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BACKGROUND: Among infants with isolated cleft palate, whether primary surgery at 6 months of age is more beneficial than surgery at 12 months of age with respect to speech outcomes, hearing outcomes, dentofacial development, and safety is unknown. METHODS: We randomly assigned infants with nonsyndromic isolated cleft palate, in a 1:1 ratio, to undergo standardized primary surgery at 6 months of age (6-month group) or at 12 months of age (12-month group) for closure of the cleft. Standardized assessments of quality-checked video and audio recordings at 1, 3, and 5 years of age were performed independently by speech and language therapists who were unaware of the trial-group assignments. The primary outcome was velopharyngeal insufficiency at 5 years of age, defined as a velopharyngeal composite summary score of at least 4 (scores range from 0 to 6, with higher scores indicating greater severity). Secondary outcomes included speech development, postoperative complications, hearing sensitivity, dentofacial development, and growth. RESULTS: We randomly assigned 558 infants at 23 centers across Europe and South America to undergo surgery at 6 months of age (281 infants) or at 12 months of age (277 infants). Speech recordings from 235 infants (83.6%) in the 6-month group and 226 (81.6%) in the 12-month group were analyzable. Insufficient velopharyngeal function at 5 years of age was observed in 21 of 235 infants (8.9%) in the 6-month group as compared with 34 of 226 (15.0%) in the 12-month group (risk ratio, 0.59; 95% confidence interval, 0.36 to 0.99; P = 0.04). Postoperative complications were infrequent and similar in the 6-month and 12-month groups. Four serious adverse events were reported (three in the 6-month group and one in the 12-month group) and had resolved at follow-up. CONCLUSIONS: Medically fit infants who underwent primary surgery for isolated cleft palate in adequately resourced settings at 6 months of age were less likely to have velopharyngeal insufficiency at the age of 5 years than those who had surgery at 12 months of age. (Funded by the National Institute of Dental and Craniofacial Research; TOPS ClinicalTrials.gov number, NCT00993551.).
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Fissura Palatina , Insuficiência Velofaríngea , Pré-Escolar , Humanos , Lactente , Pessoal Técnico de Saúde , Fissura Palatina/complicações , Fissura Palatina/cirurgia , Europa (Continente) , Complicações Pós-Operatórias/epidemiologia , Insuficiência Velofaríngea/diagnóstico , Insuficiência Velofaríngea/etiologia , América do Sul , Técnicas de Diagnóstico por CirurgiaRESUMO
Primary cleft lip and palate surgeries can interfere with speech status, facial appearance, maxillary growth, and psychosocial and academic development. Therefore, different surgical protocols and techniques have been proposed, and adequate velopharyngeal function and speech is the main goal for the treatment success. The present study aimed to report preliminary speech results of the 2-stage palate repair of children with unilateral cleft lip and palate. One hundred seventy nonsyndromic patients with unilateral cleft lip and palate were included in this report, 35% males and 65% females, submitted to the 2-stage palatoplasty protocol, composed by lip, nasal ala, and hard palate repair at 3 to 6 m (stage 1) and soft palate repair at 12 to 18 m (stage 2). The target age range for speech recording was 5 to 10 years, and the speech material included repetition of Brazilian Portuguese sentences. These samples were obtained over 5 years and assessed by 3 of 14 experienced speech pathologists. When discordant, the majority rate was adopted. Average velopharyngeal dysfunction (VPD) rates were 19,5%, varying according to the soft palate technique, with better results when the Sommerlad technique was performed (VPD=11%), followed by Braithwaite (VPD=15%) and then Von Langenbeck (VPD=25%). Passive errors were observed in 32% and active errors in 25%. Speech results reflect the outcomes of an interdisciplinary team's work, where facial growth and nasolabial appearance must also be considered. Further analysis and a wider casuistic are recommended. Hence outcomes audit needs to be a permanent process, providing solid and updated evidence for optimal cleft care.
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Fenda Labial , Fissura Palatina , Insuficiência Velofaríngea , Masculino , Criança , Feminino , Humanos , Pré-Escolar , Fissura Palatina/cirurgia , Fenda Labial/cirurgia , Fala , Seguimentos , Palato Duro/cirurgia , Palato Mole/cirurgia , Resultado do Tratamento , Insuficiência Velofaríngea/cirurgiaRESUMO
OBJECTIVE: To develop tools for predicting velopharyngeal competence (VPC) based on auditory-perceptual assessment and its correlation with objective measures of velopharyngeal orifice area. DESIGN: Methodological study. PARTICIPANTS AND METHODS: Sixty-two patients with repaired cleft palate, aged 6 to 45 years, underwent aerodynamic evaluation by means of the pressure-flow technique and audiovisual recording of speech samples. Three experienced speech-language pathologists analysed the speech samples by rating the following resonance, visual, and speech variables: hypernasality, audible nasal air emission, nasal turbulence, weak pressure consonants, facial grimacing, active nonoral errors, and overall velopharyngeal competence. The correlation between the perceptual speech variables and velopharyngeal orifice area estimates was analysed with Spearman's correlation coefficient. Two statistical models (discriminant and exploratory) were used to predict VPC based on the orifice area estimates. Sensitivity and specificity analyses were performed to verify the clinical applicability of the models. RESULTS: There was a strong correlation between VPC (based on the orifice area estimates) and each speech variable. Both models showed 88.7% accuracy in predicting VPC. The sensitivity and specificity for the discriminant model were 92.3% and 97.2%, respectively, and 96.2% and 94.4% for the exploratory model. CONCLUSION: Two predictor models based on ratings of resonance, visual, and speech variables and a simple calculation of a composite variable, SOMA (Eng. "sum"), were developed and found to be efficient in predicting VPC defined by orifice estimates categories based on aerodynamic measurements. Both tools may contribute to the diagnosis of velopharyngeal dysfunction in clinical practice.
