A Master Mind Game Code Algorithm Approach to Help Surgical Decision-Making between Retropharyngeal Fat Grafting and Pharyngoplasty for the Treatment of Velopharyngeal Incompetence

Abstract Introduction Velopharyngeal insufficiency (VPI) is a controversial pathology with many surgical options. Objectives To compare pharyngoplasty and retropharyngeal fat grafting and to build a prognostic tool to achieve perfect speech. Methods Retrospective observational cohort study of 114 patients operated for VPI from 1982 to 2019 in a single tertiary center. The instrumental assessment was made using an aerophonoscope and nasofibroscopy. The variables sex, age, genetic syndromes, and type of diagnosis were analyzed with logistic regression model adjusted with propensity score. To generalize results and to build a surgical predictive tool, a marginal analysis concludes the study. Results Among the patients (median [range] age 7 [4-48]), 63 (55.26%) underwent pharyngoplasty and 51 (44.74%) graft. The graft group had no complication, but it had a failure rate of 7.84%. The pharyngoplasty group had no failure, but one patient had postoperative obstructive sleep apnea. The marginal analysis demonstrated that age lower than 7 years, cleft lip and palate, absence of syndrome, and intermittent VPI were important predictive factors of good result regardless of surgical technique. Conclusions Without a statistical demonstration of the superiority of pharyngoplasty over graft, and in the uncertainty of literature background, our perfect-speech patient profile represents an important tool for a postoperative forecast of results in which, like in the Master Mind game, every feature has to be considered not individually but as a pattern of characteristics whose association contributes to the outcome.

Beginner's Intelligibility Test (BIT): translation, cultural adaptation to Brazilian Portuguese and validation

Abstract Objective: Translate and validate the Beginner's Intelligibility Test (BIT) speech intelligibility assessment instrument into Brazilian Portuguese. Method: Study developed in two stages: 1st translation and cross-cultural adaptation of the Beginner's Intelligibility Test instrument into Brazilian Portuguese; 2nd application of the instrument. The second stage of the study involved 20 children using cochlear implants, aged between 4 and 11 years old, enrolled in the Cochlear Implant Program at Hospital das Clínicas de Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo. All data collection procedures were video, and audio recorded for analysis by judges. After orthographic transcription of each sentence repeated by the child, the judge was asked to score the participant's speech intelligibility and classify it according to criteria established in the literature. Results: The translation stage took place for the four lists and 40 sentences of the Beginner's Intelligibility Test (BIT) instrument into Brazilian Portuguese, the semantic, idiomatic, experimental and conceptual equivalences were considered, and it took place without any difficulties identified by the translators. The terms used in the Portuguese language were similar and those that presented differences among the translators did not bring significant divergences to its understanding. In the inter-evaluator analysis, there was reliability between the classification and the score obtained. Different judges evaluated the same children and a concordance was observed in classification and scoring. Conclusions: Face validity of the BIT was confirmed through the understanding of each sentence of the four lists by the majority of children using cochlear implants participating in the pretest phase. The content validity among experts was unanimous for the four lists of sentences. The Brazilian Portuguese adapted version maintained the semantic, idiomatic, conceptual, and cultural equivalence, according to the evaluation of the expert committee. Evidence level: 02.

Parâmetros e tipos de avaliação da disartria na esclerose lateral amiotrófica / Parameters and types of dysarthria assessment in amyotrophic lateral sclerosis

RESUMO Objetivo identificar estudos a respeito dos parâmetros e dos tipos de avaliação utilizados para avaliar a disartria na esclerose lateral amiotrófica (ELA). Estratégia de pesquisa estudo de revisão integrativa da literatura realizada nas bases de dados LILACS, SciELO, PubMed, Web of Science, CINAHL, Scopus e Cochrane, por meios dos descritores, em português e em inglês, "Avaliação AND Disartria AND Esclerose Lateral Amiotrófica". Critérios de seleção os critérios de inclusão foram: artigos que abordavam estudos sobre avaliação da disartria na ELA, nas línguas inglesa, espanhola e portuguesa, disponíveis na íntegra, no período de 2015 a 2022. Resultados do total de 38 estudos, apenas 3 usaram um único tipo de avaliação da disartria. A maior parte dos estudos utilizou mais de um tipo de avaliação variando de 2 a 4. Foram 3 os tipos de avaliação mais utilizados, com o intuito de avaliar o grau de inteligibilidade de fala: avaliação perceptivo-auditiva (31 estudos), avaliação acústica (18 estudos) e avaliação do movimento (27 estudos). Conclusão a avaliação da disartria na ELA é realizada por diferentes procedimentos e com vários parâmetros de análise, em especial pela avaliação perceptivo-auditiva e do movimento.

ABSTRACT Purpose to identify studies regarding the parameters and types of assessment used to evaluate dysarthria in amyotrophic lateral sclerosis (ALS). Research strategy an integrative literature review study was conducted on the LILACS, SciELO, PubMed, Web of Science, CINAHL, Scopus, and Cochrane databases using the descriptors "Assessment AND Dysarthria AND Amyotrophic Lateral Sclerosis" in both Portuguese and English. Selection criteria the inclusion criteria consisted of articles that addressed studies on dysarthria assessment in ALS, written in English, Spanish, and Portuguese, which should be available in full, and published from 2015 to 2022. Results: out of the total of 38 studies, only 3 used a single type of dysarthria assessment. Most studies employed more than one type of assessment, ranging from 2 to 4 types. Three assessment types were predominantly used to assess the degree of speech intelligibility: auditoryperceptual assessment (31 studies), acoustic assessment (18 studies), and movement assessment (27 studies). Conclusion dysarthria assessment in ALS is conducted through various procedures and with multiple analysis parameters, notably through auditory-perceptual and movement assessments.

