Data mining of an acoustic biomarker in tongue cancers and its clinical validation.

The promise of speech disorders as biomarkers in clinical examination has been identified in a broad spectrum of neurodegenerative diseases. However, to the best of our knowledge, a validated acoustic marker with established discriminative and evaluative properties has not yet been developed for oral tongue cancers. Here we cross-sectionally collected a screening dataset that included acoustic parameters extracted from 3 sustained vowels /ɑ/, /i/, /u/ and binary perceptual outcomes from 12 consonant-vowel syllables. We used a support vector machine with linear kernel function within this dataset to identify the formant centralization ratio (FCR) as a dominant predictor of different perceptual outcomes across gender and syllable. The Acoustic analysis, Perceptual evaluation and Quality of Life assessment (APeQoL) was used to validate the FCR in 33 patients with primary resectable oral tongue cancers. Measurements were taken before (pre-op) and four to six weeks after (post-op) surgery. The speech handicap index (SHI), a speech-specific questionnaire, was also administrated at these time points. Pre-op correlation analysis within the APeQoL revealed overall consistency and a strong correlation between FCR and SHI scores. FCRs also increased significantly with increasing T classification pre-operatively, especially for women. Longitudinally, the main effects of T classification, the extent of resection, and their interaction effects with time (pre-op vs. post-op) on FCRs were all significant. For pre-operative FCR, after merging the two datasets, a cut-off value of 0.970 produced an AUC of 0.861 (95% confidence interval: 0.785-0.938) for T3-4 patients. In sum, this study determined that FCR is an acoustic marker with the potential to detect disease and related speech function in oral tongue cancers. These are preliminary findings that need to be replicated in longitudinal studies and/or larger cohorts.

Comparison of simple frenotomy with 4-flap Z-frenuloplasty in treatment for ankyloglossia with articulation difficulty: A prospective randomized study.

OBJECTIVE: To compare the surgical outcomes of simple frenotomy and the 4-flap Z-frenuloplasty according to the articulation test values and tongue-tie classification in patients with ankyloglossia with articulation difficulty. STUDY DESIGN: prospective randomized study. SETTING: Tertiary academic center. SUBJECTS: and methods: Children with ankyloglossia with articulation difficulty were randomly divided into 2 groups for surgical treatment. Patients were evaluated for the tongue-tie classification and articulation test before surgery. Three months after the operation, the frenulum classification and articulation test were re-evaluated to compare the differences in surgical outcome between the two surgical methods. RESULTS: Out of 37 patients, 19 underwent the 4-flap Z-frenuloplasty and 18, the simple frenotomy. No differences were observed in the baseline characteristics of the patients assigned to both groups. Changes in the tongue-tie classification and improvement in the articulation test results were observed with both the surgical methods. Both surgical groups had significant improvement in the speech articulation test (consonants) but there was no difference in the speech outcomes between the surgical groups. CONCLUSION: Although there was no significant difference in the surgical outcome between the two surgical methods, ankyloglossia patients showed improvement in a Korean speech articulation test 3 months after undergoing surgery to release the lingual frenulum.

Evidências de validade e fidedignidade de um instrumento de avaliação fonológica / Evidence of validity and reliability of a phonological assessment tool

RESUMO Objetivo Apresentar evidências de validade e fidedignidade de um instrumento de avaliação fonológica (INFONO) desenvolvido para avaliar os fonemas do Português Brasileiro. Método Participaram do estudo 866 crianças com idades entre 3 e 8:11 anos, divididas em grupos: típico, controle e clínico. Os participantes foram avaliados pelo INFONO por nomeação espontânea. A produção da criança foi gravada e transcrita no momento da avaliação, no próprio software. Para análise de validade e fidedignidade, foram analisadas a consistência interna a partir da técnica Alpha de Cronbach. Para a validade de critério, comparou-se o desempenho entre os grupos através do teste t de Student para amostras independentes. A fidedignidade foi analisada pela concordância intra e interavaliadores por meio do Teste de Kendall. Considerou-se significância quando p ≤0,05. Resultados O INFONO apresentou evidências de validade e fidedignidade (consistência interna), indicando uma confiabilidade satisfatória dos itens, bem como excelente concordância entre os avaliadores em relação aos escores do teste (confiabilidade intra e interavaliador). Em relação à validade de critério, o desempenho do grupo clínico para todos os fonemas foi inferior ao grupo controle, mostrando que os escores são sensíveis para identificar crianças com desvio fonológico. Conclusão O INFONO apresentou fortes evidências de validade e fidedignidade.

