The influence of tight tongue-ties and tongue-tie clips on speech development.

Ankyloglossia or tongue-tie is a condition where the anatomical variation of the sublingual frenulum can limit normal tongue function. In Denmark, as in other countries, an increase in the number of children treated for ankyloglossia has been described over the past years. Whether or not ankyloglossia and its release affect the speech has also been increasingly discussed on Danish television and social media. In this review, the possible connection between ankyloglossia, its surgical treatment, and speech development in children is discussed.

Normative Voice Range Profile of the Young Female Voice.

OBJECTIVES: Normative data are important in the clinical setting of Speech and Language Pathology. The purpose of this study was to develop a normative reference dataset of voice range profiles from young females. STUDY DESIGN: Descriptive study including a prospective collection of voice range profile data. METHODS: Voice range profile recordings from 39 females with healthy voices aged 18 to 28 years were conducted. Seven voice range profile variables were analyzed: minimum and maximum fundamental frequency and intensity, semitone and intensity ranges, and voice range profile area. Descriptive statistical methods were applied. RESULTS: An age-specific voice range profile normative dataset was established. The mean values and standard deviations were as follows: semitone range 34.7 ± 3.9 ST, minimum fundamental frequency 143.6 ± 21.7 hertz, maximum fundamental frequency 1063.5 ± 160 hertz, intensity range 65.6 ± 5.0 dB, minimum intensity 43.2 ± 2.5 dB SPL, maximum SPL 108.9 ± 5.1 dB SPL, and voice range profile area 1346 ± 222 cells. CONCLUSION: A normative dataset usable for optimization of future voice assessments has been established. It may especially benefit evaluation and treatment planning for younger females suffering from vocal fold nodules.

Vocal Outcome After Cordectomy by Transoral CO2 Laser Microsurgery in Patients With Laryngeal Intraepithelial Neoplasia and Non-neoplastic Lesions.

OBJECTIVES: This study investigates vocal outcome after cordectomy by transoral CO2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy. STUDY DESIGN: Prospective, longitudinal, quasi-experimental time series. METHODS: Consecutively included patients (n = 155) with LIN (n = 84) or NNL (n = 71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings. RESULTS: Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy. CONCLUSION: Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands.

Crosscultural Adaption and Validation of the Danish Voice Handicap Index-10.

BACKGROUND: The Voice Handicap Index 30 (VHI-30) is a much-used voice specific quality of life questionnaire. A shortened 10 item version has been developed by eliminating redundant items using item analyses. This is the first Danish translation of the VHI-10. OBJECTIVES: To evaluate the psychometric properties of the Danish VHI-10 questionnaire. STUDY DESIGN: Cross-sectional survey study. METHODS: A Danish translation of the VHI-10 was answered by 72 patients with voice disorders of different etiology (neurogenic, functional, and structural) and by a control group of 94 vocally healthy individuals. Thirty-two patients and 68 controls participated in a test-retest reliability analysis. The internal consistency, test-retest reliability, and clinical validity were assessed. RESULTS: Excellent internal consistency was found in the patient group with a Cronbach's α of >0.90. In the control group the internal consistency was good with a Cronbach's α of 0.88. Test-retest reliability was good with intra class correlation coefficient of 0.94 (95% confidence interval [95%CI]: 0.88-0.97) for patients and 0.82 (95%CI: 0.73-0.89) for the control group. This indicates a sufficient reliability of the questionnaire. The correlation between the Danish VHI-10 score and the patient's perception of the severity of the voice disorder was 0.75 (P < 0.001) indicating good clinical validity of the Danish VHI-10. CONCLUSION: The newly translated Danish VHI-10 was validated and performs similar to the original VHI-10. It showed good internal consistency, test-retest reliability, and clinical validity. The questionnaire is preferably for use in patients with moderate to severe voice complaints as its ability to distinguish mild voice changes from healthy voices is limited. However, the questionnaire is capable of assessing patients' perception of the severity of their voice disorder and is available for use in daily practice and in research projects.

The Dual-Microphone Voice Range Profile Assessment-Interrater Reliability.