Research progress on early speech interventions for children with cleft lip and palate / 口腔疾病防治

@#Children born with cleft lip and palate (CLP) are at high risk of disorders involving early speech production, and these problems can persist into later childhood, leading to the emergence of compensatory articulation errors. These difficulties in early vocalization directly impact the subsequent development of children's speech and vocabulary. Studies have shown that providing naturalistic interventions, such as milieu teaching and focused stimulation, for children with CLP in the first three years of life have positive impacts on the speech development of children, such as the potential to increase phonemic inventories and the percentage of correct consonants. In addition to speech and language therapists who perform systematic speech therapy, parents can be trained and supervised to deliver early speech intervention. The percentage of correct consonants can be used to assess outcome measures of speech intervention when combined with other measures, such as consonant inventory and speech intelligibility. However, much recent research in the field has focused on older children. Therefore, it must be determined if intervening during the early phase of typical speech development leads to better results. Future research should use more robust methodological designs to determine whether early speech intervention exhibits a positive impact on the speech and future physical and mental development of children with CLP.

Produção da fala de crianças e adolescentes de um programa de reabilitação auditiva / Speech production of children and adolescents from an auditory rehabilitation program

RESUMO Objetivo caracterizar a produção da fala de crianças e adolescentes usuários de aparelho de amplificação sonora individual (AASI) ou implante coclear (IC) de um programa de reabilitação auditiva. Métodos estudo observacional transversal. Foram analisadas amostras de fala de 15 participantes de um programa de reabilitação auditiva, que consistiam na prova de fonologia do ABFW (ABFW - Teste de Linguagem Infantil nas Áreas de Fonologia, Vocabulário, Fluência e Pragmática) e na fala espontânea, adaptada do Protocolo de Avaliação de Voz do Deficiente Auditivo. Foi aplicado o teste de Wilcoxon para comparar os índices de Porcentagem de Consoantes Corretas (PCC) e Porcentagem de Consoantes Corretas revisado (PCC-r) das provas de fonologia e o teste de Mann-Whitney para comparar os referidos índices, em relação aos graus de inteligibilidade da fala espontânea. Também foi analisada a variabilidade de produção dos fonemas das provas de fonologia. Resultados verificou-se desvio leve nos índices de PCC e PCC-r para as provas de fonologia, com escores superiores para o PCC-r. Os participantes com médias maiores que 85% alcançaram inteligibilidade "Boa" e participantes com médias entre 85% e 50% apresentaram inteligibilidade "Regular/Insuficiente". Os usuários de AASI não produziram adequadamente os fonemas /s/, /z/, /Ʒ/ /ɲ/, /l, /ʎ/, arquifonema /S/ e arquifonema /R/ e os usuários de IC, os fonemas /ʎ/ e arquifonema /R/. Conclusão o grupo estudado apresentou desvio leve nos índices de PCC e PCC-r, com médias superiores, quando considerada a distorção como acerto. Participantes com inteligibilidade "Boa" apresentaram maiores escores de PCC e PCC-r. Usuários de AASI não produziram fonemas fricativos adequadamente. Foram observadas produções com variação linguística social e regional.

ABSTRACT Purpose To characterize the speech production of children and adolescents from an auditory rehabilitation program who use hearing aids (HA) or cochlear implant (CI). Methods Cross-sectional observational study. Speech samples from 15 participants of a hearing rehabilitation program were analyzed through the phonology test of the ABFW Test and spontaneous conversation, which were adapted from the Protocol for the Evaluation of Voice in Subjects with Hearing Impairment. The Wilcoxon test was used to compare the Percentage of Consonants Correct (PCC) and the Percentage of Consonants Correct-revised (PCC-r) indexes of the phonology test, and the Mann-Whitney test was used to compare these indexes to the degrees of intelligibility of spontaneous conversation. The variability of production of the phonemes of the phonology tests was also analyzed. Results There was a mild deviation in the PCC and PCC-r indexes for the phonology tests, with higher scores for the PCC-r. Participants with averages greater than 85% achieved "Good" intelligibility, and participants with averages between 85% and 50% had "Regular/Insufficient" intelligibility. The HA users did not properly produce the phonemes /s/, /z/, /Ʒ/ /ɲ/, /l, /ʎ/, the archiphoneme /S/, and the archiphoneme /R/. The CI users did not properly produce the phonemes /ʎ/ and the archiphoneme /R/. Conclusion The group had a mild deviation in the PCC and PCC-r indexes, with higher means when the distortion was considered correct. Participants with "Good" intelligibility had higher PCC and PCC-r scores. HA users did not produce fricative phonemes properly. There were productions with a social and regional linguistic variation.

Métodos de avaliação da apraxia de fala na infância: revisão sistemática / Methods of assessing of childhood apraxia of speech: systematic review

RESUMO Objetivos Revisar sistematicamente os protocolos e/ou avaliações que contribuem para o diagnóstico de apraxia de fala na infância (AFI) e classificá-los de acordo com a dimensão clínica avaliada. Estratégia de pesquisa Estudo de revisão sistemática da literatura nas bases de dados MEDLINE (acessado via PubMed), LILACS, Scopus e SciELO, com os descritores Apraxias, Childhood apraxia of speech, Evaluation, Assessment, Validation Studies, Evaluation Studies, Language Therapy, Rehabilitation of Speech and Language Disorders, Child e Child, Preschool. Critérios de seleção A busca nas bases de dados foi conduzida por três pesquisadores independentes. Foram incluídos estudos que avaliavam, de forma clara, sujeitos com suspeita ou diagnóstico de AFI. Os revisores realizaram a coleta de dados no que diz respeito às características metodológicas, intervenções e desfechos dos estudos, por meio de planilhas previamente elaboradas especificamente para o presente estudo. O dado principal coletado foi referente aos procedimentos de avaliação da AFI para crianças. Resultados A maior parte dos estudos (14 dos 21 incluídos) realizou a associação entre a avaliação de habilidades motoras e/ou articulatórias e segmentais. Cinco realizaram avaliação de todos os aspectos elencados: motor e/ou articulatória, segmental e suprassegmental e dois realizaram apenas avaliação motora e/ou articulatória. A idade dos sujeitos variou de 3 a 12 anos. Conclusão A maioria das pesquisas considerou a associação entre habilidades motoras e/ou articulatórias e segmentais para avaliação da apraxia de fala na infância. Sugere-se a realização de mais estudos, a fim de buscar evidências de validade.

