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OBJECTIVE: Nasal rustle (also called nasal turbulence) refers to a loud distracting sound that sometimes occurs with audible nasal emission (ANE) during the production of pressure-sensitive consonants in patients with velopharyngeal insufficiency (VPI). This article examines evidence for two hypotheses of causality: vibration of the soft palate (velar flutter) and periodic motion of mucus above the velopharyngeal port (turbulent mucus). CONCLUSION: A review of the relevant literature shows inconclusive evidence to support velar flutter as a cause of nasal rustle. In contrast, clinical observations and research involving high-speed nasopharyngoscopy suggest that nasal rustle is the result of turbulent mucus above a small velopharyngeal opening. Therefore, it is our contention that a plausible explanation for nasal rustle is one of turbulent mucus and not velar flutter.
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OBJECTIVE: The inaugural Cleft Summit aimed to unite experts and foster interdisciplinary collaboration, seeking a collective understanding of velopharyngeal insufficiency (VPI) management. DESIGN: An interactive debate and conversation between a multidisciplinary cleft care team on VPI management. SETTING: A two-hour discussion within a four-day comprehensive cleft care workshop (CCCW). PARTICIPANTS: Thirty-two global leaders from various cleft disciplines. INTERVENTIONS: Cleft Summit that allows for meaningful interdisciplinary collaboration and knowledge exchange. MAIN OUTCOME MEASURES: Ability to reach consensus on a unified statement for VPI management. RESULTS: Participants agreed that a patient with significant VPI and a dynamic velum should first receive a surgery that lengthens the velum to optimize patient outcome. A global, multicenter prospective study should be done to test this hypothesis. CONCLUSION: The 1st Cleft Summit successfully distilled global expertise into actionable best-practice guidelines through iterative discussions, fostering interdisciplinary collaboration and paving the way for a transformative multi-center prospective study on VPI care.
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The purpose of this article is to (1) define the diagnostic characteristics of ankyloglossia, (2) identify potential problems associated with ankyloglossia, and (3) discuss treatment options, when treatment is appropriate. This article is based on a review of the literature, including recent systematic reviews, and the author's experience as a cleft and orofacial specialist. Ankyloglossia is a common congenital condition characterized by an anterior attachment of the lingual frenulum on the tongue. This causes difficulty elevating and/or protruding the tongue tip. As such, ankyloglossia has been thought to affect neonatal feeding, speech, and other functions. Although systematic reviews have concluded that most infants with ankyloglossia can be fed normally, a small percentage of affected infants will show improved efficiency of feeding post-frenotomy. They also concluded that frenotomy may relieve nipple pain in the breastfeeding mothers of affected infants. Regarding speech, the systematic reviews concluded that there is no evidence that ankyloglossia causes speech disorders. This may be because simple compensations will result in normal acoustics of the sounds. Therefore, frenotomy should be recommended sparingly for newborn infants, and it should rarely, if ever, be recommended for speech disorders.
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Anquiloglossia , Lactente , Recém-Nascido , Humanos , Anquiloglossia/diagnóstico , Língua , Fala , Distúrbios da FalaRESUMO
OBJECTIVE: Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance. DESIGN: Cross-sectional survey-based evaluation. SETTING: International comprehensive cleft care workshop. PARTICIPANTS: Total of 489 participants. INTERVENTIONS: Three-day simulation-based hybrid comprehensive cleft care workshop. MAIN OUTCOME MEASURES: Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance. RESULTS: The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 ± 3.08 vs 27.63 ± 3.93; P = .04) and perceived impact on their clinical practice (22.37 ± 3.42 vs 21.02 ± 3.45 P = .01). CONCLUSION: Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.
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Fenda Labial , Fissura Palatina , Humanos , Fissura Palatina/terapia , Fenda Labial/terapia , Estudos Transversais , Cabeça , Satisfação PessoalRESUMO
PURPOSE: Secretion bubbling on the superior aspect of the velopharyngeal (VP) valve typically occurs with a small VP opening during production of oral pressure consonants. The use of high-speed nasopharyngoscopy has shown correlation between the bubbling frequency and the acoustics captured with the nasal microphone of the nasometer. The purpose of this study was to investigate if the sound generated by the bubbling process is perceived as nasal rustle (also known as nasal turbulence). METHOD: Speech samples were extracted from the data of patients who were diagnosed with nasal rustle (five boys and five girls, ranging in age from 5 to 10 years old). A customized filter was used to remove the sound generated by the secretion bubbling. Six experienced listeners were asked to rate the perception of nasal rustle in each speech stimuli before and after the filtering process. RESULTS: Rating values for the perception of nasal rustle were overall reduced in all cases after the filtering process. Furthermore, the perception of nasal rustle was eliminated in 40% of the cases. Rating reliability was excellent before the filtering process and moderate to good after filtering. CONCLUSION: Reducing the perception of nasal rustle using spectral filtering based on the bubbling frequencies supports the hypothesis that undesired sound in the nasal cavity is generated from the interaction of the turbulent airflow with the secretion bubbling. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19111544.
