Search Results (18)

The basic tone of the human voice is generated in the larynx, which is reinforced by and derives its distinctive features from the resonance of the oral and nasal cavities An inappropriate ratio between oral and nasal resonance results in a more nasal timbre of the voice, which is referred to as nasality (hypernasality). Nasality is often present in hearing-impaired patients, and various studies have shown that hypoacusis, including partial deafness (PD), causes voice disorders as a result of disturbed control over the complex process of voice production. This study describes our investigation of nasality in 20 adult Polish patients with post-lingual partial deafness. The results show that PD patients developed more nasality in their voices when compared with individuals in the control group. Observations made 9 months after cochlear implantation for partial deafness indicated a reduction in nasality, with the changes in acoustic parameters achieving statistical significance. Background/Objectives: This study aimed to assess whether partial deafness (PD) causes changes in nasal resonance in adult patients and whether partial deafness cochlear implantation (PDCI) influences the level of nasality. Methods: Voice samples from 20 patients attending the Institute of Physiology and Pathology of Hearing in Warsaw with partial deafness were analyzed and compared with samples from 20 individuals with normal hearing. Voice samples from the same patients were comparatively analyzed at 9 months after cochlear implantation. The level of nasality was assessed using the FFT (Fast Fourier Transform) for acoustic analysis, as well as subjective description by two experienced medical professionals (a medical doctor and a clinical acoustician). Pearson analysis was then performed to determine the correlations between the objective and subjective assessments. Paired two-sample t-tests for means were conducted for statistical analysis. All patients of the Institute of Physiology and Pathology of Hearing in Warsaw declared their deliberate consent to all necessary diagnostic and therapeutic procedures upon admittance. Results: The results show that post-lingual partial deafness causes nasality in adult patients when measured both objectively (p = 0.0001) and subjectively. The average objective level of nasality was 21 dB (SD 4.5), while the subjective level was an average grade of 1.25. The level of nasality presented a positive correlation with the duration of partial deafness. The assessment performed 9 months after cochlear implantation showed a reduction in nasality, achieving 17 dB (SD 4.2) in the objective measurement (p = 0.0002) and a grade of 0.5 when assessed subjectively. Pearson analysis showed a weak correlation between the objective measurement and subjective assessment (r = 0.2). Conclusions: Post-lingual partial deafness causes nasality in adults in a manner that is positively correlated with the duration of hearing impairment. Partial deafness cochlear implantation reduced nasality after 9 months of observation, as shown both objectively (MDVP) and subjectively (perceptual assessment). However, the correlation between the objective and subjective results is rather weak; therefore, objective acoustic methods (e.g., MDVP) should preferably be used for a more credible assessment, while the subjective method may only serve as a rough and general tool in everyday clinical use. Full article

Background: This systematic review investigates how different surgical techniques influence speech outcomes in children with cleft palate, focusing on the effectiveness of key palatoplasty methods and the timing of surgery on vocal function. Methods: A thorough search of the PubMed, Scopus, and Web of Science databases was conducted for studies published between 2014 and 2024, including clinical research reporting speech results after palatal repair, with bias assessed using the ROBINS tool. Additionally, two clinical cases are presented to demonstrate the practical application of the surgical approaches. Results: Analysis of fourteen studies revealed that modified Z-plasty and V-Y procedures enhance soft palate mobility and reduce hypernasality, although they require advanced surgical skills. Early closure of the hard palate, performed within the first year of life, was linked to improved consonant articulation compared to later surgeries. No significant differences were found between single-stage and two-stage repairs, but surgeon experience emerged as a crucial factor influencing outcomes. Conclusions: Overall, both the surgical technique selected and the timing of intervention play important roles in optimizing speech development in children affected by cleft palate. Full article

This clinical pilot study aimed to assess the clinical effectiveness of a newly developed device, Smart Naso^TM, for resonance disorders and compare its performance with that of the Nasometer II 6450. A group of 18 total participants (nine each in normal and hypernasality groups) were examined using the VIP inspection and K SNAP Test while wearing Nasometer II 6450 or Smart Naso^TM, and the reliability of the new device and similarity of both devices were evaluated. When the newly developed Smart Naso™ and Nasometer II 6450 were applied to the hypernasality group, similarity was observed (Smart Naso^TM: 0.776–0.989, Nasometer II: 0.922–0.996). In the test–retest reliability evaluation, both devices were found to be highly effective and reliable in the hypernasality group (Smart Naso^TM: 0.948, Nasometer II: 0.953); the Smart Naso^TM was found to be similarly effective and reliable for clinical applications. Smart Naso™ exhibited comparable effectiveness to that of Nasometer II 6450 and exhibits clinical utility for patients with hypernasality and those diagnosed with cleft lip and palate, cleft palate, and submucosal cleft palate. Full article