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OBJECTIVE: To investigate the speech outcomes in individuals with cleft lip and palate (CLP) from the Amazon region and determine their correlation with sociodemographic factors. DESIGN: Cross-sectional, prospective, single-blind study. SETTING: Tertiary care institute in Manaus, Amazonas, Brazil. PATIENTS: Four hundred twenty individuals with CLP, aged 4 to 57 years. MAIN OUTCOME MEASURES: The samples were judged by 3 speech pathologists experienced in the speech assessment of individuals with CLP. Hypernasality was scored using a 4-point scale, being 1 = absent, 2 = mild, 3 = moderate, and 4 = severe, and the active speech symptoms were classified as absent or present. The final score for each speech symptom was reached by consensus among the 3 examiners Descriptive analysis of sociodemographic data included origin, socioeconomic status, type of cleft, surgical technique employed, the age they underwent primary and secondary palatoplasty, and palatal fistula. RESULTS: Absence of hypernasality was observed in 41% of the individuals, 18% had mild, 28% moderate, and 13% severe hypernasality. Active speech symptoms were observed in 57% of the individuals. Significant correlations were found between speech outcomes and the variables such as origin, socioeconomic status, age at primary and secondary palatoplasty, and presence of fistula. CONCLUSIONS: Most individuals with repaired CLP from the Amazon region presented speech disorders, characterized by hypernasality and active errors. Patients living outside the state capital, of low socioeconomic level, underwent palatoplasty late and with presence of palatal fistula tended to have the worst speech outcomes.
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Fenda Labial , Fissura Palatina , Fístula , Doenças Nasais , Insuficiência Velofaríngea , Distúrbios da Voz , Brasil/epidemiologia , Fenda Labial/cirurgia , Fissura Palatina/diagnóstico , Fissura Palatina/cirurgia , Estudos Transversais , Humanos , Estudos Prospectivos , Método Simples-Cego , Fala , Resultado do Tratamento , Insuficiência Velofaríngea/cirurgiaRESUMO
OBJECTIVE: To verify the effect of orthognathic surgery (OS) on nasal dimensions and its correlation with respiratory symptoms in patients operated on over the past 20 years. DESIGN: Retrospective study. SETTING: Tertiary level craniofacial hospital. PARTICIPANTS: 535 patients with CLP previously repaired, without syndromes, age over 18, who performed OS between 2000 and 2019 and rhinomanometric evaluation pre and post OS. INTERVENTIONS: Maxillary advancement isolated and combined with turbinectomy and/or mandibular osteotomy. MAIN OUTCOME MEASURES: Minimum nasal cross-sectional area (CSA) assessed by posterior (PR) and anterior rhinomanometry (AR), nasopharyngeal cross-sectional area (NCSA) verified by modified AR, and self-perceived respiratory symptoms through a questionnaire. RESULTS: After OS, there was a significant increase in CSA assessed by PR (p < .001) and AR (p < .001), while there was no significant difference in NCSA (p = 0.319). Regarding respiratory symptoms after OS, 26.3% showed improvement in nasal obstruction, 28.5% in oronasal breathing, 18.5% in snoring, and 5.2% in respiratory obstruction during sleep. However, a weak correlation between increased CSA and improvement of symptoms was observed. In the first decade, lower values of CSA (p < .001) and NCSA (p < .001) were observed compared to the second decade. Both periods showed a significant increase in CSA (p < .001). CONCLUSIONS: Nasal dimensions and breathing symptoms were improved by OS when combined with turbinectomy. Comparing the results of patients operated on between two different decades, patients had more favorable conditions for breathing in the most recent decade of care. However, this was not statistically correlated with the improvement in patient symptoms in this study.
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Young children with cleft palate with or without cleft lip (CL/P) are at risk for early vocabulary and speech sound production delays. Early intervention studies have shown some promising findings to promote early speech and vocabulary development following palate repair; however, we know little about how these interventions can be used in other international contexts. This study adapted an early speech and language intervention developed in the US, Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE), to the Brazilian context at the Hospital for Rehabilitation of Craniofacial Anomalies at the University of São Paulo-Bauru. The purpose of this study was to compare the speech and language performance of 24 toddlers with CL/P randomized into an EMT+PE intervention group and a business-as-usual (BAU) comparison group over three time points: prior to, immediately following, and three months after intervention. Results immediately following intervention indicate gains in multiple measures of language. Three months following intervention, participants showed gains in both language and speech measures.