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Insuficiência Velofaríngea , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Nariz , Faringe , Reprodutibilidade dos Testes , FalaRESUMO
OBJECTIVE: To establish nasalance score norms for adolescent and young adult native speakers of American English and also determine age-group and gender differences using the Simplified Nasometric Assessment Procedures (SNAP) Test-R and Nasometer II. DESIGN: Prospective study using a randomly selected sample of participants. SETTING: Greater Cincinnati area and Miami University of Ohio. PARTICIPANTS: Participants had a history of normal speech and language development and no history of speech therapy. Participants in the adolescent group were recruited from schools in West Clermont and Hamilton County, whereas the young adults were recruited from Miami University of Ohio. The participants of both groups were residents of Cincinnati, Ohio or Oxford, Ohio and spoke midland American English dialect. OUTCOME MEASURES: Mean nasalance scores for the SNAP Test-R. RESULTS: Normative nasalance scores were obtained for the Syllable Repetition/Prolonged Sounds, Picture-Cued, and Paragraph subtests. Results showed statistically significant nasalance score differences between adolescents and young adults in the Syllable Repetition, Picture-Cued, and Paragraph subtests, and between males and females in the Syllable Repetition and the Sound-Prolonged subtests. A significant univariate effect was found for the syllables and sentences containing nasal consonants and high vowels compared to syllables and sentences containing oral consonants and low vowels. Across all the SNAP Test-R subtests, the females' nasalance scores were higher than the males. A significant univariate effect was also found across nasal syllables, and high vowels such that the females' nasalance scores were higher than the males. Tables of normative data are provided that may be useful for clinical purposes. CONCLUSION: Norms obtained demonstrated nasalance score differences according to age and gender, particularly in the Syllable Repetition/Prolonged Sound subtest. These differences were discussed in light of potential reasons for their existence and implications for understanding velopharyngeal function. In addition, nasalance scores are affected by the vowel type and place of articulation of the consonant. These facts should be considered when nasometry is used clinically and for research purposes.
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Idioma , Nariz , Adolescente , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores Sexuais , Acústica da Fala , Medida da Produção da Fala , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to investigate the clinical application of the Intelligibility in Context Scale (ICS) instrument in children with velopharyngeal insufficiency (VPI). This study investigated the relationship between clinical speech outcomes and parental reports of speech intelligibility across various communicative partners. METHODS: The ICS was completed by the parents of 20 English-speaking children aged 4-12 years diagnosed with VPI. The parents were asked to rate their children's speech intelligibility across communication partners using a 5-point scale. Clinical metrics obtained using standard clinical transcription on the Picture-Cued SNAP-R Test were: (1) percentage of consonants correct (PCC), (2) percentage of vowels correct (PVC), and (3) percentage of phonemes correct (PPC). Nasalance from nasometer data was included as an indirect measure of nasality. Intelligibility scores obtained from naive listener's transcriptions and speech-language pathologists' (SLP) ratings were compared with the ICS results. RESULT: Greater PCC, PPC, PVC, and transcription-based intelligibility values were significantly associated with higher ICS values, respectively (r[20] = 0.84, 0.82, 0.51, and 0.70, respectively; p < 0.05 in all cases). There was a negative and significant correlation between ICS mean scores and SLP ratings of intelligibility (r = -0.74; p < 0.001). There was no significant correlation between ICS values and nasalance scores (r[20] = -0.28; p = 0.22). CONCLUSION: The high correlations obtained between the ICS with PCC and PPC measures indicate that articulation accuracy has had a great impact on parents' decision-making regarding intelligibility in this population. Significant agreement among ICS scores with naive listener transcriptions and clinical ratings supports use of the ICS in practice.
