phenylephrine-hydrochloride and Articulation-Disorders

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.

Topics: Articulation Disorders; Cleft Palate; Humans; Nose; Pharynx; Speech; Velopharyngeal Insufficiency

The characteristics of speech following ablative surgery for oral malignancies are presented. The speech following cheilotomy, maxillectomy, mandibulectomy, nasopharyngeal excavation, and glossectomy is described. Emphasis is placed on glossectomy because of the prevalence of this surgery and the nature of the research being done in this area. Finally, a discussion of research needs involving the oral surgeon, dentist, and speech pathologist is presented.

Topics: Articulation Disorders; Face; Glossectomy; Humans; Lip; Mandible; Maxilla; Mouth Neoplasms; Nasopharynx; Nose; Osteotomy; Speech Disorders

We conducted a retrospective study to evaluate the short-term effect of uvulopalatopharyngoplasty (UPPP) on changes in the nasalance of five vowels: /a/, /ε/, /i/, /ɔ/, and /u/. Our study group was made up of 20 patients-15 males and 5 females, aged 16 to 57 years (mean: 37.3 ± 11.5)-who had undergone UPPP as a treatment for mild to moderate obstructive sleep apnea. Nasometry was used to obtain nasalance scores in all patients on the morning of the operation (day 1) and subsequently on day 4 or 5 (mean: 4.5 ± 0.5). Preoperatively, nasalance scores were highest for /i/ (mean: 29.8 ± 12.6) and /a/ (mean: 24.1 ± 10.3). After the operation, nasalance scores for all five studied vowels increased; they were highest for /i/ (mean: 40.7 ± +17.8) and /ε/ (mean: 30.0 ± 10.8). The increases in the nasalance of /i/, /ε/, and /u/ were statistically significant (p < 0.05). Our findings indicate that UPPP has a significant impact on nasalance immediately after surgery.

Topics: Adolescent; Adult; Articulation Disorders; Female; Humans; Male; Middle Aged; Nose; Otorhinolaryngologic Surgical Procedures; Palate, Soft; Pharynx; Phonetics; Postoperative Complications; Postoperative Period; Retrospective Studies; Sleep Apnea, Obstructive; Speech; Speech Production Measurement; Time Factors; Uvula; Young Adult

The purpose of this controlled study is to determine satisfaction with speech and facial appearance in Flemish pre-pubescent children with unilateral cleft lip and palate. Forty-three subjects with unilateral cleft lip and palate and 43 age and gender matched controls participated in this study. The Cleft Evaluation Profile was used to assess the perceived satisfaction for individual features related to cleft care. Both the cleft palate subjects and their parents were satisfied with the speech and facial appearance. The Pearson χ(2) test revealed significant difference between the cleft palate and the control group regarding hearing, nasal aesthetics and function, and the appearance of the lip. An in depth analysis of well specified speech characteristics revealed that children with clefts and their parents significantly more often reported the presence of an articulation, voice and resonance disorder and experienced /s/ /r/ /t/ and /d/ as the most difficult consonants. To what extent the incorporation of specific motor oriented oral speech techniques regarding the realisation of specific consonants, attention to vocal and ear care, and the recommendation of secondary velopharyngeal surgery, with the incorporation of primary correction of the cleft nose deformity simultaneously with primary lip closure, will aid these patients are future research subjects.

Topics: Adolescent; Articulation Disorders; Attitude to Health; Case-Control Studies; Child; Cleft Lip; Cleft Palate; Esthetics; Esthetics, Dental; Face; Female; Finland; Hearing; Humans; Interpersonal Relations; Lip; Male; Nose; Parents; Patient Satisfaction; Personal Satisfaction; Phonetics; Respiration; Self Concept; Speech; Speech Intelligibility; Speech Therapy; Voice Disorders

This paper presents an assessment protocol for the evaluation and description of speech, resonance and myofunctional characteristics commonly associated with cleft palate and/or velopharyngeal dysfunction. The protocol is partly based on the GOS.SP.ASS'98 and adapted to Flemish. It focuses on the relevant aspects of cleft type speech necessary to facilitate assessment, adequate diagnosis and management planning in a multi-disciplinary setting of cleft team care.