A model of the vocal tract that mimicked velopharyngeal insufficiency was created, and acoustic analysis was performed using the boundary element method to clarify the acoustic characteristics of velopharyngeal insufficiency. The participants were six healthy adults. Computed tomography (CT) images were taken from the frontal sinus to the glottis during phonation of the Japanese vowels /i/ and /u/, and models of the vocal tracts were created from the CT data. To recreate velopharyngeal insufficiency, coupling of the nasopharynx was carried out in vocal tract models with no nasopharyngeal coupling, and the coupling site was enlarged in models with nasopharyngeal coupling. The vocal tract models were extended virtually for 12 cm in a cylindrical shape to represent the region from the lower part of the glottis to the tracheal bifurcation. The Kirchhoff–Helmholtz integral equation was used for the wave equation, and the boundary element method was used for discretization. Frequency response curves from 1 to 3000 Hz were calculated by applying the boundary element method. The curves showed the appearance of a pole–zero pair around 500 Hz, increased intensity around 250 Hz, decreased intensity around 500 Hz, decreased intensities of the first and second formants (F1 and F2), and a lower frequency of F2. Of these findings, increased intensity around 250 Hz, decreased intensity around 500 Hz, decreased intensities of F1 and F2, and lower frequency of F2 agree with the previously reported acoustic characteristics of hypernasality. Full article

Background: Velopharyngeal insufficiency (VPI) is a failure of the sphincter mechanism, causing speech patterns like hypernasality and decreased intelligibility. Causes include structural, neurologic, and mechanical issues. Treatment options include non-surgical and surgical interventions, but complications can arise. A new approach using the buccal flap (BF) has been suggested for palatal length augmentation. This systematic review assessed speech outcomes after BF palatal lengthening. Methods: A thorough investigation was conducted by methodically reviewing numerous databases, including PubMed, Scopus, Web of Science, and Embase, until December 2024. The goal of our analysis was to find studies that assess the short- and long-term efficacy of BF on speech outcomes on patients with VPI. We used the NIH Quality Assessment Tool to assess the quality of the evidence, ensuring the dependability of the results reached during these investigations. Results: This systematic review identified 23 studies (total sample size of 995) that assessed the speech outcomes of BF on VPI. The BF significantly improves speech outcomes in patients with VPI. Hypernasality improved significantly post-surgery, with outcomes measured using different scales and methods, including both subjective and objective tools. Benefits were observed within three months postoperatively, with sustained benefits up to 15 months in several studies. Speech intelligibility also improved notably, with mean differences up to 1.09 (p < 0.001). Reductions in audible nasal air emissions were observed, though some variability was noted across studies. Secondary outcomes, including better velopharyngeal closure and decreased facial grimacing, further highlight its efficacy. However, inconsistent findings for nasal turbulence and limited long-term data suggest that benefits may plateau over time. These findings support the BF as an effective intervention, though further research is needed on extended outcomes. Conclusions: BF is an effective surgical intervention for VPI, significantly improving hypernasality, speech intelligibility, and audible nasal air emissions. While benefits are evident across diverse populations, long-term outcomes and secondary features, such as nasal turbulence, show variability, emphasizing the need for individualized approaches and continued follow-up. This technique offers a reliable option for functional and speech rehabilitation, though further research is needed to optimize its long-term efficacy and broader outcomes. Full article