ABSTRACT Purpose Systematically review the protocols and/or assessments that contribute to the diagnosis of CAS and classify them according to the clinical dimension evaluated Research strategy Study of systematic literature review in the databases MEDLINE (accessed via PubMed), LILACS, Scopus and SciELO with the descriptors Apraxias, Childhood apraxia of speech, Evaluation, Assessment, Validation Studies, Evaluation Studies, Language Therapy, Rehabilitation of Speech and Language Disorders, Child and Child, Preschool. Selection criteria The search for scientific articles in the databases was conducted by three independent researchers. Studies that clearly assessed subjects with suspected or diagnosed PIA were included. The reviewers performed data collection with regard to methodological characteristics, interventions and study outcomes using standardized forms. The main data collected was related to the assessment procedures of CAS. Results Most studies (14 of the 21 included) made an association between the assessment of motor and/or articulatory and segmental skills. Five performed an evaluation of all listed aspects: motor and/or articulatory, segmental and suprasegmental; and two underwent only motor and/or articulatory assessment. The age of the subjects in the present study ranged from 3 to 12 years. Conclusion The assessment of CAS generally involves the association between the assessment of motor and/or articulatory and segmental skills. It is suggested that further studies in order to evidence validity for the assessment of CAS.

Influence of different types of noise on sentence recognition in normally hearing adults / A influência de diferentes tipos de ruídos no reconhecimento de sentenças em adultos normo-ouvintes

ABSTRACT Objective: to analyze speech perception in normally hearing adults when listening in silence and with different types of noise. Methods: 40 individuals of both sexes, aged 18 to 45 years, participated in the study. Speech perception was assessed with the Lists of Sentences in Portuguese test, without a competing noise and with speech-spectrum, babble, and cocktail party noise. A mixed-effects linear regression model and the 95% confidence interval were used. Results: the subjects' performance was worse in the three types of noise than in silence. When comparing the types of noise, differences were found in all combinations (speech-spectrum X babble, speech-spectrum X cocktail party, and babble X cocktail party), with a worse performance in babble, noise, followed by cocktail party. Conclusion: all noises negatively influenced speech perception, with a worse performance in babble, followed by cocktail party and speech-spectrum.

RESUMO Objetivo: analisar a percepção da fala em adultos normo-ouvintes na situação de escuta no silêncio e com diferentes tipos de ruídos. Métodos: participaram 40 indivíduos de ambos os gêneros, de 18 a 45 anos. Foi realizada a avaliação da percepção de fala com o teste Lista de Sentenças para o Português, sem ruído competitivo e com os ruídos: espectro de fala, babble e cocktail party. Foi utilizado modelo de regressão linear com efeitos mistos e adotado intervalo de confiança de 95%. Resultados: houve pior desempenho dos indivíduos com todos os ruídos em comparação a situação de escuta no silêncio. Na comparação entre os tipos de ruídos, também foi constatado diferença em todas as combinações (espectro de fala X babble, espectro de fala X cocktail party e babble X cocktail party), com pior desempenho dos indivíduos com os ruídos babble e cocktail party, respectivamente. Conclusão: todos os ruídos influenciaram negativamente a percepção de fala, com pior desempenho quando utilizado o ruído babble, seguido pelo cocktail party e espectro de fala.

Câncer bucal: voz e qualidade de vida pós mutilação / Oral cancer: voice and quality of life after mutilation / Cáncer oral: voz y calidad de vida después de la mutilación

Objetivo: investigar o impacto da deformidade bucal oncológica na comunicação oral e na qualidade de vida de adultos e idosos. Métodos: estudo observacional descritivo, transversal, com abordagem mista. Amostra de 41 pacientes, submetidos à cirurgia para retirada do câncer bucal, resultando em mutilação e inteligibilidade verbal. Instrumentos: Questionário sociodemográfico; Índice de Desvantagem Vocal; Questionário Qualidade de Vida da Universidade de Washington; Roteiro Semiestruturado para análise no software Iramuteq®.Resultado: a mutilação predominou em região de palato. Avaliação vocal mostrou o sexo masculino com pior qualidade de vida, expressivamente escala Social, enquanto, o feminino, escala Física. A análise lexical mostrou necessidades, frustrações e expectativas. Conclusão: o estudo revelou a vergonha, o medo, o isolamento social e, ao mesmo tempo, a esperança de voltar a, pelo menos, poder falar e ser compreendido pelas outras pessoas através do uso da prótese

Objective: to investigate the impact of oral cancer deformity on oral communication and the quality of life of adults and the elderly. Methods: descriptive, cross-sectional observational study with a mixed approach. Sample of 41 patients undergoing surgery to remove oral cancer, resulting in mutilation and verbal intelligibility. Instruments: Sociodemographic questionnaire; Voice Handicap Index; University of Washington Quality of Life Questionnaire; Semi-structured script for analysis in the Iramuteq® software. Result: mutilation predominated in the palate region. Vocal assessment showed the male sex with worse quality of life, significantly on the Social scale, while the female, Physical scale. Lexical analysis showed needs, frustrations and expectations. Conclusion:the study revealed shame, fear, social isolation and, at the same time, the hope of returning to at least being able to talk and be understood by other people through the use of the prosthesis

Objetivo: investigar el impacto de la deformidad del cáncer oral en la comunicación oral y la calidad de vida de adultos y ancianos. Métodos: estudio observacional descriptivo, transversal con enfoque mixto. Muestra de 41 pacientes sometidos a cirugía para extirpar el cáncer oral, lo que resulta en mutilación e inteligibilidad verbal. Instrumentos: cuestionario sociodemográfico; Índice de discapacidad de voz; Cuestionario de calidad de vida de la Universidad de Washington; Guión semiestructurado para análisis en el software Iramuteq®. Resultado: la mutilación predominó en la región del paladar. La evaluación vocal mostró el sexo masculino con peor calidad de vida, significativamente en la escala social, mientras que la hembra, la escala física. El análisis léxico mostró necesidades, frustraciones y expectativas. Conclusión: el estudio reveló vergüenza, miedo, aislamiento social y, al mismo tiempo, la esperanza de volver al menos a poder hablar y ser entendido por otras personas mediante el uso de la prótesis