OBJECTIVES: The dual-microphone voice range profile (VRP) is an objective measurement of vocal frequency and intensity. Precise assessments are required to ensure correct interpretation of treatment outcome. The objective of this study was to investigate the interrater reliability of the assessment. STUDY DESIGN: Prospective repeated measures. METHODS: Thirty-five healthy participants underwent two VRP assessments with an interval of 2-84 days. Seven speech-language pathologists with special training in the used VRP protocol conducted the assessments. Dependent variables were voice frequency and intensity (minimum, maximum, and ranges), and VRP area. RESULTS: In the frequency measures and highest intensity, intraclass correlations were moderate to excellent and there were no statistically significant differences between test and retest. VRP area, minimum intensity, and intensity range showed poor to moderate reliability and significant enlargement in the retest; VRP area (117 cells, [{95% CI: 69-164}, P < 0.001]), softest intensity (-2.2 dB [{95% CI: -3.3 to -1.0}, P < 0.001]), and intensity range (2.3 dB [{95% CI: 0.5-4.1}, P < 0.001]). The 10% and 90% percentiles were provided. Minor systematical differences were detected in max SPL, max fo, and VRP area; otherwise no systematical sources of error could explain the results. CONCLUSION: The VRP assessment is a reliable tool when assessing frequency and maximum intensity. Care must be taken in interpretation of minimum intensity, intensity range, and VRP area. Different speech-language pathologists can assess the individual voice before and after treatment, if they are trained in and adhere to the same protocol.

The Impact of Post-thyroidectomy Paresis on Quality of Life in Patients with Nodular Thyroid Disease.

OBJECTIVE: To investigate the impact of postoperative paresis on disease-specific quality of life (DSQoL) after thyroidectomy in patients with benign nodular thyroid disease. STUDY DESIGN: Observational study. SETTING: University hospital. SUBJECTS AND METHODS: Patients were evaluated before and 3 weeks and 6 months after surgery in an individual prospective cohort study using videolaryngostroboscopy (VLS), voice range profile, voice handicap index (VHI), multidimensional voice program, maximum phonation time (MPT), and auditory perceptual evaluation. Changes in DSQoL were assessed by the Thyroid-specific Patient-Reported Outcome measure. Cohen's effect size was used to evaluate changes. RESULTS: Sixty-two patients were included, 55 of whom completed all examinations. Three weeks after surgery, a blinded VLS examination showed signs of paresis of either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve (RLN/EBSLN) in 13 patients (24%). A paresis corresponded to a 12 ± 28 point increase in VHI (P = .002) and was associated with a significant 4.3 ± 7.5 semitone decrease in the maximum fundamental frequency (P < .001) and a 5.3 ± 8.2 dB reduction in maximum intensity. Further, it was associated with a 4.5 ± 11.2 second reduction in MPT (P = .001) and an increase of 0.40 ± 1.19 in grade, 0.42 ± 1.41 in roughness, and 0.36 ± 1.11 in breathiness. Signs of postoperative RLN/EBSLN paresis correlated with an 11.0-point (P = .02) poorer improvement in goiter symptoms at both 3 weeks and 6 months after surgery. CONCLUSION: Signs of RLN/EBSLN paresis after thyroidectomy were associated with less pronounced improvement in goiter symptoms in patients with thyroid nodular disease. However, thyroidectomy was associated with an overall improved DSQoL by 6 months after surgery.

Cross-cultural Adaption and Validation of the Danish Voice Handicap Index.

OBJECTIVES: We aimed to assess psychometric properties, including internal consistency, reliability, and clinical validity of the Danish version of the Voice Handicap Index (VHI). STUDY DESIGN: A cross-sectional survey study was carried out. METHODS: For validation, the existing nonvalidated Danish version of the VHI was used. Data from 208 patients with voice disorders of different etiology (neurogenic, functional, and structural) and a control group of 85 vocally healthy individuals were included. A test-retest reliability analysis of 42 patients and 45 control persons was performed. The internal consistency, test-retest reliability, and clinical validity of the questionnaire were assessed. RESULTS: Internal consistency was high with a Cronbach α >0.90 for both the patient and control group. Test-retest reliability measured as intraclass correlation coefficient was good with 0.93 (95% confidence interval [95% confidence interval]: 0.87-0.96) for patients and 0.78 (95% confidence interval: 0.63-0.87) for the control group which indicates sufficient reliability of the questionnaire. The Danish VHI has good clinical validity as it has a strong correlation between patient's perception of the severity of their voice disorder and the VHI score from the Spearman correlation of 0.69. CONCLUSION: The existing Danish version of the VHI has been thoroughly validated and found to be in line with the original VHI from Jacobsen et al. It showed good internal consistency, test-retest reliability, and clinical validity. It is suitable for use in daily practice and in research projects as it is able to assess patients' perception of their voice disorder severity.

[Verbal and oral dyspraxia in children and juveniles].