Topics: Articulation Disorders; Cleft Palate; Facial Expression; Humans; Language Development; Nose; Palatal Muscles; Palate, Soft; Patient Care Planning; Phonetics; Speech; Speech Disorders; Velopharyngeal Insufficiency; Voice; Voice Disorders; Voice Quality

The correlation between the nasalance score and the perceptual rating of several aspects of speech of speakers with velopharyngeal insufficiency (VPI) by six speech-language pathologists was evaluated.. The overall grade of severity, hypernasality, audible nasal emission, misarticulations, and intelligibility were rated on visual analog scales. Speech samples with a normal distribution of phonemes (normal text [NT]) and those free of nasal consonants (denasal text [DT]) of 43 patients with VPI were used. Mean nasalance scores were computed for the speech samples, and Spearman correlation coefficients were computed between the mean nasalance score and the five parameters of the differentiated rating.. The Institute of Phoniatrics, Utrecht University Hospital, The Netherlands.. The correlation coefficient between the mean nasalance and the perceptual rating of hypernasality ranged among judges from .31 to .56 for NT speech samples and .36 to .60 for DT speech samples. Only small differences were found between speech pathologists with and without expertise in cleft palate speech. The rating of the overall grade of severity appeared to correlate quite well with the rating of the intelligibility (r(NT) = .77, r(DT) = .79). Lower correlation coefficients, ranging from .34 to .71, were found between overall grade of severity and hypernasality, audible nasal emission, and misarticulations.. A low correlation between the nasalance and the perceptual rating of hypernasality was found. The parameter overall grade of severity appeared to be determined mainly by the parameter intelligibility. Expertise in rating of cleft palate speech does not guarantee a high correlation between instrumental measurement and perceptual rating.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Articulation Disorders; Child; Child, Preschool; Cleft Palate; Female; Humans; Male; Matched-Pair Analysis; Middle Aged; Netherlands; Nose; Phonetics; Signal Processing, Computer-Assisted; Speech Disorders; Speech Intelligibility; Speech Perception; Speech-Language Pathology; Statistics, Nonparametric; Velopharyngeal Insufficiency

The aim was to study the relationship between perceptual evaluation of speech variables related to velopharyngeal function and the pattern of nasal airflow during the velopharyngeal closing phase in speech in children with and without cleft palate.. Fourteen children with cleft lip and palate or cleft palate only and 15 controls aged 7 and 10 years. All were native Swedish speakers.. Three experienced listeners performed a blinded perceptual speech evaluation. Nasal airflow was transduced with a pneumotachograph attached to a nasal mask. The duration from peak to 5% nasal airflow, maximum flow declination rate, and nasal airflow at selected points in time during the transition from nasal to stop consonants in bilabial and velar articulatory positions in sentences were estimated. The analysis was focused on the perceptual ratings of "velopharyngeal function" and "hypernasality.". A strong association was found between ratings of "velopharyngeal function" and "hypernasality" and the pattern of nasal airflow during the bilabial nasal-to-stop combination /mp/. Both the sensitivity and specificity were 1.00 for the bilabial temporal airflow measure in relation to ratings of "velopharyngeal function." The nasal airflow rate during /p/ in /mp/ had a sensitivity of 1.00 and specificity of 0.92 to 0.96 in relation to ratings of "hypernasality.". Assessment of the nasal airflow dynamics during the velopharyngeal closing phase in speech presents quantitative, objective data that appear to distinguish between perceptually normal and deviant velopharyngeal function with high sensitivity and specificity.

