Treatment of Vocal Fold Nodules: Transnasal Steroid Injection Versus Microlaryngoscopic Phonomicrosurgery.

OBJECTIVES: Vocal fold nodules (VFNs) are bilateral, mid-membranous, swellings of the vocal folds. Intralesional steroid injection was successfully tried in the management of benign vocal fold lesions including nodules. The aim of the present study was to compare treatment outcomes of vocal fold steroid injection (VFSI) and surgery in patients with VFNs in terms of lesion regression, subjective, and objective voice parameters. STUDY DESIGN: Nonrandomized controlled clinical trial. METHODS: This bicenter interventional study was conducted on 32 patients with VFNs, in the age range of 16-63 years. Sixteen patients underwent transnasal VFSI under local anesthesia (the injection group), and 16 underwent surgical excision of the nodules under general anesthesia (the surgery group). Prior to intervention and at the follow-up visit, participants were subjected to videolaryngoscopic examination with evaluation of nodules' sizes as well as subjective voice assessment by auditory perceptual assessment (APA) of voice and the international nine-item Voice Handicap Index (VHI-9i). Objective voice assessments including the measurements of cepstral peak prominence, jitter, shimmer, harmonic to noise ratio, and maximum phonation time were also administered. RESULTS: The size of vocal fold nodules was significantly decreased postintervention in both studied groups. There was a decrease in the VHI-9i score, a decrease in the values of jitter and shimmer, together with an increase in the values of cepstral peak prominence and maximum phonation time after interventions indicating improvement of subjective and objective voice outcomes in both groups. CONCLUSION: Office-based transnasal VFSI is a safe and tolerable therapy option for VFNs. Voice outcomes of VFSI were comparable to surgery, hereby VFSI can be considered a promising therapy for VFNs and could be used as an alternative to surgery in selected cases.

Screening for oropharyngeal dysphagia in hospitalized COVID-19 patients: a prospective study.

PURPOSE: To screen for oropharyngeal dysphagia (OD) in hospitalized COVID-19 patients. METHODS: A descriptive longitudinal study was conducted on 500 adult patients with confirmed COVID-19 in the age range of 19-65 years who were admitted to the main university isolation hospital (whether admitted in the ward or the intensive care unit). Screening for OD was done using the Arabic version of the Eating Assessment Tool (EAT-10) and the Yale swallow protocol. RESULTS: 45.4% of the admitted and 40.97% of the discharged COVID-19 patients had a positive screen for OD. Several risk factors for OD could be detected. These include older age, longer duration of presenting symptoms of COVID-19, presence of ageusia and anosmia, presence of dysphonia, ICU admission, lower oxygen saturation, higher respiratory rate, presence of OD at admission, longer duration of hospital stay, and use of noninvasive ventilation (NIV) and/or invasive mechanical ventilation (IMV). CONCLUSIONS: Screening for OD in hospitalized COVID-19 patients is a mandatory procedure, whether for admitted or discharged patients.

Developing an arabic questionnaire to assess sensory processing disorders among preschool Egyptian children.

BACKGROUND: Sensory processing disorder (SPD) is a neurophysiologic disorder in which sensory input is poorly detected, modulated, interpreted and/or to which atypical responses occur. The objective of this study was to validate an Arabic questionnaire for identification of SPD among preschool Arabic-speaking children with Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). METHODS: A newly constructed Arabic questionnaire for assessment of SPD was completed by parents of 100 Egyptian Arabic-speaking children including 40 typically-developing children (control group), 30 children with ASD, and 30 children with ADHD in the age range 3-6 years RESULTS AND CONCLUSION: Sensory processing differences were detected between typically-developing children and children with ASD and ADHD. Significant differences were found in auditory processing, visual processing, oral sensory processing, olfactory processing, total scores and emotional/social response. The current study revealed non-significant differences between ASD and ADHD children as regards auditory, visual, touch, oral sensory, olfactory and total processing scores. On the other hand, ASD children showed higher scores in proprioceptive processing and lower scores in emotional/social response than children with ADHD. The designed Arabic questionnaire is a valid and reliable assessment tool for identification of SPD in preschool Arabic-speaking children.

Clinical and videofluoroscopic evaluation of feeding and swallowing in infants with oropharyngeal dysphagia.