Childhood apraxia of speech and oral dyspraxia are subtypes of dyspraxia: a neurological motor disorder with absence of neuromuscular deficits. The core impairment is in planning and/or programming spatiotemporal parameters of movement sequences, which results in errors in speech sound production and prosody, or in oral motor movements and gestures. Correct diagnostics and focus on differential diagnoses and co-morbidity are crucial, as treatment differs from other types of speech- and oral motor disorders. Early and specialized intervention is recommended.

Reproducibility of Automated Voice Range Profiles, a Systematic Literature Review.

OBJECTIVE: Reliable voice range profiles are of great importance when measuring effects and side effects from surgery affecting voice capacity. Automated recording systems are increasingly used, but the reproducibility of results is uncertain. Our objective was to identify and review the existing literature on test-retest accuracy of the automated voice range profile assessment. STUDY DESIGN: Systematic review. DATA SOURCES: PubMed, Scopus, Cochrane Library, ComDisDome, Embase, and CINAHL (EBSCO). METHODS: We conducted a systematic literature search of six databases from 1983 to 2016. The following keywords were used: phonetogram, voice range profile, and acoustic voice analysis. Inclusion criteria were automated recording procedure, healthy voices, and no intervention between test and retest. Test-retest values concerning fundamental frequency and voice intensity were reviewed. RESULTS: Of 483 abstracts, 231 full-text articles were read, resulting in six articles included in the final results. The studies found high reliability, but data are few and heterogeneous. CONCLUSION: The reviewed articles generally reported high reliability of the voice range profile, and thus clinical usefulness, but uncertainty remains because of low sample sizes and different procedures for selecting, collecting, and analyzing data. More data are needed, and clinical conclusions must be drawn with caution.

Test-Retest Reliability of the Dual-Microphone Voice Range Profile.

OBJECTIVES: The voice range profile (VRP) measures vocal intensity and fundamental frequency. Phonosurgical and logopedic treatment outcome studies using the VRP report voice improvements of 3-6 semitones (ST) in ST range and 4-7 decibels (dB) in sound pressure level range after treatment. These small improvements stress the importance of reliable measurements. The aim was to evaluate the test-retest reliability of the dual-microphone computerized VRP on participants with healthy voices. STUDY DESIGN: This is a prospective test-retest reliability study. METHODS: Dual-microphone VRPs were repeated twice on healthy participants (n = 37) with an interval of 6-37 days. Voice frequency and intensity (minimum, maximum, and ranges) were assessed in combination with the area of the VRP. RESULTS: Correlations between VRP parameters were high (r > 0.60). However, in the retest, a statistically significant increase in voice frequency range (1.4 ST [95% confidence interval {CI}: 0.8-2.1 ST], P < 0.001), intensity ranges (2.2 dB [95% CI: 1.0-3.4 dB], P < 0.001), maximum frequency (1.0 ST [95% CI: 0.5-1.6 ST], P < 0.001), maximum intensity (1.4 dB [95% CI: 0.5-2.3 dB], P = 0.002), and area inside the VRP (148 cells [95% CI: 87-210 cells], P < 0.001) was observed. CONCLUSION: The intra-examiner variation of the dual-microphone VRP is well below the differences seen after surgical or logopedic intervention, even when measuring in non-sound-treated rooms. There is a need for studies regarding inter-examiner reliability with a longer interval between test and retest before the assessment is fully reliable for clinical application.

Reproducibility of Dual-Microphone Voice Range Profile Equipment.

Purpose: The aim of this study was to add further knowledge about the usefulness of the Voice Range Profile (VRP) assessment in clinical settings and research by analyzing VRP dual-microphone equipment precision, reliability, and room effect. Method: Test-retest studies were conducted in an anechoic chamber and an office: (a) comparing sound pressure levels (SPLs) from a dual-microphone VRP device, the Voice Profiler, when given the same input repeatedly (test-retest reliability); (b) comparing SPLs from 3 devices when given the same input repeatedly (intervariation); and (c) assessing the room effect. Results: (a) The mean standard deviation across 17 measurement points was 0.7 dB for 1 device. (b) One device was less precise than the other 2 devices. All devices presented high SPLs at low frequencies compared with the reference. (c) Mean SPLs were almost equal in the anechoic chamber and the office. Conclusions: The high test-retest reliability of the dual-microphone VRP equipment, especially in general office surroundings, is a positive finding. Attention must be paid to specific factors such as using the same device when comparing the same voice before and after treatment, caution in headset placement, and manual recalibrations when automatic recalibration occurs. We suggest recalibrations verified with a reference source at regular intervals.