Topics: Articulation Disorders; Case-Control Studies; Child; Cleft Lip; Cleft Palate; Female; Humans; Male; Nose; Observer Variation; Pulmonary Ventilation; Sensitivity and Specificity; Speech Disorders; Speech Production Measurement; Velopharyngeal Insufficiency; Voice Disorders

(1) To study the nasal airflow patterns during the velopharyngeal closing phase in speech produced by children with and without cleft palate. (2) To compare the nasal airflow patterns in bilabial, dental, and velar articulation in these children.. Prospective, cross-sectional study of a consecutive series of children with cleft palate referred for routine speech evaluation and controls.. Sahlgrenska University Hospital, Göteborg, Sweden.. Seventeen children with cleft lip and palate or cleft palate only and 22 controls aged 7 and 10 years.. Nasal airflow was transduced with a pneumotachograph attached to a nose mask and registered together with the acoustic speech signal. Sentences containing nasal-to-stop combinations in bilabial, dental, and velar articulatory positions were used.. The duration from peak to 5% nasal airflow, the maximum flow declination rate, and the nasal airflow at selected points in time during the transition from nasal-to-stop consonants.. In the cleft palate group, duration from peak to 5% nasal airflow was clearly longer than among the controls (p <.0001). The declination of airflow was slower (p <.006) and the rate of nasal airflow at the release of the stop consonant was higher (p <.004) in the cleft palate group. Differences between bilabial versus dental and velar articulation were found in the control group.. Studies of the temporal and dynamic characteristics of the nasal airflow variations during speech appear potentially useful for the assessment of velopharyngeal function.

Topics: Articulation Disorders; Case-Control Studies; Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Female; Humans; Male; Nose; Palate, Soft; Prospective Studies; Pulmonary Ventilation; Speech Production Measurement; Statistics, Nonparametric; Velopharyngeal Insufficiency; Voice Quality

This study was conducted to evaluate the relationship between size of residual clefts in the hard palate and speech.. Fifteen 7-year-old children born with complete cleft lip and palate were investigated.. All of the children were treated according to a surgical regimen involving early soft palate repair and delayed hard palate closure. Measures were taken of the area, length, and maximal width of the residual cleft in the hard palate about a year before its closure and correlated with a perceptual judgment of several speech variables.. Significant positive correlations were obtained between the size of the cleft and two variables: weak pressure consonants and hypernasality. Nasal escape was very common among the patients, and almost half the children had retracted palatal or velar articulation of dental stop consonants. Neither of these two variables correlated with the size of the residual cleft.. Perceived oral pressure and, perhaps, resonance seem to be related to size of the opening of the residual cleft, whereas audible nasal escape and articulatory compensations are not, at least not the latter once established.

Topics: Articulation Disorders; Cephalometry; Child; Cleft Lip; Cleft Palate; Evaluation Studies as Topic; Female; Humans; Male; Mouth; Nose; Palate; Palate, Soft; Phonetics; Pressure; Reproducibility of Results; Speech; Speech Disorders; Speech Intelligibility

The influence of an open residual cleft in the hard palate on speech was studied in nine children with cleft lip and palate at about 7 years of age. The subjects were treated by early repair of the velum (before 12 months of age), whereas the repair of the cleft in the hard palate was postponed until about 8 years of age. Speech and velopharyngeal function were assessed systematically with the residual cleft open and temporarily covered with an oral bandage. Listeners' judgments, the Nasal Oral RAtio Meter (NORAM), videofluoroscopy, and cephalometrics were used for the analyses. Four patients were also examined with a pressure-flow technique. Nasality registered by NORAM, nasal escape, and weak pressure consonants judged by listeners were common but decreased appreciably when the residual cleft was covered. Retracted articulation was found in four patients (44%) and glottal compensations in one (11%), with no improvement after covering.

Topics: Age Factors; Articulation Disorders; Bandages; Cephalometry; Child; Cineradiography; Cleft Lip; Cleft Palate; Female; Fluoroscopy; Humans; Male; Nose; Palate; Palate, Soft; Pharynx; Pressure; Pulmonary Ventilation; Speech; Speech Disorders; Speech Perception; Video Recording

Aerodynamic and acoustic characteristics were determined from the speech of an adult female with mild mental retardation and severe velopharyngeal inadequacy. The speaker's productions of /s/ were characterized by consistent nasal grimacing and turbulent air emission. Aerodynamic assessment estimated the size of the velopharyngeal orifice to exceed 200 mm2 during plosive production. Nasal cross-sectional area was estimated to be 35 mm2 during quiet breathing. Nasometric evaluation indicated nasalance of 63% associated with the "Zoo" passage. Acoustic analysis of the separately recorded oral and nasal speech signals indicated spectral energies in the region of approximately 2.5 to 7.0 kHz associated with nasal emission during /s/ production. The occurrence of these frequencies suggested an acoustic/perceptual function of the nasal grimace. Pressure-flow evidence also suggested that the nasal grimace, perhaps with lingual assistance, functioned to enhance speech aerodynamics.