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Fenda Labial , Fissura Palatina , Pré-Escolar , Fenda Labial/terapia , Humanos , Portugal , FalaRESUMO
The objective of this study was to determine normative nasalance scores for non-cleft children, adolescents and adults, native speakers of Brazilian Portuguese, during the production of words and syllables, for cross-linguistic comparisons in populations with and without cleft palate. Nasalance was assessed in 62 individuals, aged 6-10 years (n = 20), 11-17 years (n = 20) and 18-35 years (n = 22), using a nasometer II model 6450 (KayPENTAX), during production of one sequence of nine oral words (pipa, bis, burro, tatu, pilha, cuca, gui, fila, luz) and of sequences of isolated syllables (e.g. pa, pa, pa, pa, pa, pa) composed of plosive, fricative, liquid and nasal consonants with high and low vowels. In order to validate the new nasalance stimuli, nasalance scores for traditional oral and nasal stimuli were also obtained. Differences were analyzed at a significance level of 0.01. Mean nasalance scores (±SD) during the production of the sequence of words were 18 ± 5% (children), 18 ± 7% (adolescents) and 21 ± 5% (adults). Differences between age groups were not significant. During the production of syllables, adults had the highest mean nasalance scores (except for syllable /mi/); significant differences between age groups were observed only for /pa/ ,/sa/ and /la/. Nasalance scores were significantly higher in oral and nasal syllables with high vowels than with low vowels, and in nasal syllables than in oral syllables with high and low vowels. The nasalance scores obtained for the sentences were comparable to previously established norms. In conclusion, the nasalance scores defined for Brazilian Portuguese speakers, in different stimuli, may be adopted as normative values for local and cross-language comparisons in the identification of hypernasality related to conditions such as cleft palate, neurogenic disorders and syndromes.
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Idioma , Nariz/fisiologia , Fonética , Adolescente , Adulto , Fatores Etários , Brasil , Criança , Feminino , Humanos , Masculino , FalaRESUMO
OBJECTIVE: The transverse maxillary deficiency frequently observed in patients with cleft lip and palate (CLP) is usually treated by rapid maxillary expansion (RME). Considering that RME causes a significant increase of the internal nasal dimensions in children with unilateral CLP (UCLP), this study aimed to characterize the internal nasal geometry of children with bilateral CLP (BCLP) and transverse maxillary deficiency using acoustic rhinometry. The study also aimed to analyze changes caused by RME. DESIGN: Cross-sectional prospective study. SETTING: Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil. PARTICIPANTS: Fifteen children with repaired BCLP of both genders, aged 8 to 15 years, referred for RME, were prospectively analyzed. INTERVENTIONS: Subjects underwent acoustic rhinometry before the expander installation and after the active phase of expansion. Cross-sectional areas (CSA) and volumes (V) of the nasal valve regions (CSA1 and V1) and turbinates (CSA2, CSA3, and V2), were measured after nasal decongestion. MAIN OUTCOME MEASURES: In the majority of the subjects, an increase of internal nasal dimensions was observed. RESULTS: Percent changes of CSA1, CSA2, CSA3, V1, and V2 were: +25%, +11%, +9%, 20%, and +12%, respectively. Differences were significant for all variables studied, except CSA3 (P < .05). CONCLUSIONS: RME promotes an increase in the internal nasal dimensions of children with BCLP, suggesting that RME is capable of substantially improving nasal patency in this population.
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Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Cavidade Nasal/cirurgia , Técnica de Expansão Palatina , Adolescente , Brasil , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Cavidade Nasal/anatomia & histologia , Estudos ProspectivosRESUMO
PURPOSE: To investigate the effectiveness of a proposal for classification of facial grimace (FG) and its correlation with objective evaluation of velopharyngeal closure (VPC). METHODS: Twenty individuals with repaired cleft lip and palate underwent velopharyngeal area measurement by means of rhinomanometry and speech sample recording. The FG was rated in two steps, by three speech-language pathologists. First the evaluators rated the FG using their own criteria as: 1= absent FG; 2=mild; 3=moderate; 4=severe. Subsequently, they were submitted to a training session that established the following FG rating criteria: 1=absent FG; 2=movement only of the nose or upper third of the face; 3=strong movement of the nose or upper third of the face; 4=movement of the nose and upper third of the face. The evaluators rated the FG using the established criteria. Intra- and inter-rater agreement were calculated using weighted Kappa coefficient. Correlation between the two stage ratings with the VPC was calculated by Spearman's correlation coefficient. RESULTS: In the first stage inter-rater agreement ranged from fair to substantial; in the second stage, from substantial to almost perfect. Intra-rater agreement ranged from moderate to almost perfect in the first stage, and from moderate to substantial in the second stage. The correlation between FG and velopharyngeal area was positive and significant in both stages. CONCLUSION: The proposed FG judgement proved to be effective in determining the symptom and reliable in diagnosing the severity of velopharyngeal dysfunction. The significant correlation between perceptual and instrumental methods suggests that FG can be used in predicting VPC.