BACKGROUND: Dysphagia impacts infants' health and well-being and may result in aspiration pneumonia. OBJECTIVE: This study aimed to evaluate feeding and swallowing functions in infants with dysphagia to determine the possible causes of dysphagia and their relationship with the medical diagnoses. Clinical and videofluoroscopic findings were compared to determine the diagnostic accuracy of clinical evaluation and identify clinical predictors of laryngeal penetration and aspiration. METHODS: This study was conducted on 60 infants in the age range 2-19 months (median seven months) with suspected aspiration and/or feeding problems. All cases were subjected to both clinical and videofluoroscopic evaluation of swallowing. RESULTS: The two most frequently observed videofluoroscopic findings were aspiration and suck-swallow-breathing incoordination. Infants with structural laryngeal abnormalities were significantly more likely to experience aspiration. A significant association was found between the presence of aspiration and the presence of both recurrent chest infection and gurgly voice combined, which increased the risk of aspiration by 3.57 times. However, the presence of gagging alone and gagging combined with a recurrent chest infection significantly reduced the risk of aspiration. The clinical assessment accuracy presented 56.70%, with 55.60% sensitivity, 58.30% specificity, and a positive predictive value higher than the negative. CONCLUSION: The study highlights the importance of complementing clinical evaluation, in infants with dysphagia, with an objective evaluation of swallowing such as videofluoroscopy due to the high proportion of false positives noticed in clinical evaluation and the high prevalence of silent aspiration in infants.

Acoustic Features of Cry of Deaf and Hard-of-Hearing Infants.

Previous research has demonstrated differences in the acoustic features of crying signals between deaf and typical hearing (TH) infants. This study aims at comparing the acoustic parameters of cries of infants with different degrees of deafness versus TH infants. About 110 infants aged 6-12 months (61 TH infants, 34 infants with bilateral deafness of variable degrees and 15 infants with unilateral deafness) were enrolled in the study. Results indicated that the most important acoustic parameters to demonstrate the difference between the crying of TH infants and deaf and hard-of-hearing (DHH) infants as well as between the crying of infants with different degrees of deafness are F0, cry duration, intensity, F2, and F4. In terms of accuracy, the parameter that showed the highest accuracy to differentiate between TH infants and DHH infants was F0 (74.5%). The accuracy of the combined acoustic parameters (F0, cry duration, intensity, and F4) was 70%. F0 was considered the best predictor and F4 the second best predictor of severity of deafness.

The Relationship between Phonological Processing and Emergent Literacy Skills in Arabic-Speaking Kindergarten Children.

INTRODUCTION: Children with weak emergent literacy skills are at risk for later reading problems. The majority of research on the relationship between phonological processing and emergent literacy has been conducted on children who speak English and European languages. The aim of the current study was to address the relationship between phonological processing and emergent literacy skills in Arabic-speaking Egyptian children. METHODS: A cross-sectional correlational study was conducted on a sample of 50 typically developing kindergarten children in the age range from 4 years 6 months to 6 years 5 months. Children were subjected to assessment of both phonological processing and emergent literacy using a specially constructed test battery in Arabic. RESULTS: A highly significant positive correlation was found between total scores of phonological processing and of emergent literacy tests. Both isolating final phonemes and rapid naming were the best predictors of emergent literacy. CONCLUSIONS: Phonological processing skills are important prerequisites for the development of emergent literacy skills in Arabic-speaking children. The designed test battery proved to be both valid and reliable and can be used as a screening tool for the identification of children at risk of later reading problems.

Developing a functional assessment tool for the auditory performance of Arabic-speaking Egyptian hearing impaired children.

BACKGROUND: Auditory performance outcome of children with hearing impairment has been widely studied, and the related factors of the performance have been explored among different age groups for English speaking hearing impaired children. OBJECTIVES: The objective of this study was to construct Arabic questionnaires for the evaluation of the auditory abilities of hearing impaired Egyptian Arabic-speaking children. METHODS: Three Arabic questionnaires targeting the auditory abilities were constructed by selecting items from different English-based questionnaires and translating them into Arabic and adapted to Egyptian culture. The questionnaires were administered to 210 Arabic-speaking Egyptian children in the age range 1-12 years who were divided into three age groups. They included 90 hearing impaired children fitted with hearing aids and 30 hearing impaired children with a cochlear implant and 90 children with normal hearing (as a control group). Participants' responses were statistically analyzed to assess the validity and reliability of the questionnaires and to compare hearing impaired children with normal hearing children. RESULTS: There were non-significant differences between cochlear implanted children and children with hearing aids regarding auditory abilities performances. Language age and aided pure tone audiometry were considered the best predictors of auditory abilities of hearing impaired Egyptian children. CONCLUSION: The constructed Arabic questionnaires proved to be reliable and valid functional assessment tools that provide information about auditory behaviors of hearing impaired Egyptian children in everyday life and would complement other objective test results in evaluating and monitoring the performance of these children.

Identification of phonological processes in Arabic-speaking Egyptian children by single-word test.