ABSTRACT Purpose To present evidence of the validity and reliability of a phonological assessment tool developed to assess the phonological inventory of Brazilian Portuguese. Methods The study included 866 children aged between 3 and 8:11 years, divided into three groups: typical, control and clinical. Participants were evaluated using a phonological assessment software, which prompted the spontaneous naming of a series of images. The children's responses were audio recorded and transcribed at the time of the assessment, by the software itself. The Cronbach's alpha coefficient was used to evaluate the internal consistency of the instrument for reliability and validity purposes. Criterion validity was examined by comparing the performance of different groups using Student's t-test for independent samples. Intra- and inter-rater agreement were investigated using Kendall's tau. Results were considered significant at p ≤ 0.05. Results The present study provided evidence of validity and reliability (internal consistency) for this phonological assessment tool, confirming the reliability of its items and demonstrating excellent agreement rates between examiners regarding its scoring (intra- and inter-rater reliability). The criterion validity assessment demonstrated that the control group outperformed the clinical group across all phonemes, showing that test scores were successful in identifying children with speech sound disorders (phonological disorders). Conclusion The present findings provide strong evidence of the validity and reliability of this phonological assessment tool.

Procesos de aprendizaje en niños de 6 a 10 años de edad con antecedente de nacimiento prematuro / Learning processes of children aged 6 to 10 years old that were born prematurely / Processos de aprendizagem em crianças de 6 a 10 anos de idade com antecedentes de nascimento prematuro

En este estudio sobre los procesos de aprendizaje en niños y niñas prematuros, buscamos establecer las características del desempeño del niño o la niña pretérmino en las actividades base del aprendizaje, en comparación con un grupo de niños y niñas nacidos a término, entre 6 y 10 años de edad. Seleccionamos la muestra según un modelo no probabilístico y voluntario, con un total de 160 participantes, divididos en un grupo clínico de 80 niños y niñas prematuros y otro grupo de 80 niños y niñas nacidos a término. El enfoque empleado para esta investigación es de tipo cuantitativo y el diseño que utilizamos fue comparativo-correlacional, con la aplicación de subtest para evaluar procesos de escritura, lectura, cálculo y lenguaje, siendo la comprensión y la discriminación fonológica las principales dificultades para las personas prematuras, así como procesos de cálculo mental.

This study on the learning processes of children born prematurely aims to establish their academic performance characteristics of these children based on their learning activities, which was then compared to the academic performance of a group of children aged between 6 and 10 years old that were born full-term. The sample is selected using a non-probabilistic and voluntary model, with a total of 160 participants, divided into a clinical group of 80 children that were born prematurely and another group of 80 children that were born full-term. A quantitative approach was used for this research along with a comparative-correlational design. This was achieved through applying a subtest with the two groups that evaluated their writing, reading, arithmetic and language

Este estudo sobre os processos de aprendizagem em crianças prematuras procura estabelecer as características do desempenho da criança que nasceu prematura nas atividades base da aprendizagem, em comparação com um grupo de crianças nascidos a termo, entre 6 e 10 anos de idade. A amostra foi selecionada a partir de um modelo não probabilístico e voluntário, com um total de 160 participantes, divididos num grupo clínico de 80 crianças prematuras e outro grupo de 80 crianças nascidas no tempo normal. O enfoque empregado para esta pesquisa é de tipo quantitativo e a concepção utilizada foi a comparativa-correlacional, com a aplicação de subtestes para avaliar os processos de escrita, leitura, cálculo e linguagem, sendo o entendimento e a discriminação fonológica as principais dificuldades para os prematuros, bem como os processos de cálculo mental

Use of an automated mobile application to assess effects of nicotine withdrawal on verbal fluency: A pilot study.