OBJETIVO: Investigar a efetividade de proposta de classificação da mímica facial (MF), e sua correlação com avaliação objetiva do fechamento velofaríngeo (FVF). MÉTODO: Vinte indivíduos com fissura labiopalatina reparada foram submetidos à medida da área velofaríngea por meio da rinomanometria e à gravação de amostra de fala. A MF foi classificada em dois momentos, por três fonoaudiólogas. Inicialmente as avaliadoras classificaram a MF, utilizando critérios próprios, em: 1=MF ausente; 2=leve; 3=moderada; 4=grave. Posteriormente, foram submetidas a um treinamento com o estabelecimento dos seguintes critérios de classificação: 1=MF normal; 2=movimento somente de nariz ou terço superior da face; 3=movimento acentuado de nariz ou terço superior da face; 4=movimento de nariz e terço superior da face e, classificaram a MF utilizando os critérios estabelecidos. Concordância intra e interavaliadores foram calculadas pelo coeficiente Kappa ponderado. A correlação entre os resultados das etapas com o FVF foi feita pelo coeficiente de correlação de Spearman. RESULTADOS: Na primeira etapa, a concordância interavaliadores variou de regular a substancial e na segunda, de substancial a quase perfeita. A concordância intra-avaliadores variou de moderada a quase perfeita na primeira etapa, e de moderada a substancial, na segunda etapa. A correlação entre a MF e área velofaríngea na primeira e na segunda etapa foi positiva e significativa. CONCLUSÃO: A proposta de julgamento da MF mostrou-se efetiva na determinação do sintoma e confiável no diagnóstico da gravidade da disfunção velofaríngea. A correlação significativa entre os métodos perceptivo e instrumental sugere que a MF pode ser utilizada na previsão do FVF.
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Fenda Labial , Fissura Palatina , Insuficiência Velofaríngea , Humanos , Fala , Insuficiência Velofaríngea/diagnósticoRESUMO
OBJECTIVE: This study aimed to evaluate the effectiveness of pharyngeal flap surgery (PFS) for the management of velopharyngeal insufficiency in cleft lip/palate patients and to assess the impact of age at surgery, surgeon's skills, and postoperative speech therapy on the outcomes. METHODS: Prospective preoperative and postoperative assessments were performed on 240 patients aged 6 to 57 years using nasometry and pressure-flow studies.This study was carried out in a quaternary hospital.This study was superiorly based on PFS.Speech nasalance scores were assessed by nasometry and velopharyngeal orifice area assessed by pressure-flow technique, 2 days before and 1 year after PFS, on average. Differences were considered significant when P < 0.05. RESULTS: Significant reduction in nasalance scores was observed in 68% of the cases, and improvement of velopharyngeal area was observed in 66%. Rates of 55% and 48%, respectively, were observed when complete resolution was considered. Higher success rates were observed in children (81%) compared with other age groups analyzed and in patients who had concluded postoperative speech therapy (86%). Results did not differ among surgeons. CONCLUSIONS: Pharyngeal flap surgery was shown to be effective in reducing nasalance scores and velopharyngeal area during speech for a significant number of patients. Complete resolution was observed in smaller number of cases. Age at surgery and postoperative speech therapy were relevant factors for treatment success.
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Cavidade Nasal/fisiopatologia , Procedimentos Cirúrgicos Bucais/métodos , Faringe/cirurgia , Retalhos Cirúrgicos , Insuficiência Velofaríngea/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Faringe/fisiopatologia , Estudos Prospectivos , Distúrbios da Fala/fisiopatologia , Distúrbios da Fala/reabilitação , Distúrbios da Fala/cirurgia , Resultado do Tratamento , Insuficiência Velofaríngea/fisiopatologiaRESUMO
OBJECTIVE: The objective of the study was to analyze if individuals with velocardiofacial syndrome (VCFS) present the same characteristics of speech and velopharyngeal function (VPF) compared with patients with nonsyndromic submucous cleft palate, as well as to compare the effectiveness of palate surgery on the speech function and VPF between groups. METHODS: This was a prospective study performed at the Speech Therapy Sector and Physiology Laboratory, Hospital for Rehabilitation of Craniofacial Anomalies/University of São Paulo.The procedure performed was primary palatoplasty associated or not to superiorly based pharyngeal flap surgery.There were 50 patients with velopharyngeal insufficiency: 25 with signals of VCFS (VCFS group) and 25 without syndrome with submucous cleft palate (SMCP group).The hypernasality was scored by 3 examiners; nasalance was evaluated by nasometry, and VPF was assessed by the size of the velopharyngeal gap on the nasoendoscopy. The evaluations were conducted before and, in average, 18 months after surgery. RESULTS: Before surgery, the VCFS and SMCP groups presented similar speech function and VPF characteristics in all parameters, with no statistically significant differences. After surgery, there was reduction in the hypernasality, nasalance, and VPF in, respectively, 20%, 31%, and 36% of patients in the VCFS group and in 24%, 30%, and 30% in the SMCP group. Elimination/normalization of variables was obtained in 28%, 19%, and 8% of patients in the VCFS group and 20%, 40%, and 25% in the SMCP group, respectively, for hypernasality, nasalance, and VPF. There was no statistically significant difference between groups. CONCLUSIONS: Patients with VCFS presented similar speech function and VPF characteristics as patients with nonsyndromic SMCP. The surgery for velopharyngeal insufficiency correction was equally effective for the improvement and resolution of speech symptoms and VPF in patients with VCFS compared with the SMCP group.