Advances in classification and reconstruction of palatal fistula after cleft palate operation / 口腔疾病防治

@#Postoperative fistulae are one of the most significant complications of cleft palate repair. They usually has an adverse effect on patients’ oral hygiene, speech and even mental health. There has been a wide range of rates of fistula occurrence, from 0.8%-60%, with the classification and definition of fistulae differing from one author to the next. In this paper, the definition and classification of palatal fistulae and their reconstruction method are reviewed. At present, there is a lack of a consistent definition of palatal fistulae and a classification that can fully reflect the characteristics of palatal fistula. Adjacent flap is mainly used for repairing small fistulae with an adequate amount of surrounding tissue; anteriorly based dorsal tongue flaps are a safe and reliable method for large fistulae; free flap is beneficial for refractory and complicated palatal fistulae that are difficult to repair by the local and pedicle flap; and different synthetic materials are used in multilayer repair of fistulae; among them, composite polymer membrane is highly biocompatible, promoting cell attachment and proliferation in animal models, but its security in the human body needs further research.

A Predictive Model of Hearing Outcome for Cochlear Implantation in Children below 5 Years of Age

Background: Cochlear Implantation (CI) has become an important modality of treatment for children with severe to profoundpre-lingual sensorineural hearing loss who do not benefit from hearing aids (HAs). The final outcome is not totally predictable,as there are a large number of factors which either alone or in combination will play their roles in the final outcome of CI.Aim of the Study: This study aims to evaluate prospectively the relative impact of multiple pre-, peri-, and post-operative factorson the final outcome of the CI in pre-lingual hearing impaired children aged 5 years under “Sruthitharangam” free cochlearimplant program of Government of Kerala.Materials and Methods: This study was conducted at Government Medical College, Kozhikode (GMC-KKD), Kerala, fromJanuary 2014 to January 2015. The study group consisted of 60 patients screened from the patients who have attendedAuditory verbal habilitation (AVH) categories of Auditory Performance (CAP) test, Meaningful auditory integration scale (MAIS)and Speech intelligibility rating test (SIR) at GMC-KKD, Kerala. Counseling of parents was done regarding regular follow-upsand therapy/support to the child at home.Observations and Results: Pearson correlation test and Spearman correlation test were done to check the correlation betweenage at which HA was first fitted and MAIS scores. Correlation between the age at which HA first fitted and MAIS was negative.As the age at which HAs were fitted increases, the MAIS score decreases. This indicates the significance of using the residualhearing and stimulation of auditory nerve as early as possible. Pearson correlation and Spearman correlation tests were appliedto check the correlation between age of surgery and MAIS score and found that there was negative correlation existing betweenage of surgery and MAIS scores. This meant, as the age at which surgery was done increases, the MAIS score decreases.Pearson correlation test and Spearman correlation tests were applied to check the MAIS scores and duration of AVH with HAs.Conclusions: A Cochlear implant was not a passive sensory aid or sensory substitution device that simply replaces a damaged ordefective cochlea to restore normal hearing but requires prolonged period of aural rehabilitation that involves perceptual learning,adaptation, and readjustment of their attention. The various risk factors that affect the auditory gain and speech perception eitheracting singly or in combination and the statistical analysis of the present study showed are the age at implantation, duration ofauditory deprivation, and the residual hearing which have a direct impact on the outcome over a period of 1 year.

Testes de fala no ruído na clínica audiológica - Uma Revisão Integrativa / Noise speech tests in the audiological clinic - An Integrative Review

Introdução: A audiometria convencional não é suficientemente confiável para prever a compreensão de uma pessoa num ambiente ruidoso e, desta forma, inserir testes de fala no ruído na rotina clínica audiológica pode ser uma ferramenta útil para detectar possíveis problemas da função auditiva central. Objetivo: Realizar uma revisão integrativa da literatura sobre testes de fala no ruído disponíveis para uso na clínica audiológica. Método: Busca de publicações sem delimitação temporal nos bancos de dados Lilacs, PubMed, Medline, IBCS e SciELO, utilizando-se como descritores: teste de fala no ruído, percepção auditiva, testes de discriminação auditiva, distúrbios auditivos, padronização, desenvolvimento, validação, testes do limiar de recepção da fala, percepção auditiva e perda auditiva. Não houve exclusão por período de publicação. Os artigos foram pesquisados nos meses de junho e julho de 2017. Resultados: Foram localizados um total de 1200 artigos e 39 foram inseridos nesta revisão integrativa por satisfazerem os critérios de inclusão. Nos artigos selecionados, foram localizados 25 materiais diferentes que utilizaram para avaliação de fala no ruído: sílabas, palavras, sentenças, dígitos e associação de palavras e tonalidade e palavras e sentenças. Os tipos de ruídos empregados foram: espectro de fala, ruído tipo babble, ruído branco e ruído estacionário e tais materiais foram desenvolvidos para uso em adultos e/ou crianças e sujeitos com e/ou sem perda auditiva. Conclusão: Todos os autores relataram a importância de inserir testes de fala no ruído na rotina clínica, já que só a audiometria convencional não prevê a compreensão de fala em ambiente ruidoso.

Introduction: Conventional audiometry is not reliable enough to predict a person's understanding in a noisy environment, so inserting speech noise tests into the audiological clinical routine can be a useful tool for detecting possible central auditory function problems. Objective: To conduct an integrative literature review on noise speech tests available for use in the audiological clinic. Method: Search for publications without temporal delimitation in the Lilacs, PubMed, Medline, IBCS and SciELO databases, using the following keywords: Noise speech test, auditory perception, auditory discrimination tests, hearing disorders, standardization, development, validation, speech reception threshold tests, hearing perception and hearing loss. There was no exclusion by publication period. The articles were searched in June and July 2017. Results: A total of 1200 articles were found and 39 were included in this integrative review because they met the inclusion criteria. In the selected articles, 25 different materials were used to evaluate speech in noise: syllables, words, sentences, digits and association of words and tone and words and sentences. The types of noise used were: speech spectrum, babble noise, white noise and stationary noise and these materials were developed for use in adults and / or children and subjects with and / or without hearing loss. Conclusion: All authors reported the importance of inserting speech tests in noise into the clinical routine, since only conventional audiometry does not predict speech comprehension in noisy environment.