Topics: Adult; Air Pressure; Airway Resistance; Articulation Disorders; Female; Humans; Intellectual Disability; Nose; Pulmonary Ventilation; Sound Spectrography; Speech Production Measurement; Velopharyngeal Insufficiency; Voice Quality

The relationship between nasal airway size and articulatory performance was studied in a group of cleft palate patients. Articulation analysis revealed that children with bilateral cleft lip and palate were nearly twice as likely to manifest compensatory articulations as children with unilateral cleft lip and palate or with cleft palate only. When subjects were grouped according to speech performance, aerodynamic assessment indicated that children with compensatory articulations had significantly larger nasal cross-sectional areas than children without compensatory articulations. The findings suggest that children with comparatively large nasal airways may be at increased risk for developing abnormal speech patterns. If these findings are confirmed by further research, such children may be candidates for relatively early palate repair.

Topics: Articulation Disorders; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Nose; Palate, Soft; Pharynx; Phonetics; Pressure; Prevalence; Pulmonary Ventilation; Speech; Speech Intelligibility

Nasal coarticulation in phonetically controlled nonsense syllables was investigated in four normal adult speakers. Nasalization was determined using the ratio of a nasal accelerometer signal amplitude to airborn microphone signal amplitude. Measurements of nasalization were made at the midpoint of vowels and at a constant time from the nasal consonant. Nasal acoustical coupling was greater for high vowels than for low vowels in all consonant contexts. Nasalization was also greater for vowels between two nasal consonants than for vowels between a nasal consonant and a fricative or stop. Results for progressive versus regressive assimilation depended on the measurement strategy. For within-vowel measurements made a constant time from the nasal consonant, prenasal vowels showed greater nasalization than postnasal vowels. This nasal accelerometric technique shows promise for clinical assessment of articulatory details of velar function.

Topics: Adult; Articulation Disorders; Female; Humans; Nose; Speech Articulation Tests; Speech Production Measurement; Voice; Voice Disorders; Voice Quality

Two groups of parents (27 parents of children with cleft palate and 25 parents of normal children) listened to 14 pairs of tape-recorded words produced by two children with cleft palate. In each pair, one word was produced with compensatory articulation and the other with audible nasal escape of air. The parents indicated their preference by selecting from each pair the word that sounded better. Parents considered single words produced with compensatory articulation to be better than single words produced with nasal escape of air. Results are interpreted in terms of existing hypotheses and information concerning the acquisition of speech by children with cleft palate.

Topics: Adult; Air; Articulation Disorders; Child; Cleft Palate; Female; Humans; Male; Middle Aged; Nose; Parent-Child Relations; Sex Factors; Speech

The focus of this article has been on the disorders of the motor aspects of speech and voice production, as contrasted with the symbolic aspects of the communication process (language). Categories of motor speech problems include those in which the articulation of speech sounds is aberrant, phonatory problems related to laryngeal function, those resulting from craniofacial anomalies, and finally those characterized by disruption in the flow or fluency of speech. Guidelines for timing and type of referral have been suggested. In each case, early referral is urged so that diagnosis of the problem based upon complete assessment can serve to guide treatment planning. Parental reports and concerns about a child's speech development (as well as language, cognitive and auditory behavior) should be given credence and attended to rather than ignored or postponed. Speech disorders are often amenable to total resolution and almost always to a significant degree of improvement, especially if diagnosed and treated early.

Topics: Adolescent; Articulation Disorders; Child; Child, Preschool; Humans; Male; Mouth Abnormalities; Nose; Phonation; Puberty; Speech Disorders; Stuttering; Voice Disorders