Mild-to-moderate impairment in frontally mediated functions such as sustained attention, working memory, and inhibition have been found to occur during tobacco withdrawal and may present a barrier to successful cessation. These findings have led to studies evaluating cessation treatments that target nicotine withdrawal related cognitive impairment. The instruments currently used to assess cognitive function provide detailed and specific information but have limitations including being time consuming, cumbersome, anxiety provoking, and having poor ecological validity. The authors examined the feasibility of using a mobile computer application to test verbal fluency (VF) as a quick, easy-to-administer, and more ecologically valid method of measuring the effects of short-term smoking abstinence on frontally mediated cognitive functions. Thirty participants completed 2 assessments-1 during ad lib smoking and 1 after overnight abstinence. At each assessment, semantic and phonemic VF tests were administered using a mobile application and nicotine craving and withdrawal symptom severity was assessed. In repeated assessments, performance on both semantic and phonemic VF tests is expected to improve due to practice effects; however, significant improvements were observed only in semantic (p = .012) but not phonemic (p = .154) VF. In addition, the change between assessments in phonemic (but not semantic) score was significantly associated with withdrawal (p = .006) and craving (p = .037) severity measured postabstinence. This study demonstrates that nicotine withdrawal has differential effects on semantic versus phonemic VF suggesting impairments of working memory, attention, and inhibition. These effects were measured using methods easily used in large groups of participants, potentially with remote test administration and automated scoring. (PsycINFO Database Record

Gestational syphilis and stillbirth in the Americas: a systematic review and meta-analysis / Sífilis gestacional y mortinatalidad en la Región de las Américas: una revisión sistemática y metanálisis

OBJECTIVE: To perform a systematic review and meta-analysis of reported estimates of the association between gestational syphilis (GS) and stillbirth in the Americas region. METHODS: Cochrane Library, Embase, LILACS, MEDLINE/PubMed, PLOS, and ScienceDirect were searched for original research studies quantifying the relationship between GS and stillbirth in the region. A final sample of eight studies was selected. A cumulative meta-analysis plus four subgroup meta-analyses of study data on the association between maternal syphilis during pregnancy and stillbirth were conducted. The four meta-analyses were based on 1) definition of cases and the control; 2) syphilis treatment (presence or absence, effective or ineffective); 3) definition of stillbirth as "showing no signs of life at birth"; and 4) definition of stillbirth based on low birth weight and gestational age. Random-effects metaanalyses were used to calculate pooled estimates of stillbirth with exposure to GS, and each subgroup analysis was tested for heterogeneity. RESULTS: Women with GS had increased odds of stillbirth (pooled odds ratio (OR): 6.87; 95% confidence interval: 2.93, 16.08). There was considerable heterogeneity across the eight studies (percentage of variance (I²) = 95). The funnel plot was not statistically significant, pointing to a lack of publication bias. Increased odds of stillbirth among pregnant women with syphilis were also seen in all four subgroup meta-analyses. CONCLUSIONS: GS is a major contributing factor for stillbirths in the Americas. Interventions targeting GS are highly cost-effective and, along with high-quality point-of-care testing, should be implemented across the region to help reach the goal of eliminating congenital syphilis.

