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Cleft Lip and Palate
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
David M. Wynne, Louisa Ferguson
Management decisions come down to underlying symptoms and the size and location of the velopharyngeal gap. Palatoplasty may be indicated to treat VPI, either as a re-repair where there is evidence of anterior insertion of the levator muscles, or in the case of a submucous cleft. It is mainly used where the velopharyngeal gap is small73,74 and has been shown to have a lower morbidity than a pharyngoplasty.75 Pharyngoplasty involves altering the shape of the velopharyngeal port in order to allow closure on speech. This can be done either by using flaps from the midline of the pharyngeal wall or by employing medial transposition of flaps from the lateral pharyngeal wall. Both types of pharyngoplasty have been shown to improve speech outcomes, with the possibility of achieving normal resonance in up to 85% of cases. The main downside to pharyngoplasty is the associated increased risk of sleep apnoea, and this must be discussed with the patient and their family pre-operatively.
Vocal Motor Disorders *
Published in Rolland S. Parker, Concussive Brain Trauma, 2016
A phoneme is a single distinct sound, the minimal sound unit that contrasts meaning and defines a word in a language (e.g., /p/ and /b/). Phonemes consist of distinctive features of sound production (i.e., voicing, aspiration, roundedness, and the location and degree of maximal constriction of the vocal tract creating pitch). In a given language, some sequences are permitted while others are forbidden (Blumstein, 1991; Caplan et al., 1999). Air has to go through the larynx either whispered or voiced. Voiced is defined as sounds produced with vocal cord vibrations (/b/), as contrasted with voiceless air (t/p/,/s/) (i.e., without vibration of the vocal cords). For voiceless consonants, the vocal cords vibrate 30 msec after the stop consonant is released (s/). Phonemes are formed by the location and the maximal constriction of the vocal tract, as well as voicing (glottal or laryngeal vibrations) (i.e., speech sounds produced by vibration of the vocal cords with the opening between them, as b/d/c). A glottal stop is a speech sound made by the closure and then explosive release of the glottis. Opening and closing of the velopharyngeal port is required to produce appropriate nasal and oral resonance of speech and the intraoral pressures necessary for the articulation of phonemes, as well as to affect prosody and articulation in dysarthritic speakers. Dysfunction may result after lesions to the upper motor neurons (UMNs) that supply the bulbar region of the brainstem, and the lower motor neurons (LMNs) that supply muscles of the soft palate and pharynx, and subcortical structures such as the basal ganglia and cerebellum (Theodoros & Murdoch, 2001a). Voice-onset time is timing between the release of a stop consonant and the onset of glottal pulsing. Anterior patients have difficulty with phonetic dimensions requiring the timing of two independent articulators (Blumstein, 1991). The brain processes complex acoustic information and identifies a phoneme based on known categories of speech signals (Fitch et al., 1997). Contrast between related sounds involves both voicing and the place of articulation.
Normative nasalance scores in Tamil-speaking Indian children
Published in Logopedics Phoniatrics Vocology, 2022
Apar Pokharel, P. Naina, Swapna Sebastain, Kamran Asif Syed, Mary John, Ajoy Mathew Varghese
We found that the mean nasalance values of children aged 9–12 years were significantly greater than children aged 5–8 years and 13–16 years especially for nasal sentences. Puberty onset related changes in oropharynx, larynx, and nose, age-related regression of lymphoid tissue at the velopharyngeal port and effect of speech programming are the potential reasons for this finding in our population [20,22]. Although the mean nasalance scores have statistically differed between subgroups, differences between means were so minimal, that they may not indicate a clinical difference. The difference in nasalance across the different age groups was less than 5 points in this study which has been considered as the reasonable standard for typical variation [9]. De Boor et al. have concluded that a 6–8 point variability must be allowed in the interpretation of nasalance scores [23]. Age and sex-related differences have been studied in various populations while some have found significant variation others have reported small absolute differences in the mean which may not be clinically relevant [2,18,20].
A pilot investigation of twang quality using magnetic resonance imaging
Published in Logopedics Phoniatrics Vocology, 2021
Karen Perta, Youkyung Bae, Kerrie Obert
In agreement with the hypothesized direction, two of our participants with experience in Estill Voice Training demonstrated the ability to produce twang quality while maintaining the raised velar position with direct contact against the posterior pharyngeal wall. This observation of a consistently elevated velar position, and presumably closed velopharyngeal port, in the twang condition for both participants provides physiologic evidence supporting the notion that twang is a phenomenon independent of nasality [8–10,14].
Nasalance in adolescents with autism spectrum disorders
Published in International Journal of Speech-Language Pathology, 2020
Rachel Kasthurirathne, Karen Forrest, Jared Ross, Rita Patel
Speech recordings were collected with the Nasometer II Model 6450 (PENTAX Medical, Montvale, New Jersey) and Computerised Speech Lab PENTAX Medical Model 4500 (Montvale, New Jersey) in a soundproof booth. At the start of the experiment, the Nasometer was calibrated, the mask was positioned according to specifications and participants were given as much time as needed to acclimate to the device while talking with the first author. Participants told the researcher when they were comfortable and ready to begin the experiment. All participants read four passages as part of the nasometery assessment in a fixed order: the Nasal Sentences passage, the Zoo passage, Bobby and Billy Play Ball, and A School Day for Suzy (Fletcher, 1976; Kummer, 2018). Passages were selected as stimuli rather than single words or short sentences in an effort to place adequate stress on the velopharyngeal system during the speech production task (Kummer & Lee, 1996). The Nasal Sentences passage (henceforth, “Nasal”) is loaded with 35% nasal consonants, a ratio three times the norm for Standard American English sentences and is used to screen for hyponasality. Passages with oral-only sounds [the Zoo passage (henceforth “Zoo”)] and A School Day for Suzy (henceforth “Suzy”)] and passages predominantly containing plosives with some nasals (Bobby and Billy Play Ball; henceforth, “Bobby”) are also used to evaluate oral-nasal balance by targeting phonetic effects on velopharyngeal closure. In contrast to the Nasal passage, passages with predominantly oral sounds require more continous closure of the velopharyngeal port (Zoo and Suzy). Mixed bilabial passages require tight closure of the velopharyngeal port for plosives (Moll, 1962) with allowances for velopharyngeal opening during production of nasals (Bobby). Hypernasality in this study is indicated when oral passages yield elevated mean nasalance scores of ≥30%).