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Insuficiência Velofaríngea , Criança , Linguagem Infantil , Humanos , Idioma , Reprodutibilidade dos Testes , Inteligibilidade da Fala , Insuficiência Velofaríngea/complicações , Insuficiência Velofaríngea/diagnósticoRESUMO
OBJECTIVE: Palatoplasty outcome measurements vary widely among institutions. A standardized outcome metric would help provide quality benchmarks. DESIGN: Retrospective review of primary palatoplasty patients from 2007 to 2013. SETTING: Tertiary care children's hospital. MAIN OUTCOME MEASURES: We created a novel conceptual quality metric called "OOR" (Optimal Outcome Reporting). Optimal Outcome Reporting is designed to reflect the percentage of patients with cleft palate who experience the best outcomes: one operation, velar competence by age 5 years, and no unintended palatal fistula. RESULTS: Optimal Outcome Reporting was 72.3% (68/94). Eight patients had "suboptimal" outcomes for having undergone more than one operation. Eighteen patients failed for velar incompetence. No additional patients fell out of the algorithm for fistula. A significantly higher proportion of nonsyndromic patients demonstrated an "optimal" result compared to syndromic patients (61/80, 76.3% vs 7/14, 50.0%; P = .04). Patients who required more than one procedure had significantly more clinic visits (32.6 vs 14.9; P < .01) and accrued higher costs compared to "optimal" patients (US$34 019.88 vs US$15 357.25; P < .01). CONCLUSIONS: Optimal Outcome Reporting represents a novel quality metric that can provide meaningful information for patients with cleft palate. Optimal Outcome Reporting utilization can help cleft centers adopt changes that matter to patients and their families. By allowing for cross-institutional comparisons in a clear and objective manner, OOR can promote competition, innovation, and value in cleft palate care.
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Fissura Palatina , Procedimentos de Cirurgia Plástica , Insuficiência Velofaríngea , Criança , Pré-Escolar , Fissura Palatina/cirurgia , Humanos , Lactente , Estudos Retrospectivos , Resultado do Tratamento , Insuficiência Velofaríngea/cirurgiaRESUMO
OBJECTIVE: "Nasal rustle" is a type of nasal emission associated with a small velopharyngeal (VP) gap and distracting loud noise. Currently, the mechanisms behind noise generation are unclear. In this study, we use a combination of retrospective and prospective data to test the hypotheses that bubbling of secretions could be a source of audible noise. DESIGN: Retrospective: Nasopharyngoscopy records of 151 patients with nasal rustle were reviewed to determine if bubbling occurred during their nasopharyngoscopy examination. Prospective: Nine children with nasal rustle and bubbling of secretions were suctioned with the scope in place to assure removal of secretions. The Nasometer II was used to record the children's production of oral sentences prior to and post suctioning. All sentences were analyzed for the presence or absence of noise, nasalance scores, and Cepstral Peak Prominence (CPP). Intra-and inter-judge reliability of coding was high. RESULTS: Retrospective: 70% of the patients with nasal rustle had bubbling of secretions during nasopharyngoscopy. Prospective: Percentages of audible noise were reduced significantly post suctioning (Friedman's Test, Chi-square = 24.5, p = 0.001) with the greatest decrease in syllables with fricatives and bilabial stops (p < 0.05). The average CPP and nasalance scores pre-vs post-suctioning showed no significant differences (p = 0.91, 0.29). CONCLUSIONS: Retrospective: The high percentage of patients with nasal rustle had bubbling of secretions when producing speech in nasopharyngoscopy evaluations. Prospective: The incidence of audible noise was reduced as a result of suctioning. This suggests that the presence of secretions contributes to the production of nasal rustle.
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Fissura Palatina , Insuficiência Velofaríngea , Criança , Humanos , Nariz , Estudos Prospectivos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fala , Medida da Produção da FalaRESUMO
OBJECTIVE: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact. DESIGN: Cross-sectional survey-based evaluation. SETTING: Simulation-based comprehensive cleft care workshop. PARTICIPANTS: Total of 180 participants. INTERVENTIONS: Three-day simulation-based comprehensive cleft care workshop. MAIN OUTCOME MEASURES: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice. RESULTS: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; P < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; P < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices. CONCLUSION: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants' clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.