Introducción: La audiometría convencional no es confiable para predecir la comprensión de una persona en entorno ruidoso, por lo que insertar pruebas de ruido del habla en la rutina audiológica puede ser una herramienta útil para detectar posibles problemas de la función auditiva central. Objetivo: realizar una revisión integral de literatura sobre las pruebas de ruido en el habla disponibles para su uso en la clínica audiológica. Método: Búsqueda de publicaciones sin delimitación temporal en las bases de datos Lilacs, PubMed, Medline, IBCS y SciELO, utilizando las palabras clave: prueba de ruido, percepción auditiva, pruebas de discriminación auditiva, trastornos auditivos, estandarización, desarrollo, validación , pruebas de umbral de recepción del habla, percepción auditiva y pérdida auditiva. No hubo exclusión por período de publicación. Se buscaron los artículos en junio y julio de 2017. Resultados: se encontraron un total de 1200 artículos y se incluyeron 39 en esta revisión porque cumplían con los criterios de inclusión. En los artículos seleccionados, se utilizaron 25 materiales diferentes para evaluar el habla en ruido: sílabas, palabras, oraciones, dígitos y asociación de palabras y tonos y oraciones. Tipos de ruido utilizados: espectro del habla, ruido de balbuceo, ruido blanco y ruido estacionario, y estos materiales se desarrollaron para su uso en adultos y/o niños y sujetos con y/o sin pérdida auditiva. Conclusión: Todos los autores informaron la importancia de insertar pruebas de habla en ruido en la rutina clínica, ya que solo la audiometría convencional no predice la comprensión del habla en entornos ruidosos.

Relações entre medidas de capacidade auditiva e desempenho em tarefas de percepção da fala em crianças com deficiência auditiva / Relationship between hearing capacity and performance on tasks of speech perception in children with hearing loss

RESUMO Objetivo Estabelecer relações entre o desempenho em tarefa de reconhecimento de palavras com e sem sentido e grau e configuração da perda auditiva, utilizando valores de Índices de Inteligibilidade de Fala (SII) como indicadores, em crianças com deficiência auditiva. Método Foram estabelecidos os SII para sons de entradas de 55 e 65 Decibéis Nível de Pressão Sonora (dBNPS) de dez crianças com perda auditiva neurossensorial usuárias de aparelho de amplificação sonora individual bilateralmente que têm a linguagem oral como principal modalidade de comunicação. As crianças foram submetidas à tarefa de repetição de palavras com e sem sentido em duas ou três diferentes intensidades. As emissões foram analisadas de acordo com o Protocolo Word Association for Syllable Perception (WASP). Na análise dos dados, o SII foi comparado com os resultados obtidos em cada critério de análise. Resultados Para o desempenho em palavras, houve diferença estatisticamente significante entre os dois tipos de estímulo em 55dBNPS. Para o desempenho em consoantes e ponto de articulação, houve diferença estatisticamente significante entre os tipos de estímulos em 65 e 55dBNPS e também entre as intensidades de 65 e 55 dBNPS nas palavras sem sentido. Conclusão De modo geral, não houve regularidade na relação entre capacidade auditiva e desempenho em tarefas de percepção da fala. Os resultados sugerem que o desempenho nas tarefas de reconhecimento de palavras sem sentido tem maior relação com o índice de inteligibilidade do que as palavras com sentido, possivelmente por limitar as estratégias de fechamento semântico pelo sujeito.

ABSTRACT Purpose To establish the relationship between the performance on word recognition tasks, using words with and without sense and degree, and the configuration of hearing loss, by using Speech Inteligibility Index (SII) values as indicators, in children with hearing loss. Methods SII were established for 55 and 65 Decibel of Sound Pressure Level (dB SPL) input sounds of ten children presenting bilateral sensorineural hearing loss (SNHL), adapted with bilateral hearing aids, and who have oral language as the main mode of communication. The children were submitted to a word and nonsense-word repetition task of two or three intensity degrees. Their productions were analyzed according to the Word Association for Syllable Perception (WASP) Protocol. In the data analysis, the values of SII were compared with the results obtained in each analysis criterion. Results Pertaining to the words, there was statistically significant difference between the two types of stimuli in 55 dBSPL. As for the performance of consonants and point of articulation, there was a statistically significant difference between stimuli types in 65 and 55 dB SPL, and between intensities 65 and 55 dB SPL in nonsense words. Conclusion Overall, there was no regularity in the relationship between hearing ability and performance in speech perception tasks. The results suggest that performance in the nonsense words recognition tasks was more related to intelligibility index than to words with meaning, possibly because it limits semantic closure strategies by the subject.

Ganho auditivo e influência do tempo de privação auditiva na percepção de fala em usuários de implante coclear / Hearing improvement and influence of hearing deprivation time on speech perception in cochlear implant users

RESUMO Objetivo Avaliar o ganho de percepção de fala na ausência e na presença de ruído competitivo; avaliar, após três meses de uso do implante coclear, se houve correlação entre a percepção de fala nas duas condições e correlacionar o tempo de privação auditiva e o lado implantado com a percepção de fala na ausência e na presença do ruído. Métodos Participaram deste ensaio clínico 12 indivíduos com perda auditiva de severa a profunda, submetidos à cirurgia de implante coclear. A percepção de fala foi avaliada através do teste Listas de Sentenças em Português, utilizando a direcionalidade Opti Omni, em situações de ausência e presença de ruído competitivo. Resultados A percepção de fala na ausência e na presença de ruído competitivo aumentou, em comparação com a percepção de fala pré-operatória com a utilização da direcionalidade Opti Omni e estes achados não tiveram associação com o tempo de privação auditiva ou o lado implantado. Conclusão Houve ganho na percepção de fala, tanto na ausência, como na presença do ruído competitivo, com forte correlação entre essas duas situações. Além disso, não houve associação entre tempo de privação auditiva sem o uso do aparelho de amplificação sonora individual ou o lado implantado com o desempenho na percepção de fala.

