Laryngeal Desiccation Challenge and Nebulized Isotonic Saline in Healthy Male Singers and Nonsingers: Effects on Acoustic, Aerodynamic, and Self-Perceived Effort and Dryness Measures.

OBJECTIVES: This study examined the effects of a laryngeal desiccation challenge and nebulized isotonic saline on voice production in young, healthy male singers and nonsingers. STUDY DESIGN: This is a prospective, double-blind, within-subjects experimental design. METHODS: Participants included 10 male university-trained singers and 10 age-matched nonsingers (mean age, 21.8 years; range, 18-26 years) who underwent a 30-minute oral breathing laryngeal desiccation challenge using medical grade dry air (<1% relative humidity) on two occasions in consecutive weeks. After the challenge, participants received either 3 mL or 9 mL of nebulized isotonic saline (0.9% Na+Cl-); order of administration was counterbalanced. Phonation threshold pressure (PTP), the cepstral spectral index of dysphonia (CSID) for sustained vowels and connected speech, and self-perceived vocal effort, mouth dryness, and throat dryness were measured at each recording (baseline, after challenge, and at 5, 35, and 65 minutes after treatment). RESULTS: Self-perceived effort and dryness measures increased (worsened) after desiccation challenge and decreased (improved) after nebulized treatment (P < 0.05). No consistent changes were observed for PTP or CSID over time. Overall, singers demonstrated significantly lower vocal effort and CSID as compared with nonsingers. CONCLUSIONS: Young, vocally healthy men may not experience physiologic changes in voice production associated with laryngeal desiccation and nebulized saline treatments; however, self-reported increases in vocal effort which are associated with dryness symptoms might improve with nebulized treatments. Future hydration research should consider age and sex variables.

Nebulized isotonic saline improves voice production in Sjögren's syndrome.

OBJECTIVE: This study examined the effects of a topical vocal fold hydration treatment on voice production over time. STUDY DESIGN: Prospective, longitudinal, within-subjects A (baseline), B (treatment), A (withdrawal/reversal), B (treatment) experimental design. METHODS: Eight individuals with primary Sjögren's syndrome (SS), an autoimmune disease causing laryngeal dryness, completed an 8-week A-B-A-B experiment. Participants performed twice-daily audio recordings of connected speech and sustained vowels and then rated vocal effort, mouth dryness, and throat dryness. Two-week treatment phases introduced twice-daily 9-mL doses of nebulized isotonic saline (0.9% Na(+)Cl(-)). Voice handicap and patient-based measures of SS disease severity were collected before and after each 2-week phase. Connected speech and sustained vowels were analyzed using the Cepstral Spectral Index of Dysphonia (CSID). Acoustic and patient-based ratings during each baseline and treatment phase were analyzed and compared. RESULTS: Baseline CSID and patient-based ratings were in the mild-to-moderate range. CSID measures of voice severity improved by approximately 20% with nebulized saline treatment and worsened during treatment withdrawal. Posttreatment CSID values fell within the normal-to-mild range. Similar patterns were observed in patient-based ratings of vocal effort and dryness. CSID values and patient-based ratings correlated significantly (P < .05). CONCLUSION: Nebulized isotonic saline improves voice production based on acoustic and patient-based ratings of voice severity. Future work should optimize topical vocal fold hydration treatment formulations, dose, and delivery methodologies for various patient populations. This study lays the groundwork for future topical vocal fold hydration treatment development to manage and possibly prevent dehydration-related voice disorders. LEVEL OF EVIDENCE: 2b.

Impact of prematurity on language skills at school age.

PURPOSE: The existing literature on language outcomes in children born prematurely focuses almost exclusively on standardized test scores rather than discourse-level abilities. The authors of this study looked longitudinally at school-age language outcomes and potential moderating variables for a group of twins born prematurely versus a control group of twins born at full term, analyzing both standardized test results and language sample data from the population-based Western Reserve Reading Project (WRRP; Petrill, Deater-Deckard, Thompson, DeThorne, & Schatschneider, 2006). METHOD: Fifty-seven children born prematurely, at ≤32 weeks or <1,500 g, were compared with 57 children born at full term and were matched for age, gender, race, and parental education. Data included discourse-level language samples and standardized test results, collected at average ages 7, 8, and 10 years. The language samples were analyzed to yield a number of semantic and syntactic measures that were consolidated via factor analysis. RESULTS: Regression models showed significant differences between the 2 groups for standardized test results, although the mean score for both groups fell in the normal range. For the discourse-level language measures, however, differences never reached statistical significance. Parental education was significantly associated with improved standardized test scores. CONCLUSIONS: These findings suggest that in the absence of frank neurological impairment, sophisticated semantic and syntactic skills may be relatively intact in the discourse-level language of children born prematurely. Implications for assessment, particularly the potential role of attention and executive function in standardized testing tasks, are reviewed.

The effect of dialect on speech audiometry testing.