OBJETIVO: Llevar a cabo una revisión sistemática y metanálisis de los cálculos notificados de la asociación entre sífilis gestacional (SG) y mortinatalidad en la Región de las Américas. MÉTODOS: Se realizó una búsqueda en Cochrane Library, Embase, LILACS, MEDLINE/PubMed, PLOS y ScienceDirect de estudios de investigación originales que cuantificaran la relación entre la SG y la mortinatalidad en la Región de las Américas. Se seleccionó una muestra final de ocho estudios. Se efectuaron un meta-nálisis acumulativo y cuatro metanálisis de subgrupo de los datos de estudio sobre la asociación entre sífilis materna durante el embarazo y mortinatalidad. Los cuatro metanálisis se basaron en 1) la definición de casos y del control; 2) el tratamiento de la sífilis (presencia o ausencia, eficaz o ineficaz); 3) la definición de mortinatalidad como "ausencia de signos de vida al nacer"; y 4) la definición de mortinatalidad basada en el bajo peso al nacer y la edad gestacional. Se emplearon metanálisis de efectos aleatorios para calcular las estimaciones acumuladas de mortinatalidad con exposición a la SG, y se comprobó la heterogeneidad de cada uno de los análisis de subgrupo. RESULTADOS: Las mujeres con SG presentaron mayores probabilidades de mortinatalidad (razón de posibilidades [OR] acumulada: 6,87; IC de 95%: 2,93-16,08). Se observó una heterogeneidad considerable en los ocho estudios (porcentaje de variación [I2] = 95). El gráfico en embudo no fue estadísticamente significativo, lo que indica una ausencia de sesgo de publicación. En los cuatro metanálisis de subgrupo, también se observaron mayores probabilidades de mortinatalidad en las mujeres embarazadas con sífilis. CONCLUSIONES: La SG es un importante factor contribuyente a la mortinatalidad en la Región de las Américas. Las intervenciones dirigidas a la SG son altamente eficaces en función de los costos y deben ejecutarse en toda la región, junto con las pruebas diagnósticas de alta calidad en el lugar de asistencia, para ayudar a alcanzar la meta de eliminación de la sífilis congénita.

Post-treatment neutrophil-lymphocyte ratio independently predicts amputation in critical limb ischemia without operation

OBJECTIVES: Limited information is available concerning the post-treatment neutrophil-lymphocyte ratio in critical limb ischemia patients who receive conservative therapy. Accordingly, this study was designed to evaluate the predictive value of the post-treatment neutrophil-lymphocyte ratio in critical limb ischemia patients without surgery. METHOD: From January 2009 to January 2011, critical limb ischemia patients were admitted to a vascular center. The demographic data, patient histories, comorbidities and risk factors were documented, and the differential cell count was determined at admission and seven days later after conservative therapy. The cutoff value of the post-treatment neutrophil-lymphocyte ratio was determined by an ROC curve. Patients were divided into groups A and B according to the cutoff value. Amputation-free survival was compared between groups. Univariate and multivariate analyses were used to identify independent risk factors. RESULT: A total of 172 patients were identified with a mean age 71.98±10.09 years; among them, 122 were male. A value of 3.8 was identified as the cutoff value of the post-treatment neutrophil-lymphocyte ratio. Groups A (post-treatment neutrophil-lymphocyte ratio ≥3.8) and B (post-treatment neutrophil-lymphocyte ratio <3.8) showed a significant difference in amputation-free survival (P<0.001). The 1-year, 2-year and 3-year amputation-free survival rates were 79.6%, 55.6% and 46.3%, respectively, in group A; however, in group B, these values were 89.7%, 79.3% and 75.9%, respectively. The post-treatment neutrophil-lymphocyte ratio was identified as an independent predictive factor for amputation in critical limb ischemia patients (P<0.001). CONCLUSION: The post-treatment neutrophil-lymphocyte ratio is an independent predictive factor for amputation in critical limb ischemia patients. Patients with a post-treatment neutrophil-lymphocyte ratio ≥3.8 are likely to suffer from ...

Extent of palatal lengthening after cleft palate repair as a contributing factor to the speech outcome.

Operative techniques in performing cleft palate repair have gradually evolved to achieve better speech ability with its main focus on palatal lengthening and accurate approximation of the velar musculature. The authors doubted whether the extent of palatal lengthening would be directly proportional to the speech outcome. Patients with incomplete cleft palates who went into surgery before 18 months of age were intended for this study. Cases with associated syndromes, mental retardation, hearing loss, or presence of postoperative complications were excluded from the analysis. Palatal length was measured by the authors' devised method before and immediately after the cleft palate repair. Postoperative speech outcome was evaluated around 4 years by a definite pronunciation scoring system. Statistical analysis was carried out between the extent of palatal lengthening and the postoperative pronunciation score by Spearman correlation coefficient method. However, the authors could not find any significant correlation. Although the need for additional research on other variables affecting speech outcome is unequivocal, we carefully conclude that other intraoperative constituents such as accurate reapproximation of the velar musculature should be emphasized more in cleft palate repair rather than palatal lengthening itself.

