Effects of multitasker babble noise on speech intelligibility in children with velopharyngeal insufficiency (VPI).

BACKGROUND: Intelligibility measurement is influenced by the characteristics of a speaker, listener and contextual factors. This study addresses the clinical problem of measuring speech intelligibility in children with velopharyngeal insufficiency (VPI) in real-world conditions. AIMS: The purpose of the study was to investigate the effects of background noise on speech intelligibility in speakers with velopharyngeal insufficiency (VPI) compared to typical speech. The study further determined the contribution of nasalance and articulation accuracy in judgments of intelligibility. METHODS & PROCEDURES: Fifteen speakers diagnosed with VPI and their typical peers provided audio recordings of 20 sentences from the Hearing in Noise Test. Speech samples were presented over quiet and noise (+5 dB signal-to-noise ratio) conditions to 70 naïve listeners. Intelligibility scores from naïve listeners' orthographic transcriptions were obtained as the percentage of correctly identified words. OUTCOMES & RESULTS: A repeated-measures analysis of variance showed diagnosis of VPI (F(1, 28) = 13.44, p = 0.001, and presence of noise (F(1, 28) = 39.18, p < 0.001) significantly affected the intelligibility scores. There was no interaction between the diagnosis of VPI and noise (F(1, 28) = 0.06, p = 0.80). The multivariate regression analysis indicated that nasalance and articulation accuracy explain a significant amount of variance in the intelligibility scores of VPI speakers in quiet (F(2, 12) = 7.11, p < 0.05, R2   = 0.55, R2 Adjusted   = 0.47) and noise (F(2, 12) = 6.32, p < 0.05, R2   = 0.51, R2 Adjusted   = 0.43), but the significance mainly came from the effect of percentage of consonants correct (ß = 0.97, t(12) = 2.90, p = 0.01). Percentage of consonants correct significantly increased the speech intelligibility in either with or without noise conditions. CONCLUSIONS & IMPLICATIONS: The current work suggests that background noise will significantly affect reductions in intelligibility in both groups; the effect is more prominent in VPI speech. It was also further noted that articulation accuracy significantly affected intelligibility in quiet and noise rather than nasalance scores. WHAT THIS PAPER ADDS: What is already known on the subject Intelligibility measurement is influenced by the characteristics of a speaker, listener and contextual factors. Accordingly, it is essential to determine the degree to which speech assessments in the clinic can predict communication difficulties in the presence of background noise in real life. Background noise can adversely cause speech intelligibility degradation in individuals with speech disorders. What this study adds The study examined the effects of background noise on speech intelligibility in speakers with velopharyngeal insufficiency (VPI) secondary to cleft palate compared to typical speech. The study results suggested that the presence of background noise will significantly affect reductions in intelligibility in both groups; however, the effect is more prominent in VPI speech. What are the clinical implications of this work? We found out that the intelligibility of VPI speech is lower in the presence of background noise, and therefore, assessments of speech intelligibility in clinical settings should take this into account. To ensure effective communication in noisy environments, recommended strategies include selecting quiet locations, eliminating potential distractions and supplementing communication with nonverbal cues. It is important to recognize that the effectiveness of these strategies may vary depending on the individual and the specific communication context.

Nasal rustle: The retrospective and prospective investigation of effects of bubbling of secretions on speech.

OBJECTIVE: "Nasal rustle" is a type of nasal emission associated with a small velopharyngeal (VP) gap and distracting loud noise. Currently, the mechanisms behind noise generation are unclear. In this study, we use a combination of retrospective and prospective data to test the hypotheses that bubbling of secretions could be a source of audible noise. DESIGN: Retrospective: Nasopharyngoscopy records of 151 patients with nasal rustle were reviewed to determine if bubbling occurred during their nasopharyngoscopy examination. Prospective: Nine children with nasal rustle and bubbling of secretions were suctioned with the scope in place to assure removal of secretions. The Nasometer II was used to record the children's production of oral sentences prior to and post suctioning. All sentences were analyzed for the presence or absence of noise, nasalance scores, and Cepstral Peak Prominence (CPP). Intra-and inter-judge reliability of coding was high. RESULTS: Retrospective: 70% of the patients with nasal rustle had bubbling of secretions during nasopharyngoscopy. Prospective: Percentages of audible noise were reduced significantly post suctioning (Friedman's Test, Chi-square = 24.5, p = 0.001) with the greatest decrease in syllables with fricatives and bilabial stops (p < 0.05). The average CPP and nasalance scores pre-vs post-suctioning showed no significant differences (p = 0.91, 0.29). CONCLUSIONS: Retrospective: The high percentage of patients with nasal rustle had bubbling of secretions when producing speech in nasopharyngoscopy evaluations. Prospective: The incidence of audible noise was reduced as a result of suctioning. This suggests that the presence of secretions contributes to the production of nasal rustle.

Protocols for Reporting Speech Outcomes following Palatoplasty or Velopharyngeal Surgery: A Literature Review.