ABSTRACT Purpose To evaluate speech perception improvement in the absence and presence of competing noise; to evaluate, after three months using a cochlear implant, whether there was a correlation between speech perception in these two conditions, and to correlate the time of hearing deprivation and the implanted side with speech perception in the absence and presence of noise. Methods Twelve individuals with severe-to-profound hearing loss who underwent cochlear implant surgery participated in this clinical trial. Speech perception was assessed using the Lists of Phrases in Portuguese test, using the Opti Omni directionality, in situations of absence and presence of competing noise. Results Speech perception with the use of Opti Omni directionality in the absence and presence of competing noise increased when compared with preoperative speech perception; these findings were not associated with hearing deprivation time or implanted side. Conclusion There was an improvement in speech perception both in the absence and presence of competing noise, with a strong correlation between these two situations. Besides, there was no association between time of hearing deprivation without the use of hearing aid, or the implanted side, with performance in speech perception.

Estudo da correlação entre índice de inteligibilidade de fala Speech Intelligibility Index (SII) e índice percentual de reconhecimento de fala / Study of correlation between Speech Intelligibility Index (SII) and speech recognition percentage index / Estudio de Correlaçao entre el Índice de inteligibilidad del habla (SII) y el índice de porcentaje de reconocimiento de voz

Introdução: A audição é um dos sentidos mais nobres, uma vez que sua principal função está ligada à aquisição e ao desenvolvimento da linguagem oral, essencial para a comunicação nas relações interpessoais e para o contato com o meio ambiente. O impacto de uma privação sensorial auditiva interfere na habilidade de interpretar sons de fala. Objetivo: Verificar se há correlação entre os valores do Speech Intelligibility Index (SII) e do Índice Percentual de Reconhecimento de fala (IPRF). Método: Foram avaliados os dados obtidos nos prontuários de 55 idosos de ambos os sexos com perda auditiva neurossensorial adquirida bilateral de grau moderado a severo, usuários de próteses auditivas acompanhados no serviço de saúde auditiva do Hospital São Paulo. Foram analisados os valores de SII obtidos na verificação dos AASI por meio do equipamento Verifit®Audioscan e os valores de IPRF para estímulos monossilábicos. Após a coleta dos dados os resultados foram submetidos à análise estatística. Resultados: As perdas auditivas foram classificadas quanto ao grau. Os idosos foram caracterizados segundo a idade e gênero e os valores de SII e IPRF foram analisados por orelha (direita e esquerda). O IPRF médio foi de 72,56% na OD e de 73,85% na OE e o SII de 58,44% na OD e 59,73% na OE. Foram determinadas equações para classificação da perda auditiva conforme grupos e equações para determinação de valores de SII e IPRF, conforme cada orelha. Conclusão: Houve correlação fraca entre os valores de SII e o IPRF obtido com estímulos monossilábicos nos idosos com perda auditiva de grau moderado a severo.

Introduction: Hearing is one of the noblest senses, since its main function is linked to the acquisition and development of oral language, essential in interpersonal relations and with the environment. The impact of hearing sensory deprivation interferes with the ability to interpret speech sounds. Purpose: Check if there is a correlation between the values of Speech Inteligibility Index (SII) and Word Recognition (WR). Method: The data obtained in the records of 55 elderly of both sexes, with bilateral sensorineural hearing loss of moderate to severe, users of hearing aids accompanied in the auditory health service of Hospital São Paulo, were evaluated. The SII values obtained in the verification of the hearing aid gain in the Verifit ® Audioscan equipment and the IPRF values for monosyillabic stimuli were analysed. After data collection, the results were submitted to statistical analysis. Results: The hearing losses were classified as to the degree (moderate and severe). The values of SII and IPRF were characterized by ear (right and left). The mean of WR was 72,56% in the right ear and 73,85 % in the left ear. The mean of SII was 58,44 % in the right ear and 59,73 % in the left ear.There were certain equations for the classification of hearing loss according to groups and equations for determining the values of SII and IPRF, according to each ear. Conclusion: There was a weak correlation between the values of SII and of WR obtained with monosyllabic stimuli in the elderly with hearing loss of moderate to severe degree.

Introducción: La audición es uno de los sentidos más nobles, ya que su función principal está ligada a la adquisición y desarrollo del lenguaje oral, esencial en las relaciones interpersonales y en el medio ambiente. El impacto de la pérdida sensorial auditiva interfiere con la capacidad de interpretar los sonidos del habla. Objetivo: Verificar que existe correlación entre los valores de Indice de inteligibilidad de habla (SII) y Indice de reconocimiento de habla. Método: Los datos obtenidos en los registros de 55 ancianos de ambos sexos fueron evaluados con pérdida auditiva sensorineural bilateral de moderado a severo, usuarios de audífonos acompañados en el servicio de salud auditiva del hospital de São Paulo. Se analizaron los valores de SII obtenidos en la verificación de los ajustes de audifono en el equipo Audioscan Verifit ® y los valores IPRF para los estímulos monosilábicoy. Después de la recolección de datos los resultados se presentaron al análisis estadístico. Resultados: Las pérdidas auditivas se clasificaron en cuanto al grado (moderado y severo). Los valores de SII y IPRF se caracterizaron por el oído (derecha e izquierda). El Indice de reconocimiento de habla medio fue de 72,56% en la OD y de 73,85% en la OI y el SII de 58,44% en la OD y 59,73% en la OI. Había ciertas ecuaciones para la clasificación de la pérdida de oído según grupos y las ecuaciones para determinar los valores de SII y de IPRF, según cada oído. Conclusión: Había una correlación débil entre los valores de SII y el IPRF obtenido con los estímulos monosilábicoy en los ancianos con la pérdida de oído de moderate al grado severo.