Verbal competence in narrative retelling in 5-year-olds with unilateral cleft lip and palate.

BACKGROUND: Research regarding expressive language performance in children born with cleft palate is sparse. The relationship between articulation/phonology and expressive language skills also needs to be further explored. AIMS: To investigate verbal competence in narrative retelling in 5-year-old children born with unilateral cleft lip and palate (UCLP) and its possible relationship with articulation/phonology at 3 and 5 years of age. METHODS & PROCEDURES: A total of 49 children, 29 with UCLP treated according to three different procedures for primary palatal surgery and a comparison group of 20 children (COMP), were included. Longitudinally recorded audio files were used for analysis. At ages 3 and 5, the children were presented with a single-word test of word naming and at age 5 also the Bus Story Test (BST). The BST was assessed according to a test manual. The single-word test was phonetically transcribed and the percentage of consonants correct adjusted for age (PCC-A) was calculated. Differences regarding the BST results within the UCLP group were analysed. The results were compared with the results of the COMP group, and also with norm values. In addition, the relationship between the results of the BST and the PCC-A scores at ages 3 and 5 years was analysed. OUTCOMES & RESULTS: No significant group differences or correlations were found. However, 65.5% of the children in the UCLP group had an information score below 1 standard deviation from the norm value compared with 30% in the COMP group. CONCLUSIONS: A larger proportion of children in the UCLP group than in the COMP group displayed problems with retelling but the differences between the two groups were not significant. There was no association between the BST results in the children with UCLP and previous or present articulatory/phonological competence. Since group size was small in both groups, the findings need to be verified in a larger study.

Prevalence and types of articulation errors in Saudi Arabic-speaking children with repaired cleft lip and palate.

OBJECTIVES: The purpose of this study was to assess prevalence and types of consonant production errors and phonological processes in Saudi Arabic-speaking children with repaired cleft lip and palate, and to determine the relationship between frequency of errors on one hand and the type of the cleft. Possible relationship between age, gender and frequency of errors was also investigated. METHODS: Eighty Saudi children with repaired cleft lip and palate aged 6-15 years (mean 6.7 years), underwent speech, language, and hearing evaluation. The diagnosis of articulation deficits was based on the results of an Arabic articulation test. Phonological processes were reported based on the productivity scale of a minimum 20% of occurrence. Diagnosis of nasality was based on a 5-point scale that reflects severity from 0 through 4. All participants underwent intraoral examination, informal language assessment, and hearing evaluation to assess their speech and language abilities. The Chi-Square test for independence was used to analyze the results of consonant production as a function of type of CLP and age. RESULTS: Out of 80 participants with CLP, 21 participants had normal articulation and resonance, 59 of participants (74%) showed speech abnormalities. Twenty-one of these 59 participants showed only articulation errors; 17 showed only hypernasality; and 21 showed both articulation and resonance deficits. CAs were observed in 20 participant. The productive phonological processes were consonant backing, final consonant deletion, gliding, and stopping. At age 6 and older, 37% of participants had persisting hearing loss. CONCLUSIONS: Despite early age at time of surgery (mean 6.7 months) for the studied CLP participants in this study, a substantial number of them demonstrated articulation errors and hypernasality. The results showed desirable findings for diverse languages. It is especially interesting to consider the prevalence of glottal stops and pharyngeal fricatives in a population for whom these sound are phonemic.

Production of tongue twisters by speakers with partial glossectomy.

