results are as follows: (1) the highest nasalance score among the Vietnamese normal vowels is the low vowel /a/; however, that of Korean normal vowels is the high vowel /i/. (2) The average nasalance score of Korean cleft palate vowels is 18% higher than that of Vietnamese cleft palate vowels. There was a nasalance score of over 45% among the vowels /e/ and /i/ in Vietnamese cleft palate patients and /i/, /o/, and /u/ in Korean cleft palate patients.

CONCLUSION

These different nasalance scores of the same vowels seem to cause an ethnic difference between Vietnamese and Korean cleft palate children.

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.

Nasalance and nasality at experimental velopharyngeal openings in palatal prosthesis: a case study

The use of prosthetic devices for correction of velopharyngeal insufficiency (VPI) is an alternative treatment for patients with conditions that preclude surgery and for those individuals with a hypofunctional velopharynx (HV) with a poor prognosis for the surgical repair of VPI. Understanding the role and measuring the outcome of prosthetic treatment of velopharyngeal dysfunction requires the use of tools that allow for documenting pre- and post-treatment outcomes. Experimental openings in speech bulbs have been used for simulating VPI in studies documenting changes in aerodynamic, acoustic and kinematics aspects of speech associated with the use of palatal prosthetic devices. The use of nasometry to document changes in speech associated with experimental openings in speech bulbs, however, has not been described in the literature.

Voice low tone to high tone ratio, nasalance, and nasality ratings in connected speech of native Mandarin speakers: a pilot study

OBJECTIVE

Voice low tone to high tone ratio (VLHR) is defined as the power ratio of a voice spectrum with a specific cut-off frequency. Previous studies have shown that there are significant correlations between VLHR and nasalance and hypernasality ratings in vowels. The correlation was investigated in this study using connected speech material.

DESIGN

The Zoo Passage, the Rainbow Passage, the English Nasal Sentences, the Mandarin Nonnasal Sentences, and the Mandarin Nasal Sentences were used to acquire VLHRs, nasalance scores, and perceptual judgments of nasality. Each passage was recorded twice for averaging, and the cut-off frequencies from 200 Hz to 1200 Hz were used to survey for the presence of optimal correlations with VLHR. Participants : Ten native Mandarin speakers with an English learning history of over 8 years were enrolled. Main outcome measures : VLHRs, nasalance scores, and hypernasality ratings.

RESULTS

The correlations of VLHR with nasalance (rho  =  .76, p < .001, Spearman rank correlation) and nasality ratings (rho  =  .81, p < .001) were significant using a cut-off frequency of 300 Hz for the English passages. For the Mandarin Sentences, the optimal correlations of VLHR with nasalance (rho  =  .83, p < .001) and nasality ratings (rho  =  .79, p < .001) were identified using a cut-off frequency of 500-Hz.

CONCLUSION

The significant correlations of VLHR with nasalance and perceptual ratings of nasality using connected speech show that these approaches have a potential value in terms of basic and clinical application.

Three monosyllables for standard words in Nasometer test: to evaluate air leakage in maxillectomy patients

PURPOSE

The purpose of this study was to establish an evaluation method using a Nasometer, with several monosyllabic test words, to reveal the level of air leakage in maxillectomy patients without limitations due to language or ability to read.

METHODS

20 normal Japanese (Group 1) and 20 international adults (Group 2), were asked to read 7 monosyllables, (5 vowels and 2 combined vowels, /a/, /i/, /u/, /e/, /o/, /am/, /aj/), 6 times each and 12 Japanese maxillectomy patients (Group 3) were asked to read only 3 monosyllables (/a/, /am/, /aj/) 6 times each. The "Nasalance Score" was calculated using a Nasometer (Nasometer II, model 6400 KayPentax, Lincoln Park, NJ, USA).

RESULTS

Coefficient of variations (CVs) of three monosyllables /a/, /am/, /aj/ of Group 1 and Group 2 showed less than 0.33. There is significant difference in all pairs of three monosyllables between Group 1 and Group 3 (p < 0.05).

CONCLUSION

Using a Nasometer, these three monosyllables, /a/, /am/ and /aj/, could be used as standard test words and could reveal the level of air leakage in maxillectomy patients.

Nasal speaking valve: a device for managing velopharyngeal incompetence

Velopharyngeal incompetence is a contributing factor for speech disorders, and other frequently accompanying disorders, such as cleft palate, congenital paralysis of the soft palate and cerebrovascular disease. A palatal lift prosthesis (PLP) has been fabricated for managing velopharyngeal incompetence to improve speech. Because of discomfort, such as difficulty in swallowing or vomiting reflex, while wearing the PLP, rigorous adjustment is required. Patients may have difficulty becoming accustomed to using the prosthesis. This article reports on a newly developed device, the nasal speaking valve, for improving hypernasal speech caused by velopharyngeal incompetence.

The correlation between nasalance and a differentiated perceptual rating of speech in Dutch patients with velopharyngeal insufficiency

OBJECTIVE

The correlation between the nasalance score and the perceptual rating of several aspects of speech of speakers with velopharyngeal insufficiency (VPI) by six speech-language pathologists was evaluated.

PROCEDURE

The overall grade of severity, hypernasality, audible nasal emission, misarticulations, and intelligibility were rated on visual analog scales. Speech samples with a normal distribution of phonemes (normal text [NT]) and those free of nasal consonants (denasal text [DT]) of 43 patients with VPI were used. Mean nasalance scores were computed for the speech samples, and Spearman correlation coefficients were computed between the mean nasalance score and the five parameters of the differentiated rating.

SETTING

The Institute of Phoniatrics, Utrecht University Hospital, The Netherlands.

RESULTS

The correlation coefficient between the mean nasalance and the perceptual rating of hypernasality ranged among judges from .31 to .56 for NT speech samples and .36 to .60 for DT speech samples. Only small differences were found between speech pathologists with and without expertise in cleft palate speech. The rating of the overall grade of severity appeared to correlate quite well with the rating of the intelligibility (r(NT) = .77, r(DT) = .79). Lower correlation coefficients, ranging from .34 to .71, were found between overall grade of severity and hypernasality, audible nasal emission, and misarticulations.

CONCLUSIONS

A low correlation between the nasalance and the perceptual rating of hypernasality was found. The parameter overall grade of severity appeared to be determined mainly by the parameter intelligibility. Expertise in rating of cleft palate speech does not guarantee a high correlation between instrumental measurement and perceptual rating.