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Fenda Labial , Fissura Palatina , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Simulação por Computador , Estudos Transversais , HumanosRESUMO
OBJECTIVE: The aim of this study was to adapt the Simplified Nasometric Assessment Procedures-Revised (SNAP-R) [1] to Turkish, gather norms from Turkish speakers, and test the sensitivity and specificity of the adapted test. Finally, this study was designed to determine if there are any differences in average nasalance scores due to age, gender, and vowel content of the passage. METHODS: 240 children without any known speech, language or hearing disorders and 40 children with cleft palate participated in the study. Participants were divided into three groups according to their age (ages 4-7; 8-12; and 13-18). Data for this descriptive study was collected in the school settings and in a center of speech and language therapy. RESULTS: This study showed a slight increase in nasalance with age, but no difference in nasalance based on gender. Furthermore, the nasalance score is determined by vowel content of the passage and that high vowels have higher nasalance than the low vowels. CONCLUSION: This paper offers a new test for nasometric evaluation in the Turkish language, which has relatively high specificity and sensitivity in the evaluation of hypernasality.
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Fissura Palatina/fisiopatologia , Medida da Produção da Fala , Fala/fisiologia , Distúrbios da Voz/diagnóstico , Qualidade da Voz , Adolescente , Criança , Pré-Escolar , Fissura Palatina/complicações , Feminino , Humanos , Idioma , Masculino , Nariz , Sensibilidade e Especificidade , Turquia , Distúrbios da Voz/etiologia , Distúrbios da Voz/fisiopatologiaRESUMO
OBJECTIVE: The loud and severely distorting form of audible nasal emission (commonly known as nasal turbulence or nasal rustle) typically occurs with a small velopharyngeal opening during production of pressure-sensitive consonants. The purpose of this study was to determine whether bubbling of the secretions, which commonly occurs on the superior aspect of the velopharyngeal port when there is a small opening, is a periodic process that can generate sound in the nasal cavity. PARTICIPANTS: Ten pediatric patients were included in the study. All participants had normal articulation and resonance but exhibited audible nasal emission characterized as nasal rustle. MEASURES: For each participant, high-speed video (HSV) nasopharyngoscopy and acoustic signals were recorded simultaneously. The acoustic recordings were captured in a manner similar to nasometry using nasal and oral microphones connected to a separation plate. Spectral analysis of the audio recordings and the HSV images was used to determine correlation between the acoustic and visual measurements. RESULTS: This study showed that secretion bubbling is a periodic process and its frequency, measured from the HSV data, was also captured by the acoustic measurements. The nasal acoustic signal correlated more strongly with the video of bubbling than the oral acoustic signal in the majority of the cases where bubbling occurred. CONCLUSION: These findings are strong evidence that secretion bubbling plays a significant role in the mechanism that generates undesired sound in the nasal cavity. Further work is needed to determine whether this sound is perceived as nasal rustle.
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Insuficiência Velofaríngea , Criança , Endoscopia , Humanos , Cavidade Nasal/diagnóstico por imagem , Nariz , FaringeRESUMO
There are several different types of nasal emission that can occur during speech due to either velopharyngeal dysfunction or abnormal articulation in the pharynx. Nasal emission can be inaudible or very loud and distracting, depending on the size of the velopharyngeal opening and the physics of the flow. Nasal emission can be obligatory and/or compensatory (due to abnormal structure) or it can be caused by a misarticulation that results in a substitution of a pharyngeal sound for an oral sound, despite normal velopharyngeal structure. Nasal emission can occur on all pressure-sensitive phonemes or it can be phoneme-specific. Although it is generally recognized that the loud and distracting form of nasal emission (called nasal turbulence or nasal rustle) is due to a small velopharyngeal opening, the causality of the distracted sound is debated. This article provides a brief review of the types of nasal emission, the terms used to describe it, and the potential causes. This article also stresses the need for further research to clarify the causality of the sound generated by a small velopharyngeal opening.
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Fissura Palatina , Insuficiência Velofaríngea , Transtornos da Articulação , Humanos , Nariz , Faringe , FalaRESUMO
BACKGROUND: To determine best practices, surgeons who perform cleft palate surgery or surgery for velopharyngeal insufficiency need to be able to compare their outcomes in normalizing the velopharyngeal valve. METHODS: We conducted a comprehensive review of articles that reported speech/resonance outcomes following palatoplasty or surgery for velopharyngeal insufficiency. We analyzed protocols that were used and how the results were reported. We found 170 articles, published between 1990 and 2014, that met our inclusion criteria. RESULTS: Most studies (66%) had a sample size of <50 subjects, were retrospective (67%), were not blinded (83%), and did not report the use of reliability (68%). Most studies included 1 evaluator (27%) or 2 evaluators (30%). Only 80% of the articles specified that at least one speech pathologist was an evaluator. Most articles (56%) did not specify the speech samples used, and 65% used an informal test or did not specify the type of test used. Most studies used a perceptual rating scale for articulation (75%) and resonance (83%). Only 39% of the studies included an evaluation of velopharyngeal function. Finally, objective measures were used in only 28% of the studies (9% used aerodynamic measures and 19% used nasometry). CONCLUSIONS: Because these articles showed significant variability in how speech/resonance is evaluated and how the outcomes are reported, it is virtually impossible to compare results to determine best surgical procedures. Suggestions are given to standardize outcome measures to improve comparability of data.