PURPOSE: In this study, the authors examined the validity of using materials from 2 nonregional yet mutually intelligible dialects to evaluate an individual's speech recognition threshold (SRT) and word recognition (WR) abilities and whether a speaker of 1 dialect could accurately administer and score materials in the other dialect. METHOD: Previously created SRT and WR materials were presented to 32 Mandarin listeners with normal hearing: 16 speakers of Mainland Mandarin and 16 speakers of Taiwan Mandarin. Hearing abilities were examined using SRT and WR materials created for speakers from 2 different regional dialects. Presentation of the materials occurred during 2 test sessions, counterbalanced across material and listener dialect. Listener responses were evaluated by 2 judges; 1 spoke Mainland Mandarin, and the other spoke Taiwan Mandarin. RESULTS: For the SRT and WR results, differences in listener performance were statistically significant across material and listener dialect, with threshold differences of less than 2 dB HL when collapsed across session. The interscorer percentage of agreement was 99.5% for SRT and 99.1% for WR testing. CONCLUSION: Testing with materials in a different regional dialect does have a measurable impact on SRT and WR performance. However, this difference, though reliable, is small enough to have a negligible impact on clinical findings.

The development of psychometrically equivalent Cantonese speech audiometry materials.

OBJECTIVE: The aim of this study was to develop and psychometrically evaluate speech audiometry materials that can be used to measure word recognition (WR) and speech recognition testing (SRT) in quiet for native speakers of Cantonese. STUDY SAMPLE: Commonly used bisyllabic and trisyllabic Cantonese words were digitally recorded by native male and female talkers and then evaluated by twenty normal-hearing Cantonese listeners. DESIGN: The recorded bisyllabic words were psychometrically evaluated and arranged into four WR lists and eight half-lists that are relatively homogeneous in audibility. Using logistic regression, SRT materials were developed by selecting 28 trisyllabic words with relatively steep psychometric functions and digitally adjusting their intensity to match the listeners' mean pure-tone average. RESULT: The mean psychometric slopes for the WR materials were 7.5%/dB for the male talker and 7.6%/dB for the female talker, with no statistically significant differences between the lists or half-lists. At intensity levels required for 50% intelligibility, the mean psychometric slopes of the male and female talker SRT materials were 14.5%/dB and 14.9 %/dB, respectively. CONCLUSION: High-quality digital recordings of Cantonese speech audiometric WR and SRT materials were developed and validated in this study. These materials are available on compact disc, indexed by talker gender.

Genetic effects on children's conversational language use.

PURPOSE: The present study examined the extent of genetic and environmental influences on individual differences in children's conversational language use. METHOD: Behavioral genetic analyses focused on conversational measures and 2 standardized tests from 380 twins (M = 7.13 years) during the 2nd year of the Western Reserve Reading Project (S. A. Petrill, K. Deater-Deckard, L. A. Thompson, L. S. DeThorne, & C. Schatschneider, 2006) Multivariate analyses using latent factors were conducted to examine the extent of genetic overlap and specificity between conversational and formalized language. RESULTS: Multivariate analyses revealed a heritability of .70 for the conversational language factor and .45 for the formal language factor, with a significant genetic correlation of .37 between the two factors. Specific genetic effects were also significant for the conversational factor. CONCLUSIONS: The current study indicated that over half of the variance in children's conversational language skills can be accounted for by genetic effects with no evidence of significant shared environmental influence. This finding casts an alternative lens on past studies that have attributed differences in children's spontaneous language use to differences in environmental language exposure. In addition, multivariate results generally support the context-dependent construction of language knowledge, as suggested by the theory of activity and situated cognition (J. S. Brown, A. Collins, & P. Duguid, 1989; T. A. Ukrainetz, 1998), but also indicate some degree of overlap between language use in conversational and formalized assessment contexts.

Clinician-child interactions: adjustments in linguistic complexity.

PURPOSE: This pilot study examined the extent and nature of associations in the linguistic complexity used by child and clinician within conversational interactions. METHOD: Correlation analyses focused on semantic and morphosyntactic language sample measures from an experienced speech-language clinician and 29 children with language impairment. RESULTS: Positive associations emerged between a variety of child and clinician measures, even when the effect of child age was removed. The most robust effect related to clinician adjustments in both morphosyntactic complexity and vocabulary diversity associated with differences in children's developmental sentence scores. CONCLUSIONS: Within a conversational exchange, the clinician in this study made significant adjustments in her linguistic complexity that were due, at least in part, to the linguistic complexity used by the children with whom she was interacting. Associations were similar to adjustments reported in prior studies of parent and teacher interactions with children with differing language abilities. However, the extent to which these findings generalize to other clinicians needs to be examined. Results from the present study challenge clinicians to dedicate conscious thought toward how their linguistic input should be structured, taking into consideration both the goal of the interaction and each child's profile of linguistic strengths and weaknesses. Directions for future research are also provided.

Automated developmental sentence scoring using computerized profiling software.

This study examined the accuracy of fully automated Developmental Sentence Scoring (DSS; L. L. Lee, 1974) analysis performed by the Computerized Profiling (CP) software (S. H. Long, M. E. Fey, and R. W. Channell, 2000). Samples from 48 school-age children (28 with language impairment) yielded 9,084 utterances that were DSS coded both manually and by CP. The point-by-point agreement of CP with manual coding was 78%, with per-category levels of agreement ranging from 0% to 98%. Agreement levels were about 2% lower on samples from children with language impairment. Though significantly higher, the scores computed by CP were highly correlated (r =.97) with the manually computed scores. Further work on improving the accuracy of automated DSS analysis is warranted.