Abstract A partial glossectomy can affect speech production. The goal of this study was to investigate the effect of the presence of a tumour as well as the glossectomy surgery on the patients' production of tongue twisters with the sounds [t] and [k]. Fifteen patients with tongue cancer and 10 healthy controls took part in the study. The outcome measures were the patients' speech acceptability, rate of errors, the time needed to produce the tongue twisters, pause duration between item repetitions and the tongue shape during the production of the consonants [t] and [k] before and after surgery. The patients' speech acceptability deteriorated after the surgery. Compared to controls, the patients' productions of the tongue twisters were slower but not more errorful. Following the surgery, their speed of production did not change, but the rate of errors was higher. Pause duration between items was longer in the patients than in the controls but did not increase from before to after surgery. Analysis of the patients' tongue shapes for the productions of [t] and [k] indicated a higher elevation following the surgery for the patients with flap reconstructions. The results demonstrated that the surgical resection of the tongue changed the error rate but not the speed of production for the patient. The differences in pause duration also indicate that the tumour and the surgical resection of the tongue may impact the phonological planning of the tongue twister.

Speech production after glossectomy: methodological aspects.

This article focuses on methodological issues related to quantitative assessments of speech quality after glossectomy. Acoustic and articulatory data were collected for 8 consonants from two patients. The acoustic analysis is based on spectral moments and the Klatt VOT. Lingual movements are recorded with ultrasound without calibration. The variations of acoustic and articulatory parameters across pre- and post-surgery conditions are analyzed in the light of perceptual evaluations of the stimuli. A parameter is considered to be relevant if its variation is congruent with perceptual ratings. The most relevant acoustic parameters are the skewness and the Center of Gravity. The Klatt VOT explains differences that could not be explained by spectral parameters. The SNTS ultrasound parameter provides information to describe impairments not accounted for by acoustical parameters. These results suggest that the combination of articulatory, perceptual and acoustic data provides comprehensive complementary information for a quantitative assessment of speech after glossectomy.

Velopharyngeal function assessment in patients with cleft palate: perceptual speech assessment versus nasopharyngoscopy.

There is no doubt that perceptual speech assessment and instrumental examination could provide different diagnostic information on patients with cleft palate (CP), but not all patients simultaneously need the 2 examinations. So the purposes of this study were to explore a simple and effective evaluation method to assess velopharyngeal function and to investigate speech traits that affect the diagnosis of velopharyngeal function in patients with CP. The investigators implemented a retrospective study, and 247 postoperative patients with CP were selected, including 155 boys and 92 girls, with a mean (SD) age of 13 years and 2 months (7 years and 7 months). All of these patients were assessed by perceptual speech evaluation and nasopharyngoscopy after surgery, and the result was divided into velopharyngeal closure (VPC), velopharyngeal insufficiency, and marginal VPC. The number of diagnostic consistency patients was 170 (VPC, 51 patients; velopharyngeal insufficiency, 115 patients; marginal VPC, 4 patients), and the consistent ratio was 68.83%. There was no significant difference between perceptual speech assessment and nasopharyngoscopy. Furthermore, the difference in distribution of hypernasality between the consistent group and the inconsistent group was significant. In addition, the correlation analysis indicated that surgical age, hypernasality, nasal emission, and compensatory articulation were correlated with the velopharyngeal function (P < 0.05). In conclusion, perceptual speech assessment could make a correct diagnosis in the absence of instrumental examination. The severity of hypernasality might affect the diagnosis of the velopharyngeal function. Much more attention should be paid to the surgical age, the alteration of hypernasality, nasal emission, and compensatory articulation during CP therapy.

Velopharyngeal insufficiency, submucous cleft palate and a phonological disorder as the associated clinical features which led to the diagnosis of Jacobsen syndrome. Case report and review of the literature.

Jacobsen syndrome is an uncommon but well-known contiguous gene syndrome caused by partial deletion involving the long arm of chromosome 11. Most common features include: psychomotor impairment, facial dysmorphism, and thrombocytopenia. Cleft palate has been rarely reported. A case of Jacobsen syndrome confirmed by cytogenomic analysis is presented with review of the literature. Main clinical features were phonological disorder, submucous cleft palate (SMCP) and velopharyngeal insufficiency (VPI). VPI was corrected surgically according to findings of videonasopharyngoscopy and videofluoroscopy. It is concluded that clinicians should consider that VPI associated with SMCP may be the main manifestations of a chromosomal syndrome.