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Síndrome de DiGeorge/complicações , Síndrome de DiGeorge/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Distúrbios da Fala/etiologia , Distúrbios da Fala/cirurgia , Insuficiência Velofaríngea/etiologia , Insuficiência Velofaríngea/cirurgia , Adolescente , Adulto , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Endoscopia , Feminino , Humanos , Masculino , Estudos Prospectivos , Medida da Produção da Fala , Estatísticas não Paramétricas , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
PURPOSE: To compare the nasal cavity geometry of children and teenagers with cleft lip and palate and maxillary atresia by two methods: cone-beam computed tomography, considered the gold standard, and acoustic rhinometry. METHODS: Data on cone-beam computed tomography and acoustic rhinometry examinations of 17 children and teenagers with cleft lip and palate and maxillary atresia, previously obtained for orthodontic planning purposes, were evaluated prospectively. Using Dolphin Imaging 11.8 software, the nasal cavity was reconstructed by two evaluators, and the internal nasal volumes were obtained. Using rhinometry, the volumes of regions V1 and V2 were measured. The values of each examination were then compared at a significance level of 5%. RESULTS: Statistical analysis showed high intra- and inter-rater reproducibility in the cone-beam computed tomography analysis. The mean internal nasal volumes (± standard deviation) obtained using acoustic rhinometry and cone-beam computed tomography corresponded to 6.6 ± 1.9 cm3 and 8.1 ± 1.5 cm3, respectively. The difference between the examinations was 17.7%, which was considered statistically significant (p = 0.006). CONCLUSION: The nasal volumes measured via the two methods were different; that is, they presented discrepancies in the measurements. The gold standard technique identified larger volumes than acoustic rhinometry in the nasal cavity. Therefore, determining which test reflects clinical reality is an essential future step.
OBJETIVO: Comparar a geometria da cavidade nasal de crianças e adolescentes com fissura labiopalatina e deficiência maxilar por meio de dois métodos: a tomografia computadorizada de feixe cônico, considerada padrão-ouro, e a rinometria acústica. MÉTODO: Foram avaliados, de maneira transversal, os exames de tomografia computadorizada de feixe cônico e de rinometria acústica, previamente obtidos para fins de planejamento ortodôntico, de 17 crianças e adolescentes com fissura labiopalatina e atresia maxilar. Por meio do programa Dolphin Imaging 11.8, a cavidade nasal das imagens tomográficas foi reconstruída por dois avaliadores e foram obtidos os volumes internos nasais. Por meio da rinometria, os volumes nasais foram aferidos para as regiões V1 e V2. Os valores de cada exame foram, então, comparados, a um nível de significância de 5%. RESULTADOS: A análise estatística mostrou alta reprodutibilidade intra e interavaliadores na análise da tomografia computadorizada de feixe cônico. Os volumes internos nasais médios (± desvio-padrão), utilizando a rinometria acústica e a tomografia computadorizada de feixe cônico corresponderam a 6,6 ± 1,9 cm3 e 8,1 ± 1,5 cm3, respectivamente. A diferença entre os exames foi de 17,7%, considerada estatisticamente significante (p = 0,006). CONCLUSÃO: Os volumes nasais aferidos pelos dois métodos são diferentes, ou seja, apresentam discrepâncias nas medidas. A técnica considerada padrão-ouro identificou volumes maiores na cavidade nasal. A determinação de qual exame reflete a realidade clínica constitui passo futuro importante.
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Fenda Labial , Fissura Palatina , Adolescente , Criança , Fenda Labial/diagnóstico por imagem , Fissura Palatina/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Humanos , Reprodutibilidade dos Testes , Rinometria AcústicaRESUMO
Purpose This study investigated the influence of the cleft type on the appearance of hypernasality after surgical maxillary advancement (MA). Methods Nasality was determined by measurement of nasalance (acoustic correlate of nasality) by nasometry. The study involved analysis of the nasalance scores of 17 individuals with isolated cleft palate (CP), 118 with unilateral cleft lip and palate (UCLP) and 69 with bilateral cleft lip and palate (BCLP), of both sexes, aged 18 to 28 years, after MA. Only individuals with normal nasalance scores indicating balanced resonance before MA were included in this study. Nasometry was performed 3 days before and 15 months after MA, on average. The proportion of patients who presented nasalance scores indicating hypernasality after surgery was calculated by the ANOVA test, and comparison among the different cleft types was evaluated by the chi-square test (p < 0.05). Results No significant difference was found in the proportions of individuals with hypernasality among the cleft types. Conclusion Nasometry showed that the appearance of hypernasality after MA in individuals with cleft palate with or without cleft lip occurred in similar proportions, regardless of the cleft type.