Índice de inteligibilidade (SII) e variação da intensidade do sinal de fala em crianças com deficiência de audição / Speech Intelligibility Index (SII) and variation of speech signal intensity in hearing impaired children

RESUMO Objetivo Comparar valores do índice de inteligibilidade de fala amplificado, para diferentes entradas de sinal de fala (75, 65 e 55 dBNPS), gerados no processo de verificação dos aparelhos de amplificação sonora, nos diferentes graus e configurações de perdas auditiva. Métodos Foram selecionadas 41 crianças com idades entre 3 e 80 meses, totalizando 78 orelhas (quatro orelhas foram excluídas). As perdas auditivas foram classificadas conforme grupos de audibilidade e intervalos do índice de inteligibilidade de fala. Foram analisados 234 valores do índice de inteligibilidade de fala para os estímulos de fala e estes foram também analisados, em relação aos grupos e intervalos de audibilidade. Resultados Os grupos de audibilidade se deslocaram entre os intervalos do índice de inteligibilidade de fala, indicando a variação, conforme o nível de apresentação do sinal de entrada. Duas equações foram geradas para prever valores do índice de inteligibilidade de fala a partir do valor deste índice para o sinal de entrada de 65. Conclusão Menores níveis de pressão sonora do estímulo de fala produzem menores índices de inteligibilidade de fala. Esta diferença é mais acentuada nos deficientes auditivos, que apresentam valores do índice de inteligibilidade de fala de 65 entre 36% e 55%.

ABSTRACT Purpose To compare aided speech intelligibility index (SII) values in different speech signal inputs (75, 65, and 55 dBNPS), generated from the verification process of hearing aids, under different hearing loss severities and configurations. Methods 41 children aged between three and 80 months old were selected, totalizing 78 ears (after exclusion of four ears). Hearing loss was classified according to audibility groups and SII intervals. Two hundred and thirty-four (234) SII values were analyzed as per speech stimulus and with regard to groups and audibility intervals. Results Movement of audibility groups along SII intervals was observed, which indicates variation associated with the input signal intensity, as well as with the distance between the sound source and the hearing aid microphone. Two equations were generated to predict SII values from input signal SII65. Conclusion Lower levels of speech stimulus sound pressure produce lower levels of speech intelligibility. This difference is more pronounced in hearing-impaired persons, who present SII values between 36 and 55%.

Long-term follow-up of auditory performance and speech perception and effects of age on cochlear implantation in children with pre-lingual deafness / 中华医学杂志(英文版)

Background@#The development of auditory and speech perception ability of children with hearing loss is affected by many factors after they undergo cochlear implantation (CI). Age at CI (CI age) appears to play an important role among these factors. This study aimed to evaluate the development of auditory and speech perception ability and explore the impact of CI age on children with prelingual deafness present before 3 years of age.@*Methods@#Two hundred and seventy-eight children with pre-lingual deafness (176 boys and 102 girls) were included in this study, and the CI age ranged from 6 to 36 months (mean age, 19 months). Categorical auditory performance (CAP) was assessed to evaluate auditory ability, and the speech intelligibility rating was used to evaluate speech intelligibility. The evaluations were performed before CI and 1, 3, 6, 12, 18, 24, 36, 48, and 60 months after CI.@*Results@#The auditory ability of the pre-lingually hearing-impaired children showed the fastest development within 6 months after CI (k = 0.524, t = 30.992, P < 0.05); then, the progress started to decelerate (k = 0.14, t = 3.704, P < 0.05) and entered a plateau at the 24th month (k = 0.03, t = 1.908, P < 0.05). Speech intelligibility showed the fastest improvement between the 12th and 24th months after CI (k = 0.138, t = 5.365, P < 0.05); then, the progress started to decelerate (k = 0.026, t = 1.465, P < 0.05) and entered a plateau at the 48th month (k = 0.012, t = 1.542, P < 0.05). The CI age had no statistical significant effect on the auditory and speech abilities starting at 2 years after CI (P < 0.05). The optimal cutoff age for CI was 15 months.@*Conclusions@#Within 5 years after CI, the auditory and speech ability of young hearing-impaired children continuously improved, although speech development lagged behind that of hearing. An earlier CI age is recommended; the optimal cutoff age for CI is at 15 months.

Comparison of Speech Rate and Long-Term Average Speech Spectrum between Korean Clear Speech and Conversational Speech

BACKGROUND AND OBJECTIVES: Clear speech is an effective communication strategy used in difficult listening situations that draws on techniques such as accurate articulation, a slow speech rate, and the inclusion of pauses. Although too slow speech and improperly amplified spectral information can deteriorate overall speech intelligibility, certain amplitude of increments of the mid-frequency bands (1 to 3 dB) and around 50% slower speech rates of clear speech, when compared to those in conversational speech, were reported as factors that can improve speech intelligibility positively. The purpose of this study was to identify whether amplitude increments of mid-frequency areas and slower speech rates were evident in Korean clear speech as they were in English clear speech. SUBJECTS AND METHODS: To compare the acoustic characteristics of the two methods of speech production, the voices of 60 participants were recorded during conversational speech and then again during clear speech using a standardized sentence material. RESULTS: The speech rate and long-term average speech spectrum (LTASS) were analyzed and compared. Speech rates for clear speech were slower than those for conversational speech. Increased amplitudes in the mid-frequency bands were evident for the LTASS of clear speech. CONCLUSIONS: The observed differences in the acoustic characteristics between the two types of speech production suggest that Korean clear speech can be an effective communication strategy to improve speech intelligibility.

Advance in Assessment of Speech Intelligibility in Adults with Dysarthria (review) / 中国康复理论与实践

Dysarthria is a group of nerological speech disorder, which occurred in about 20%-30% after stroke, or 10%-60% after traumatic brain injury. The assessment of speech intelligibility is a necessary part of the evaluation of dysarthria, which can be used to communicate the patients' condition with their relations, and also in treatment planning, evaluating the communication performance and the treatment effects. The methods used to assess intelligibility can be divided into two groups: scaling methods and item identification methods. They are also divided into non-standard and standard methods based on whether a standard assessment or not. Scaling methods include interval scales, Direct Magnitude Estimation (DME), Speech Sample Pairs Scaling, Percentage Estimates, and Visual Analogue Scale (VAS), etc. The item identification methods mainly include: Word Intelligibility Test, Chinese Speech Intelligibility Test, Chinese Speech Intelligibility Test Character List, Chinese Articulation Ability Test Word List, Sentence Intelligibility Test, Assessment of Intelligibility in Dysarthric Speakers (AIDS) and Speech Intelligibility Test (SIT) software. Among them, AIDS and SIT softwares are comprehensively standardized assessments. There are few methods can be used in China. The literatures on intelligibility assessment in the past ten years were reviewed.