Velopharyngeal function of patients with cleft palate after primary palatoplasty: relevance of sex, age, and cleft type.

PURPOSE: The aim of this study was to investigate the relevance of sex, age, and cleft type to velopharyngeal function after primary Sommerlad palatoplasty so as to improve velopharyngeal function after the procedure. PATIENTS AND METHODS: Records of 503 patients with nonsyndromic cleft palate after primary Sommerlad palatoplasty were included in the retrospective study. Relevance between their velopharyngeal function and sex, age, and cleft type was analyzed. Statistical analysis was performed using SPSS 13.0 (SPSS Inc., Chicago, IL). RESULTS: There were no significant differences of velopharyngeal competence (VPC) rates between different sexes (P = 0.635). Specifically, VPC rates were significantly higher in younger-than-2-years groups than in older age groups (P < 0.05) and significantly lower in 6-years-or-older group (P < 0.05). No differences were found among 2- to 6-year-old groups (P > 0.05). The VPC rates were significantly lower in the bilateral complete cleft palate and the unilateral complete cleft palate than in the incomplete cleft palate before 2 years old (P < 0.05), whereas there were no significant differences totally (P = 0.875). Results showed that the disparity of the VPC rate among different cleft types would decrease with age. Moreover, results of multivariate logistic regression also indicated that operation age and cleft type are factors influencing velopharyngeal function. CONCLUSIONS: Primary palatoplasty should be completed before 2 years old, and the postoperative velopharygeal function will greatly decreases after 6 years old. The influence of cleft type on velopharyngeal function is limited to young patients. For those who have missed the best surgical timing, appropriate delay of operation age is reasonable, especially for patients with complete cleft palate. For patients 4 to 6 years old, the first choice is still simple palatoplasty no matter which cleft type they are classified into.

Age of diagnosis and evaluation of consequences of submucous cleft palate.

OBJECTIVES: To evaluate the frequency of submucous cleft palate (SMCP) in a group of children with clefts. The reason for suspecting submucous cleft, age of diagnosis, effect of age on speech development, problems in speech, hearing and swallowing were compared with previous literature. METHODS: Retrospective chart review: Out of 33 patients with SMCP, registered by the Groninger cleft team over approximately 20 years (1990 until July 2012), 28 non-syndromic patients with a proven diagnosis of SMCP were included: 17 males and 11 females. Speech and hearing were examined and the number of patients with SMCP and age at time of diagnosis were evaluated. The percentages of problems in resonance, articulation and hearing, present at time of diagnosis, were compared with the percentages of problems found after surgery. RESULTS: Out of 800 patients with clefts, 28 patients (3,5%) were diagnosed with SMCP at a mean age of 3;9 years. All patients presented one or more symptomatic complaints at time of diagnosis: hypernasality (65%), problems in articulation (46%), conductive hearing loss (39%) and/or swallowing problems (32%). A bifid uvula was found in 92%. Following surgery, hypernasal speech and swallowing problems were no longer observed. The articulation problems remained after surgery. Age of diagnosis seems no predictor of articulation problems. An improvement in hearing was observed but normal hearing was not achieved. Pharyngoplasty appeared to be a successful and save treatment of hypernasality. CONCLUSIONS: SMCP is a rare cleft palate which is, despite the presence of a bifid uvula and symptoms of velopharyngeal insufficiency, often diagnosed late. In children with a bifid uvula and mild problems in speech, hearing and swallowing, it is important to be alert to SMCP because SMCP may account for these persistent mild complaints. Therefore, early detecting of SMCP can yield profits.

Acoustic analysis of changes in articulation proficiency in patients with advanced head and neck cancer treated with chemoradiotherapy.