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Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Distúrbios da Fala/etiologia , Fala/fisiologia , Insuficiência Velofaríngea/etiologia , Adolescente , Adulto , Fenda Labial/fisiopatologia , Fissura Palatina/fisiopatologia , Feminino , Humanos , Masculino , Maxila/cirurgia , Osteotomia de Le Fort/efeitos adversos , Estudos Retrospectivos , Distúrbios da Fala/fisiopatologia , Medida da Produção da Fala , Insuficiência Velofaríngea/fisiopatologia , Adulto JovemRESUMO
The pursuit for quality of life urged a better understanding of aspects involved in ageing to minimize its consequences. Although many studies investigated older adults' voice, aspects affecting this population voice-related quality of life have not yet been explored. Objective To investigate how aerodynamics and vocal aspects are associated with voice-related quality of life in older adults. Methodology fifty-six older adults aged 60 years or above - 39 women and 17 men - were evaluated. The following procedures were performed: application of the Voice-Related Quality of Life (V-RQOL) protocol; vocal assessment, including auditory-perceptual and acoustic analysis, from which we obtained fundamental frequency (F 0 ), standard deviation of fundamental frequency (SDF 0 ), shimmer, amplitude perturbation quotient (APQ), jitter, pitch period perturbation quotient (PPQ), and harmonics to noise ratio (HNR); aerodynamic assessment using a spirometer; and maximum phonation time (MPT) for /a/, /s/, /z/ and number counting. Results older adults tend to present high V-RQOL scores. Among women, roughness, APQ, and HNR parameters were negatively correlated with V-RQOL, whereas F 0 was positively. We found no correlation between spirometry measurements and V-RQOL. MPT for /a/, /z/, and number counting was positively correlated with V-RQOL solely among men. Conclusion Vocal roughness and acoustic parameters have a negative impact on the quality of life of older women. Respiratory aspects related to the available air support for speaking affected the most the voice-related quality of life of older men.
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Acústica da Fala , Qualidade da Voz , Acústica , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
Introduction Breathing is one of the vital functions of the body and is essential for the maintenance of life. Preventive measures for respiratory disorders can be used by the population, as well as early self-diagnosis and immediate search for treatment based on knowledge of this subject. Objective this study developed a weblog on the breathing function targeting young people and analyzed the statistical data of views until the present moment. Methods The weblog was developed, and the stages of analysis, design, development and implementation were followed. All texts were evaluated by the Flesch Reading Index to verify the language, and the statistical data were analyzed by the number of views, countries with the highest number of views, search terms used, most viewed pages and number of comments on the blog. Results Issues related to the breathing function and those most cited in the literature were selected. The blog was structured using pages with content and curiosities, with texts with minimum readability of 50%, and was made available on the internet by means of the Wordpress tool. The statistics showed an increase in the number of visits after August 2015; the countries with the highest number of views were Brazil, United States and Portugal; the search terms used were unknown or related to mouth breathing; the most viewed pages related to mouth breathing and the comments addressed questions on mouth breathing, reports and compliments. Conclusion The blog "How do I breathe?," aimed at young people and containing information about the breathing function, was developed and is available on the internet at the address: https://comoeurespiro.wordpress.com .
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PURPOSE: To investigate the reliability in auditory-perceptual assessment of hypernasality of the Borg centiMax scale and the influence of the speech material on the reliability of two scales. METHODS: Four experienced speech-language pathologists rated hypernasality of 80 audio recordings of patients with repaired cleft palate (40 single-word string and 40 sentences) using the 5-point ordinal scale and the Borg centiMax scale. Intra and inter-rater reliability were calculated for both scales and for both types of speech samples. The comparison between the agreement coefficients of the two speech samples was calculated using the Z test and between the scales was calculated by Spearman correlation coefficient, considering as significant p<0.05. RESULTS: A very high and statistically significant correlation was found between the Borg centiMax scale and the ordinal scale for both speech samples. Intra- and inter-rater reliability was higher for Borg scale as compared to ordinal scale. Good to excellent intra-rater reliability was found for Borg scale for both speech samples. Poor to excellent intra-rater reliability was found for ordinal scale for both stimuli. Higher inter-rater reliability was demonstrated for Borg scale than ordinal scale for both speech samples. There was a significant difference between the single words string and sentences for intra- and inter-rater reliability using Borg scale, and for inter-rater reliability using ordinal scale. CONCLUSION: The Borg centiMax scale showed better intra and inter-rater reliability. Additionally, the speech material comprising of single words string showed better reliability in most of the comparisons for both scales.
OBJETIVO: Investigar a confiabilidade da escala Borg centiMax como método de avaliação perceptivo-auditiva da hipernasalidade e a influência do tipo de amostra de fala sobre a confiabilidade das avaliações. MÉTODO: Quatro fonoaudiólogas experientes classificaram a hipernasalidade de 80 amostras de fala de pacientes com fissura de palato reparada (40 vocábulos e 40 sentenças) utilizando a escala ordinal de 5 pontos e a escala Borg centiMax. Os índices de concordância intra e interavaliadores foram estabelecidos para ambas as escalas e amostras. A comparação desses índices foi feita pelo teste Z e a comparação entre as escalas foi feita pelo coeficiente de correlação de Spearman (p<0,05). RESULTADOS: Verificou-se correlação muito alta e significante entre a Escala Borg centiMax e a escala ordinal, para ambas as amostras. Os índices de concordância intra-avaliadores (CCI) para a escala Borg centiMax variaram de excelente a bom e, para a escala ordinal (Kappa), de excelente a pobre, em ambas as amostras. A concordância interavaliadores (CCI) para a escala Borg centiMax variou de excelente a moderada e, para a escala ordinal (Kappa), variou de moderada a pobre, para vocábulos e sentenças. Diferença estatisticamente significante, com melhores índices de concordância intra e interavaliadores para vocábulos, foi obtida com a escala Borg centiMax. Para a escala ordinal, diferença significante entre vocábulos e sentenças foi observada apenas para a comparação interavaliador. CONCLUSÃO: A escala Borg centiMax apresentou melhores índices de concordância intra e interavaliadores. A amostra contendo vocábulos mostrou melhores índices de concordância na maioria das comparações, para ambas as escalas.