BACKGROUND: To determine best practices, surgeons who perform cleft palate surgery or surgery for velopharyngeal insufficiency need to be able to compare their outcomes in normalizing the velopharyngeal valve. METHODS: We conducted a comprehensive review of articles that reported speech/resonance outcomes following palatoplasty or surgery for velopharyngeal insufficiency. We analyzed protocols that were used and how the results were reported. We found 170 articles, published between 1990 and 2014, that met our inclusion criteria. RESULTS: Most studies (66%) had a sample size of <50 subjects, were retrospective (67%), were not blinded (83%), and did not report the use of reliability (68%). Most studies included 1 evaluator (27%) or 2 evaluators (30%). Only 80% of the articles specified that at least one speech pathologist was an evaluator. Most articles (56%) did not specify the speech samples used, and 65% used an informal test or did not specify the type of test used. Most studies used a perceptual rating scale for articulation (75%) and resonance (83%). Only 39% of the studies included an evaluation of velopharyngeal function. Finally, objective measures were used in only 28% of the studies (9% used aerodynamic measures and 19% used nasometry). CONCLUSIONS: Because these articles showed significant variability in how speech/resonance is evaluated and how the outcomes are reported, it is virtually impossible to compare results to determine best surgical procedures. Suggestions are given to standardize outcome measures to improve comparability of data.

Speech characteristics after articulation therapy in children with cleft palate and velopharyngeal dysfunction - A single case experimental design.

OBJECTIVE: The aim of this study was to investigate the impact of an intensive 10-week course of articulation therapy on articulation errors in cleft lip and palate patients who have Velopharyngeal Insufficiency (VPI), non-oral and passive cleft speech characteristics. METHODS: Five children with cleft palate (+/-cleft lip) with VPI and non-oral and passive cleft speech characteristics underwent 40 intensive articulation therapies over 10 weeks in a single case experimental design. The percentage of non-oral CSCs (NCSCs), passive CSCs (PCSCs), stimulable consonants (SC), correct consonants in word imitation (CCI), and correct consonants in picture naming (CCN) were captured at baseline, during intervention and in follow up phases. Visual analysis and two effect size indexes of Percentage of Nonoverlapping Data and Percentage of Improvement Rate Difference were analyzed. RESULTS: Articulation therapy resulted in visible decrease in NCSCs for all 5 participants across the intervention phases. Intervention was effective in changing percentage of passive CSCs in two different ways; it reduced the PCSCs in three cases and resulted in an increase in PCSCs in the other two cases. This was interpreted as intervention having changed the non-oral CSCs to consonants produced within the oral cavity but with passive characteristics affecting manner of production including weakness, nasalized plosives and nasal realizations of plosives and fricatives. Percent SC increased throughout the intervention period in all five patients. All participants demonstrated an increase in percentage of CCI and CCN suggesting an increase in the consonant inventory. Follow-up data showed that all the subjects were able to maintain their ability to articulate learned phonemes correctly even after a 4-week break from intervention. CONCLUSION: This single case experimental study supports the hypothesis that speech intervention in patients with VPI can result in an improvement in oral placements and passive CSCs.

Incidence of velopharyngeal insufficiency and oronasal fistulae after cleft palate repair: A retrospective study of children referred to Isfahan Cleft Care Team between 2005 and 2009.

OBJECTIVE: The purpose of this study is to determine the incidence of velopharyngeal insufficiency (VPI) and fistulae development in patients seen by the Isfahan Cleft Care Team and also determine the association of gender, age at repair, and cleft type with the incidence of each. METHODS: This retrospective study was completed using records of patients referred to Isfahan Cleft Care Team between 2005 and 2009. One hundred thirty-one patients with a history of cleft palate (with or without cleft lip) who had undergone primary palate repair and were at least 4 years of age at the time of the speech evaluation were included in this review. The main outcome of this study was the incidence of fistulae and hypernasality following palatoplasty. A secondary outcome was the association of gender, age at the time of repair, and cleft type on the incidence of fistulae and hypernasality. RESULTS: A post-surgical fistula was present in 23.7% of the patients studied. Fistula rates were significantly higher in patients who had undergone repair of bilateral clefts of the lip and palate (40.9%) than for those patients who had undergone repair of a unilateral cleft lip and palate (16.9%) (p=0.02). Presence of a fistula was not associated with gender (p=0.99) or age at time of primary surgical repair (p=0.71). Mild hypernasality was noted in 15.3% of patients. Moderate or severe hypernasality was present in 66.5% of the patients and the remaining cases presented with normal resonance. Severe hypernasality was significantly higher in patients with a Veau IV type cleft as compared to patients with Veau III cleft types (p=0.04). There was a significantly higher incidence of hypernasality in boys than in girls (p<0.001). The association of age at the time of palatal repair and incidence of hypernasality was not significant (r=0.13, p=0.07). CONCLUSIONS: Overall, post-surgical complications were high in this cohort of patients who had undergone cleft palate repair by Isfahan Cleft Care Team during the study time frame. Therefore, there is a high priority need for increased training of best practices for the surgeons.