PURPOSE: Phonological processes are systematic changes in sound classes, sound sequences or syllable structure. The aim of this study was to develop an assessment tool for identification of developmental phonological processes in Arabic-speaking Egyptian children in order to provide normative data of phonological processes in typically developing children and distinguish between normal children and children with phonological impairment. METHOD: The study design was a cross-sectional descriptive one. Mansoura Arabic Test for Phonological Processes (MATPP) was developed to elicit children's single-word productions through picture naming task. After being pilot-tested, the MATPP was presented to a group of 120 typically developing children in the age range 2-5 years and another group of 30 children with developmental language disorder (DLD) in the age range 2½ - 5years for test validation. RESULTS: Assimilation processes were the commonest phonological processes followed by syllable structure processes and substitution processes. In contrast to English language, prevocalic devoicing, backing of fricatives and glottal replacement were considered normal for Egyptian children. The face validity was demonstrated by judging all words of the MATPP for being completely relevant to the purpose for which it was meant and Criterion -related validity was demonstrated by higher scores of the DLD children in all phonological processes. MATPP presented test-retest reliability when re-administered by the same examiner or a different examiner to the same child within a two week interval. CONCLUSION: MATPP is a valid and reliable assessment tool for identification of phonological processes in Arabic-speaking Egyptian children and can differentiate typically developing children from those with a phonological impairment.

Validation and Adaptation of the Singing Voice Handicap Index for Egyptian Singing Voice.

BACKGROUND: Measuring the severity of a voice disorder is difficult. This can be achieved by both subjective and objective measures. The Voice Handicap Index is the most known and used self-rating tool for voice disorders. The Classical Singing Handicap Index (CSHI) is a self-administered questionnaire measuring the impact of vocal deviation on the quality of life of singers. OBJECTIVES: The objective of this study was to develop an Arabic version of the CSHI and to test its validity and reliability in Egyptian singers with different singing styles with normal voice and with voice disorders. METHODS: The interpreted version was administered to 70 Egyptian singers including artistic singers (classical and popular) and specialized singers (Quran reciters and priests) who were divided into 40 asymptomatic singers (control group) and 30 singers with voice disorders. Participants' responses were statistically analyzed to assess the validity and reliability, and to compare the patient group with the control group. RESULTS AND CONCLUSIONS: Quran reciters, patients with no previous professional training, and patients with vocal fold lesions demonstrated the highest scores. The Arabic version of CSHI is found to be a reliable, valid, and sensitive self-assessment tool that can be used in the clinical practice for the evaluation of the impact of voice disorders on singing voice.

Evaluating the diagnostic accuracy of Arabic SNAP test for children with hypernasality.

UNLABELLED: Nasometry is a method of measuring the acoustic correlates of resonance through a computer-based instrument called nasometer. High nasalance scores in comparison to normative data suggest hypernasality and/or other nasality disorders, while low scores suggest hyponasality. Normative values of nasalance for Egyptian Arabic speakers were established using the Arabic SNAP (Simplified Nasometric Assessment Procedures) test. OBJECTIVES: to evaluate the diagnostic accuracy of Arabic SNAP test to allow for its use in the differentiation between normal and hypernasal speech in Egyptian Arabic-speaking children. METHODS: Nasalance scores of normal children (n=92) on Arabic SNAP test were compared to those of 30 children with velopharyngeal insufficiency due to cleft palate. Receiver operating characteristic (ROC) curve was used to determine cutoff points with the highest sensitivity and specificity. RESULTS: Statistically significant differences were found between both groups for all items in nasometric evaluation (p<0.05) except for prolonged/m/sound (p>0.05). Cutoff points were determined and certain items were selected for routine nasometric evaluation. CONCLUSION: The Arabic SNAP test is a sensitive and specific tool for evaluation of children with hypernasality and can be used for both diagnosis and follow up of these cases.

The nature of articulation errors in Egyptian Arabic-speaking children with velopharyngeal insufficiency due to cleft palate.

UNLABELLED: Even with early surgical repair, the majority of cleft palate children demonstrate articulation errors and have typical cleft palate speech. OBJECTIVE: Was to determine the nature of articulation errors of Arabic consonants in Egyptian Arabic-speaking children with velopharyngeal insufficiency (VPI). SUBJECTS AND METHODS: Thirty Egyptian Arabic-speaking children with VPI due to cleft palate (whether primary repaired or secondary repaired) were studied. Auditory perceptual assessment (APA) of children speech was conducted. Nasopharyngoscopy was done to assess the velopharyngeal port (VPP) movements while the child was repeating speech tasks. Mansoura Arabic Articulation test (MAAT) was performed to analyze the consonants articulation of these children. RESULTS AND CONCLUSION: The most frequent type of articulatory errors observed was substitution, more specifically, backing. Pharyngealization of anterior fricatives was the most frequent substitution, especially for the /s/ sound. The most frequent substituting sounds for other sounds were /ʔ/ followed by /k/ and /n/ sounds. Significant correlations were found between the degrees of the open nasality and VPP closure and the articulation errors. On the other hand, the sounds (/ʔ/,/h/,/ʕ/,/n/,/w/,/j/) were normally articulated in all studied group. The determination of articulation errors in VPI children could guide the therapists for designing appropriate speech therapy programs for these cases.