Assuntos
Distúrbios da Fala/diagnóstico , Medida da Produção da Fala/instrumentação , Qualidade da Voz , Fissura Palatina/fisiopatologia , Humanos , Reprodutibilidade dos Testes , Distúrbios da Fala/classificação , Distúrbios da Fala/etiologia , Insuficiência Velofaríngea/fisiopatologia , Distúrbios da Voz/fisiopatologiaRESUMO
PURPOSE: To perform the expansion, validation of the content, criterion and construct of an orofacial myofunctional assessment protocol for individuals with cleft lip and palate; and to define evaluation parameters for the instrument use. METHODS: The expansion of the instrument was performed based on the MBGR protocol; the items, sub items and possibilities of answers of the amplified instrument were analyzed for their clarity by seven examiners for the content validation.. Assessment parameters were developed for the use of the instrument in order to minimize the subjectivity. Four examiners compared the aspects of the protocol to those of another instrument for the criterion validation, and the construct validation was performed comparing the results of pre and post orthognathic surgery treatment. The Content Validation Index and the Kappa, Spearman and Wilcoxon Correlation tests were applied for the validations. RESULTS: The mobility, tonicity and sensitivity aspects of the evaluation were added to the protocol and at content validation, 72% of the items were classified as very clear and 28% as clear. A manual with assessment parameters for all items and sub items of the protocol was constructed. The inter-examiner agreement was moderate. In the comparison of the protocols, for the validation of the criterion, a good relation among them was observed. For the validation of the construct the protocol was able to identify outcome after the treatment. CONCLUSION: The protocol was expanded and considered validated in its entirety: content, criterion and construct, and evaluation parameters for its use were established.
OBJETIVO: Realizar a ampliação, validação de conteúdo, critério e construto de um protocolo de avaliação miofuncional orofacial para indivíduos com fissura labiopalatina e definir parâmetros de avaliação para a utilização do instrumento. MÉTODO: A ampliação do instrumento foi realizada com base no protocolo MBGR; os itens, subitens e possibilidades de respostas do instrumento ampliado foram analisados quanto à clareza por sete examinadores para a validação do conteúdo. Parâmetros de avaliação para a utilização do instrumento foram estabelecidos a fim de minimizar a subjetividade. Quatro examinadores compararam os aspectos do protocolo aos de outro instrumento para a validação de critério, e a validação de construto foi realizada comparando os resultados pré e pós-tratamento cirúrgico do avanço da maxila. Aplicou-se o Índice de Validação do Conteúdo e os testes Kappa, Correlação de Spearman e Wilcoxon para as validações. RESULTADOS: Foram acrescentados os aspectos da avaliação da mobilidade, tonicidade e sensibilidade ao protocolo; na validação do conteúdo, 72% dos itens foram classificados como muito claro e 28%, como claro; construiu-se um manual com parâmetros de avaliação para todos os itens e subitens do protocolo. A concordância interexaminadores apresentou-se moderada. Na comparação dos protocolos, para a validação de critério, foi observada boa relação entre eles. Para a validação do construto, o protocolo demonstrou ser capaz de identificar resultado de tratamento após a realização do tratamento. CONCLUSÃO: O protocolo foi ampliado e considerado validado em sua totalidade: conteúdo, critério e construto, e estabelecidos parâmetros de avaliação para a sua utilização.
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Fenda Labial/fisiopatologia , Fissura Palatina/fisiopatologia , Sistema Estomatognático/fisiopatologia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Protocolos Clínicos , HumanosRESUMO
RESUMO Objetivo Investigar a efetividade de proposta de classificação da mímica facial (MF), e sua correlação com avaliação objetiva do fechamento velofaríngeo (FVF). Método Vinte indivíduos com fissura labiopalatina reparada foram submetidos à medida da área velofaríngea por meio da rinomanometria e à gravação de amostra de fala. A MF foi classificada em dois momentos, por três fonoaudiólogas. Inicialmente as avaliadoras classificaram a MF, utilizando critérios próprios, em: 1=MF ausente; 2=leve; 3=moderada; 4=grave. Posteriormente, foram submetidas a um treinamento com o estabelecimento dos seguintes critérios de classificação: 1=MF normal; 2=movimento somente de nariz ou terço superior da face; 3=movimento acentuado de nariz ou terço superior da face; 4=movimento de nariz e terço superior da face e, classificaram a MF utilizando os critérios estabelecidos. Concordância intra e interavaliadores foram calculadas pelo coeficiente Kappa ponderado. A correlação entre os resultados das etapas com o FVF foi feita pelo coeficiente de correlação de Spearman. Resultados Na primeira etapa, a concordância interavaliadores variou de regular a substancial e na segunda, de substancial a quase perfeita. A concordância intra-avaliadores variou de moderada a quase perfeita na primeira etapa, e de moderada a substancial, na segunda etapa. A correlação entre a MF e área velofaríngea na primeira e na segunda etapa foi positiva e significativa. Conclusão A proposta de julgamento da MF mostrou-se efetiva na determinação do sintoma e confiável no diagnóstico da gravidade da disfunção velofaríngea. A correlação significativa entre os métodos perceptivo e instrumental sugere que a MF pode ser utilizada na previsão do FVF.