OBJECTIVES: Our aim was to characterize articulation proficiency and differences between tumor sites before and after chemoradiotherapy for advanced head and neck cancer with the help of acoustic measures. Our further goal was to improve objective speech measures and gain insight into muscle functioning before and after treatment. METHODS: In 34 patients with laryngeal or hypopharyngeal, nasal or nasopharyngeal, or oral or oropharyngeal cancer, we acoustically analyzed nasality, vowel space, precision, and strength of articulation in 12 speech sounds (/a/, /i/, /u/, /p/, /s/, /z/, /1/, /t/, /tj/, /k/, /x/, /r/) before treatment and 10 weeks and 1 year after treatment. Outcomes were compared between assessment points and between tumor sites. RESULTS: Nasality in nonlaryngeal sites was significantly reduced by treatment. Most affected in articulation were the oral or oropharyngeal cancer sites, followed by the nasal or nasopharyngeal sites. One year after treatment, vowel space had not recovered and consonant articulation had weakened. Laryngeal sites were less affected in articulation by tumor or treatment. CONCLUSIONS: Analyses of articulatory-acoustic features are a useful instrument for assessing articulation and speech quality objectively. Assessment of a number of sounds representing various articulation manners, places, and tongue shapes revealed patterns of speech deterioration after chemoradiotherapy. The results suggest that patients' speech could benefit from articulation exercises to address changes in muscle coordination and/or sensitivity and to counteract side effects and "underexercise" atrophy.

The "Interdisciplinary Orofacial Examination Protocol for Children and Adolescents": a resource for the interdisciplinary assessment of the stomatognatic system.

The Interdisciplinary Orofacial Examination Protocol for Children and Adolescents (Protocolo de exploración interdisciplinaria orofacial para niños y adolescents, Barcelona, 2008) is very useful in providing a fast, initial, expedient detection of possible morphological and functional disorders, and to guide the patient toward the appropriate professionals. With this tool it is possible to detect the risk factors which can negatively affect morphological and functional harmony and guide patients toward the necessary treatment as early as possible. This Protocol, developed by 4 orthodontists, 1 ENT and 3 speech language therapists, also contributes to the unification of concepts and nomenclature used by distinct specialists, thus making professional understanding easier and more dynamic.

Types of clefts and multianomaly craniofacial conditions.

Speech-language pathologists (SLPs) in the public schools or other nonmedical settings rarely see infants or small children with unrepaired clefts. When children with repaired clefts appear in their caseloads, it may be difficult to comprehend what the situation was before the child had surgery. Clefts vary widely in their original severity, which has a direct bearing on how the repaired cleft looks and how the orofacial structures (lip, teeth, and palate) affect speech when the child comes into the SLP's caseload. It is important to understand that a high percentage of children with nonsyndromic clefts also have other structural or functional disorders that affect their ability to accomplish their goals in life. Multianomaly, complex craniofacial conditions (associations, sequences, and syndromes) are even rarer in nonmedically based SLP practices. However, because medical habilitation for these cases is now much more easily available and because families who frequent the Internet will know that the services of an SLP may be needed for their child, it is necessary for the SLP to know some basic characteristics of these conditions and to know where to find needed information.

Population-based screening of children for specific speech and language impairment in Germany: a systematic review.

OBJECTIVE: The study was aimed at evaluating the effectiveness of a systematic population-based screening programme for specific language impairment (SLI) in preschool children in Germany. METHODS: The study question was divided into a review of (1) evidence from studies evaluating screening programmes, (2) diagnostic instruments in the German language, and (3) studies evaluating speech and language interventions. A systematic database search was conducted between June and October 2007 and was updated in January and again in May 2008. Relevant studies were identified by 2 independent reviewers based on screened titles/abstracts and full texts. RESULTS: 4,806 studies were screened. The only existing controlled screening study did not provide data for SLI. No diagnostic study met the inclusion criteria. Sixteen randomized intervention studies were included, 3 studies contributed to the appraisal of earlier against later initiation of treatment. Most studies were of limited quality. We found indications of short-term positive effects from language therapies in children with SLI. Long-term outcomes were not investigated. No evidence supporting the advantage of earlier treatment initiation was identified. CONCLUSIONS: The benefit of population-based language screening of preschool children with SLI is not proven. Controlled screening studies are therefore necessary. For Germany, the accuracy of existing diagnostic instruments has not yet been sufficiently examined.