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OBJECTIVE: To describe the conduct of the first multidisciplinary simulation-based workshop in the Middle East/North Africa region and evaluate participant satisfaction. DESIGN: Cross-sectional survey-based evaluation. SETTING: Educational comprehensive multidisciplinary simulation-based cleft care workshop. PARTICIPANTS: Total of 93 workshop participants from over 20 countries. INTERVENTIONS: Three-day educational comprehensive multidisciplinary simulation-based cleft care workshop. MAIN OUTCOME MEASURES: Number of workshop participants, number of participants stratified by specialty, satisfaction with workshop, number of workshop staff, and number of workshop staff stratified by specialty. RESULTS: The workshop included 93 participants from over 20 countries. The response rate was 47.3%, and participants reported high satisfaction with all aspects of the workshop. All participants reported they would recommend it to colleagues (100.0%) and participate again (100.0%). No significant difference was detected based on participant specialty or years of experience. The majority were unaware of other cleft practitioners in their countries (68.2%). CONCLUSION: Multidisciplinary simulation-based cleft care workshops are well received by cleft practitioners in developing countries, serve as a platform for intellectual exchange, and are only possible through strong collaborations. Advocates of international cleft surgery education should translate these successes from the regional to the global arena in order to contribute to sustainable cleft care through education.
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Fissura Palatina , África do Norte , Estudos Transversais , Países em Desenvolvimento , Humanos , Oriente MédioRESUMO
BACKGROUND: Is one-stage or two-stage palatoplasty more effective for preventing fistula formation and hypernasality in patients with complete unilateral cleft lip and palate? METHODS: This parallel blocked randomized controlled trial included 100 patients with nonsyndromic complete unilateral cleft lip and palate with a repaired cleft lip, divided into two equal groups. Group A had one-stage palatoplasty patients at age 12 to 13 months while group B had two-stage palatoplasty patients with soft palatoplasty at age 12 to 13 months and hard palatoplasty at age 24 to 25 months. Presence of a fistula was tested clinically at 3 years and speech was tested using nasometry and perceptual analyses at 6 years. Group C consisted of noncleft controls (n = 20, age 6 years) for speech using nasometry. Fistula rates, hypernasality ratings, and nasalance scores were compared between groups A and B. Nasometry recordings of groups A and B were compared with control group C. RESULTS: There was no difference in fistula rates between groups A and B (p = 0.409; 95 percent CI, 0.365 to 11.9). Mean nasalance scores of group A showed higher nasalance than group B (p = 0.006; 95 percent CI, 1.16 to 6.53). Perceptual analysis showed no difference between groups A and B (p = 0.837 and p = 1.000). Group A showed higher mean nasalance than group C (p = 0.837 and p = 1.000), whereas group B showed no difference (p = 0.088; 95 percent CI, -0.14 to 2.02). CONCLUSIONS: There was no difference in fistula rates between groups. Nasalance was slightly higher in patients in the one-stage palatoplasty group than two-stage palatoplasty group, but the difference was not clinically significant. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
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Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Fístula do Sistema Digestório/prevenção & controle , Procedimentos Cirúrgicos Ortognáticos/métodos , Complicações Pós-Operatórias/prevenção & controle , Fístula do Sistema Respiratório/prevenção & controle , Insuficiência Velofaríngea/prevenção & controle , Assistência ao Convalescente , Fístula do Sistema Digestório/etiologia , Feminino , Humanos , Lactente , Masculino , Doenças da Boca/etiologia , Doenças da Boca/prevenção & controle , Doenças Nasais/etiologia , Doenças Nasais/prevenção & controle , Palato Duro/cirurgia , Palato Mole/cirurgia , Fístula do Sistema Respiratório/etiologia , Resultado do Tratamento , Insuficiência Velofaríngea/etiologiaRESUMO
OBJECTIVE: The objective of the study was to establish the validity of passages for measuring nasalance of Jordanian speakers of Arabic. DESIGN: Two Arabic text passages were constructed; the Spring Passage is devoid of nasal consonants and the Home Passage contains both oral and nasal consonants. Nasalance was measured for participants while reciting each passage three times. Perceptual ratings of hypernasality were also obtained for each participant on each passage using a 5-point equal-appearing rating scale. PARTICIPANTS: Forty-seven children and adults ranging in age between 9 and 26 years participated in the study. Twenty-three participants had no history of communication disorders, and 24 had repaired cleft palate. RESULTS: Correlation coefficient between ratings of hypernasality and the nasalance scores was significant for the Spring Passage (r = 0.88, p > 0.001) and for the Home Passage (r = 0.78, p > .001). Using cutoff scores of 17% and 36% of nasalance for the Spring and the Home Passages, respectively, and a threshold score of 1.5 for hypernasality, sensitivity for the Spring Passage was 88% and the Home Passage was 78%. CONCLUSIONS: Results showed the validity of the Spring Passage and the Home Passage in measuring nasalance scores as proved by their high sensitivity and strong correlation with perceptual rating of hypernasality.