ABSTRACT Purpose To investigate the effectiveness of a proposal for classification of facial grimace (FG) and its correlation with objective evaluation of velopharyngeal closure (VPC). Methods Twenty individuals with repaired cleft lip and palate underwent velopharyngeal area measurement by means of rhinomanometry and speech sample recording. The FG was rated in two steps, by three speech-language pathologists. First the evaluators rated the FG using their own criteria as: 1= absent FG; 2=mild; 3=moderate; 4=severe. Subsequently, they were submitted to a training session that established the following FG rating criteria: 1=absent FG; 2=movement only of the nose or upper third of the face; 3=strong movement of the nose or upper third of the face; 4=movement of the nose and upper third of the face. The evaluators rated the FG using the established criteria. Intra- and inter-rater agreement were calculated using weighted Kappa coefficient. Correlation between the two stage ratings with the VPC was calculated by Spearman's correlation coefficient. Results In the first stage inter-rater agreement ranged from fair to substantial; in the second stage, from substantial to almost perfect. Intra-rater agreement ranged from moderate to almost perfect in the first stage, and from moderate to substantial in the second stage. The correlation between FG and velopharyngeal area was positive and significant in both stages. Conclusion The proposed FG judgement proved to be effective in determining the symptom and reliable in diagnosing the severity of velopharyngeal dysfunction. The significant correlation between perceptual and instrumental methods suggests that FG can be used in predicting VPC.
RESUMO
PURPOSE: To determine nasalance scores of Brazilian Portuguese speaking children without evident speech disorders, language delay and orofacial deformities, at age 5 years, and analyze differences between types of speech samples and genders. METHODS: Twenty children were analyzed, 11 males, age ranging from 4 years and 10 months to 5 years and 11 months. The Nasometer II 6450 (KayPENTAX) was used for nasalance assessment. Speech samples were eight consonant-vowel syllables and one sequence of nine words. The significance of differences between speech samples and genders were assessed by the Tukey test and Mann-Whitney test, respectively, at a significance level of 5%. RESULTS: Mean nasalance scores were: /pa/= 10±4%, /pi/= 22±7%, /sa/= 11±5%, /si/= 24±11%, /ma/= 57±11%, /mi/= 73±13%, /la/= 14±9%, /li/= 25±11%, words (pipa, bis, burro, tatu, pilha, cuca, gui, fila, luz)= 20±6%. Nasalance scores of nasal syllables were significantly higher than those of oral syllables (with high or neutral vowels) and nasalance scores of oral syllables with high vowels were significantly higher than those of oral syllables with neutral vowels, for the majority of comparisons. There was no difference between genders. CONCLUSION: Normative nasalance scores for 5-year-old Brazilian children were determined. The methodology can serve as a standard for the early diagnosis of nasality deviations, such as hypernasality observed in cleft palate speech.
Assuntos
Medida da Produção da Fala , Fala/fisiologia , Qualidade da Voz/fisiologia , Pré-Escolar , Feminino , Humanos , Masculino , Valores de Referência , Caracteres Sexuais , Acústica da FalaRESUMO
OBJECTIVES: To correlate quality of life of children in terms of sleep, with their oral language skills, auditory processing and orofacial myofunctional aspects. METHODS: Nineteen children (12 males and seven females, in the mean age 9.26) undergoing otorhinolaryngological and speech evaluations participated in this study. The OSA-18 questionnaire was applied, followed by verbal and nonverbal sequential memory tests, dichotic digit test, nonverbal dichotic test and Sustained Auditory Attention Ability Test, related to auditory processing. The Phonological Awareness Profile test, Rapid Automatized Naming and Phonological Working Memory were used for assessment of the phonological processing. Language was assessed by the ABFW Child Language Test, analyzing the phonological and lexical levels. Orofacial myofunctional aspects were evaluated through the MBGR Protocol. Statistical tests used: the Mann-Whitney Test, Fisher's exact test and Spearman Correlation. RESULTS: Relating the performance of children in all evaluations to the results obtained in the OSA-18, there was a statistically significant correlation in the phonological working memory for backward digits (p = 0.04); as well as in the breathing item (p = 0.03), posture of the mandible (p = 0.03) and mobility of lips (p = 0.04). CONCLUSION: A correlation was seen between the sleep quality of life and the skills related to the phonological processing, specifically in the phonological working memory in backward digits, and related to orofacial myofunctional aspects.