Audibilidade e desenvolvimento de linguagem oral em crianças com deficiência de audição / Audibility and oral language development in children with hearing loss / Audibilidad y desarrollo del lenguaje oral en niños con discapacidad auditiva

Introdução: A audibilidade, medida pelo SII (Índice de Inteligibilidade de fala), tem se mostrado uma condição necessária para o desenvolvimento de linguagem, pois permite o acesso ao input linguístico. O desenvolvimento de vocabulário tem provado ser um bom indicador do desenvolvimento de linguagem. Objetivo: investigar as características audiológicas e de desenvolvimento de linguagem oral em crianças com deficiência auditiva usuárias de aparelho de amplificação sonora individual. Método: Foram avaliadas 65 crianças entre 6 e 17 anos, usuárias de aparelho de amplificação sonora individual, quanto ao desempenho de vocabulário receptivo (Peabody Picture Vocabulary Test - PPVT-4) e audibilidade (SII 65). Resultados: A audibilidade para sons de fala revelou que, 9% dos sujeitos tinham SII 65 menor que 37, 47% tinham SII 65 entre 38 e 57 e 43% maior que 58. A pontuação média de escore padrão no teste de vocabulário foi de 51,8 pontos. Ao relacionar a audibilidade com o vocabulário, a tendência linear de aumento no desempenho de vocabulário com o aumento da audibilidade não foi significativa. Conclusões: As características e heterogeneidade da população pareceram representar as diferentes condições dos sujeitos acompanhados em um serviço de saúde auditiva no Brasil. Para a população estudada, a audibilidade não determinou o desempenho do vocabulário, sendo condição necessária, mas não suficiente para o desenvolvimento e crescimento do vocabulário.

Introduction: Audibility, measured by SII, has been shown to be a necessary condition for language development, since it allows access to the linguistic input. Likewise, vocabulary development has been shown to be a good indicator of language development. Objective: To investigate the audiological characteristics and the development of oral language characteristics in hearing impaired children who are hearing aid users. Methods: Sixty-five children aged 6 to 17 years old, hearing aid users, and based in the state of São Paulo, were evaluated for their receptive vocabulary performance (Peabody Picture Vocabulary Test ­ 4) and their relation to audibility (SII 65). Results: Audibility for speech sounds assessed by the SII values revealed that 9% of the subjects had SII scores lower than 37, 47% had SII scores between 38 and 57, and 43% scored greater than 58. The overall mean of the standard score values in the receptive vocabulary test was 51.8. When relating audibility (SII 65) with vocabulary, the linear tendency of (i) the increase vocabulary performance with (ii) the increase of audibility was not significant. Conclusions: The characteristics and heterogeneity of the studied population sample seemed to represent different conditions of the subjects attended in an auditory health service in Brazil. Within the population analyzed, audibility did not determine vocabulary performance, being a critical but not sufficient factor to ensure adequate vocabulary development and growth.

Introducción: La audibilidad, medida por SII(Índice de Inteligibilidad del Habla), ha demostrado ser una condición necesaria para el desarrollo del lenguaje, ya que permite el acceso al input lingüístico. El desarrollo del vocabulario ha demostrado ser un buen indicador del desarrollo del lenguaje. Objetivo: investigar las característicasaudiológicasy del desarrollo del lenguaje oral en niños con discapacidad auditiva,usuarios de audífonos. Método: Sesenta y cinco niños entre 6 y 17 años, usuarios de audífonos fueron evaluados por su desempeño en vocabulario receptivo (Peabody Picture VocabularyTest-PPV- 4) y su audibilidad (SII 65) . Resultados: La audibilidad para los sonidos del habla reveló que el 9% de los sujetos tenían SII65 inferiores a 37, el 47% tenían SII65 entre 38 y 57, y el 43% mayor de 58. El promedio de la puntuación estándar en la prueba de vocabulario fue de 51.8. Al relacionar la audibilidad con el vocabulario, la tendencia lineal de aumento en el rendimiento del vocabulario con el aumento de la audibilidad no fue significativa. Conclusión: las características y la heterogeneidad de la población estudiada parecieron representar las diferentes condiciones de los sujetos atendidos en un servicio de salud auditiva en Brasil. En la población analizada, la audibilidad no determinó el rendimiento del vocabulario, siendo condición necesaria pero no suficiente para el desarrollo y crecimiento del vocabulario.

Interpersonal Competence in College Students with Cochlear Implants: A Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: ObjectivesZZAlthough many studies have shown that cochlear implantation promotes restoration of adequate hearing and verbal ability, there is little research showing whether patients with cochlear implants (CI) adapted well to the society by forming a good interpersonal relationship. The purpose of this study was to investigate the interpersonal competence of college students who acquired good verbal ability through CI. SUBJECTS AND METHOD: Interpersonal competence was examined using the Korean version of interpersonal competence questionnaire. Participants were 23 college students with CI who had good verbal communication abilities. Their interpersonal competence was compared to that of 28 college students with normal hearing (NH). To identify the factors contributing to the interpersonal competence, regression analysis was performed using speech perception, vocabulary and speech intelligibility as independent variables. RESULTS: College students with CI showed significantly weaker interpersonal competence than those with NH. Among 5 sub-factors of interpersonal competence, assertion and conflict management were not significantly different between two groups and initiation, caring others, and appropriate disclosure of CI group were significantly weaker than NH group. But college students with CI who had normal vocabulary and Speech Intelligibility Ratings score of 5 showed good interpersonal competence, which was comparable to those with NH. CONCLUSION: College students with CI who acquired good verbal communication ability demonstrates lower interpersonal competence than those with NH. Therefore, it is necessary to support them to improve interpersonal competence as well as speech-language ability.