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A Technique for Cleft Palate Repair
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
Tom WM Walker, Alistair RM Cobb
There were significant improvements in hyper-nasality, intelligibility, nasal emission, and nasal turbulence. Significant improvements were identified in velar function also. There were no cases of early postoperative or secondary haemorrhage. There were no recorded cases of sleep apnea or obstructive nasal symptoms. Ten patients (11.8%) required further velopharyngeal surgery, however, it was possible to perform a less obstructive pharyngoplasty than would otherwise have been necessary. Although ten patients required a second procedure that could have been carried out at the same time as the re-repair—75 patients avoided having pharyngeal surgery that can tether the velum and cause obstructive symptoms.
Nasal emission, cleft lip and palate
Published in James Law, Alison Parkinson, Rashmin Tamhne, David Hall, Communication Difficulties in Childhood, 2017
An unrepaired cleft palate causes nasal emission (also known as nasal escape) and hypernasality. Nasal emission refers to abnormal and inappropriate escape of air through the nose during speech due to inadequate closure of the soft palate against the posterior pharyngeal wall. The effect of nasal emission is to make speech muf¯ed and indistinct, and, if severe enough, unintelligible. Hypernasality or hypernasal resonance refers to excess voice resonating in the nasal space due to inadequate velopharyngeal closure during speech.
Effects of a naturalistic intervention on the speech outcomes of young children with cleft palate
Published in International Journal of Speech-Language Pathology, 2020
Nancy J. Scherer, Ann P. Kaiser, Jennifer R. Frey, Hope Sparks Lancaster, Kari Lien, Megan Y. Roberts
The SLP was knowledgeable of group assignment. To control for potential bias, child responses on the PEEPS were scored independently a second time by the first author, who was blind to group assignment. Point-to-point agreement was calculated for all of the items on each PEEPS assessment for each child. Disagreements in consonant transcription were resolved by consensus. The first coder also re-transcribed 50% of each sample to assess intraobserver agreement. Intra- and inter-judge reliability was assessed for 50% of the total PEEPS transcriptions; reliability for coding place and manner agreements, compensatory articulation, and nasal emission was calculated separately. Intra-judge PEEPS transcription reliability was 92–95% agreement, and inter-judge rating was 87–90% across the two time points for total transcriptions. Both place and manner features showed intra-judge reliability of 97–98% agreement and inter-judge reliability of 95–98% across the two time points. Reliability of compensatory errors and ANE are reported separately since they are often problematic. Intra- and inter-judge reliability for compensatory articulation agreement was 90–92% and 85–89%, respectively. Intra- and inter-judge reliability for ratings of nasal emission were 86–88% and 78–85%.
Nasalance in adolescents with autism spectrum disorders
Published in International Journal of Speech-Language Pathology, 2020
Rachel Kasthurirathne, Karen Forrest, Jared Ross, Rita Patel
In the current study, only one out of four passages showed significantly elevated nasalance in the autism group (Bobby). Kummer, Marshall, and Wilson (2015) advise that if a single passage demonstrates elevated mean nasalance values (e.g. a passage loaded with bilabial plosives), then phoneme specific nasal emission (PNSE) or hypernasality resulting from mislearning should be considered. There is evidence of persisting non-developmental speech errors, such as PNSE, occurring in the autism population at a higher incidence (Cleland et al., 2010). However, a careful examination of the speech produced by the three hypernasal speakers in the autism group reveals that the pattern of higher nasalance was also present in other non-nasal passages produced by these speakers. We believe that the greater variability in nasalance for these passages may have led to the non-significant results. It may be that increased pressure required for bilabial plosives and other high-pressure consonants in oral passages influenced nasalance scores in the autism subgroup. At least two of three speakers in the autism subgroup had persistently elevated nasalance during production of high-pressure consonants across oral passages, which suggests difficulty maintaining velopharyngeal closure.
Speech outcomes at 5 and 10 years of age after one-stage palatal repair with muscle reconstruction in children born with isolated cleft palate
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Jill Nyberg, Erik Neovius, Anette Lohmander
Audible nasal air leakage included both audible nasal emission and velopharyngeal friction sounds (nasal turbulence). The ratings showed no/single occurrence in 23 of the children with CPH (64%), some occurrence in seven children (19%), and frequently/almost always occurring in six children (17%). Thirteen children (59%) with CPS showed no/single occurrence of audible nasal air leakage, four children (18%) had some occurrences, and five children (23%) demonstrated frequent/almost always audible nasal air leakage. The differences between the two cleft types were not statistically significant (hypernasality z = –0.97, p = .334, weak pressure consonants z = –0.56, p = .575, audible nasal air leakage z = –0.33, p = .739).