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Idioma , Leitura , Acústica da Fala , Medida da Produção da Fala , Qualidade da Voz , Acústica , Adolescente , Adulto , Criança , Fissura Palatina/fisiopatologia , Fissura Palatina/cirurgia , Feminino , Humanos , Jordânia , Julgamento , Masculino , Reprodutibilidade dos Testes , Processamento de Sinais Assistido por Computador , Percepção da Fala , Adulto JovemRESUMO
OBJECTIVE: The objective of this study is to determine whether placement of an antibiotic oral pack on the hard palate reduces fistula rates after primary cleft palatoplasty. SUBJECTS AND METHODS: This study was a parallel blocked randomized controlled trial. The study consisted of two groups of 100 patients each with non-syndromic unilateral complete cleft lip, alveolus, and hard and soft palate that underwent primary palatoplasty. Group A had an oral pack placed on the hard palate for 5 days postoperatively while group B did not. Occurrence of fistulae between both groups was tested using odds ratios (OR). RESULTS: In 2% of the patients in group A, a fistula was found 6 months after palatal surgery. In contrast, in 21% of the patients in group B, a palatal fistula could be confirmed. The fistula occurrence in group A was statistically significantly lower than that in group B (OR = 0.0768, CI = [0.02 0.34], p < 0.001). CONCLUSION: The findings of this study provide evidence that the rate of fistula formation after primary palatoplasty is significantly reduced if a pack soaked with antibiotic cream is placed on the palate postoperatively for 5 days. CLINICAL RELEVANCE: The use of an antibiotic pack after cleft palate repair can be recommended to prevent occurrence of oronasal fistulae.
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Antibacterianos/administração & dosagem , Fissura Palatina/cirurgia , Fístula Bucal/prevenção & controle , Palato Duro/cirurgia , Administração Tópica , Feminino , Humanos , Lactente , Masculino , Resultado do TratamentoRESUMO
This article describes how different types of clefts affect the child's function and, in particular, the child's communication abilities. This article also describes the evaluation process and various options for the treatment of affected speech. Because these children have many complicated needs over their entire growth period, it is important that they are referred by the pediatrician to a cleft palate/craniofacial team for the best care and best ultimate outcomes.
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Fenda Labial/complicações , Fissura Palatina/complicações , Transtornos da Comunicação/etiologia , Criança , Pré-Escolar , Transtornos da Comunicação/diagnóstico , Transtornos da Comunicação/terapia , Humanos , Lactente , Recém-Nascido , Pediatria , Encaminhamento e Consulta , Fonoterapia , Patologia da Fala e Linguagem , Insuficiência Velofaríngea/etiologia , Insuficiência Velofaríngea/cirurgia , Insuficiência Velofaríngea/terapiaRESUMO
Children with craniofacial anomalies often demonstrate disorders of speech and/or resonance. Anomalies that affect speech and resonance are most commonly caused by clefts of the primary palate and secondary palate. This article discusses how speech-language pathologists evaluate the effects of dental and occlusal anomalies on speech production and the effects of velopharyngeal insufficiency on speech sound production and resonance. How to estimate the size of a velopharyngeal opening based on speech characteristics is illustrated. Nasometry, nasopharyngoscopy, and low-tech tools are discussed as adjunct methods to aid in the evaluation, treatment planning, and measurement of outcomes.