Study design: Systematic review. Objective: Obstructive sleep apnea (OSA) is a possible complication following secondary velopharyngeal insufficiency surgery in patients with repaired cleft palate. Various surgical techniques are used to treat secondary velopharyngeal insufficiency after cleft palate repair, but the optimal procedure remains debatable. This review provides an overview of the incidence of airway obstructive outcomes related to different surgical modalities. Methods: A systematic search was performed on the 1st of February following the PRISMA guidelines and registered on PROSPERO (CRD42022299715). The following databases were reviewed: Medline, EMBASE, Web of Science, Google Scholar, and the Cochrane Library databases. Studies that included data on the occurrence of OSA following velopharyngeal surgery in children with a repaired non-syndromic cleft palate were included. Non-English articles and studies that included syndromic cleft palate patients were excluded. Results: Twenty-eight articles met the inclusion criteria. The surgical procedures are classified into three groups: pharyngeal flap procedure (PF), sphincter pharyngoplasty (SP), and palatal muscle repositioning (PMR). Incidence of post-operative OSA and symptoms of OSA were lowest after PMR compared to SP and PF (3%; 34%; 29%, respectively). Pharyngeal flap procedures resulted in the best speech outcomes. Conclusions: PMR results in fewer postoperative complications in terms of OSA and achieves a satisfactory reduction in hypernasal speech. PF procedure carries a higher risk of developing OSA postoperatively but seems to be superior in the reduction in hypernasality. Full article

Automatic evaluation of hypernasality has been traditionally computed using monophonic signals (i.e., combining nose and mouth signals). Here, this study aimed to examine if nose signals serve to increase the accuracy of hypernasality evaluation. Using a conventional microphone and a Nasometer, we recorded monophonic, mouth, and nose signals. Three main analyses were performed: (1) comparing the spectral distance between oral/nasalized vowels in monophonic, nose, and mouth signals; (2) assessing the accuracy of Deep Neural Network (DNN) models in classifying oral/nasal sounds and vowel/consonant sounds trained with nose, mouth, and monophonic signals; (3) analyzing the correlation between DNN-derived nasality scores and expert-rated hypernasality scores. The distance between oral and nasalized vowels was the highest in the nose signals. Moreover, DNN models trained on nose signals outperformed in nasal/oral classification (accuracy: 0.90), but were slightly less precise in vowel/consonant differentiation (accuracy: 0.86) compared to models trained on other signals. A strong Pearson’s correlation (0.83) was observed between nasality scores from DNNs trained with nose signals and human expert ratings, whereas those trained on mouth signals showed a weaker correlation (0.36). We conclude that mouth signals partially mask the nasality information carried by nose signals. Significance: the accuracy of hypernasality assessment tools may improve by analyzing nose signals. Full article

(1) Background: Cleft lip and palate is the most common congenital malformation of the head and neck. After surgical closure, velopharyngeal dysfunction can arise, which has implications for phonation, sucking, swallowing, middle ear function, and interpersonal well-being. This case series aimed to present an adaptation of the conventional pharyngeal obturator design in order to allow its use with fixed orthodontic appliances. (2) Methods: A new custom-made pharyngeal obturator device was built in order to enable a correct function of the velopharyngeal valve. The fabrication of the plate was made by altering the conventional Hawley retainer, replacing the Adams hooks with 0.9 mm spherical hooks and removing the buccal arch. (3) Results: The new pharyngeal obturator design was used in six cleft patients with fixed orthodontic appliances. The appliance was well tolerated and there was a slight improvement in auditory-perceptive evaluations. (4) Conclusions: The new pharyngeal bulb design proved to have good retention during fixed orthodontic treatment. Moreover, despite the short-term follow-up, it also showed a reduction in the severity of the hypernasality sentences. Full article

Congenital cleft lip and palate is one of the common deformities in the craniomaxillofacial region. The current study aimed to explore the perceptual pattern of cleft-related speech produced by Mandarin-speaking patients with repaired cleft palate using the task-based functional magnetic resonance imaging (task-fMRI) technique. Three blocks of speech stimuli, including hypernasal speech, the glottal stop, and typical speech, were played to 30 typical adult listeners with no history of cleft palate speech exploration. Using a randomized block design paradigm, the participants were instructed to assess the intelligibility of the stimuli. Simultaneously, fMRI data were collected. Brain activation was compared among the three types of speech stimuli. Results revealed that greater blood-oxygen-level-dependent (BOLD) responses to the cleft-related glottal stop than to typical speech were localized in the right fusiform gyrus and the left inferior occipital gyrus. The regions responding to the contrast between the glottal stop and cleft-related hypernasal speech were located in the right fusiform gyrus. More significant BOLD responses to hypernasal speech than to the glottal stop were localized in the left orbital part of the inferior frontal gyrus and middle temporal gyrus. More significant BOLD responses to typical speech than to the glottal stop were localized in the left inferior temporal gyrus, left superior temporal gyrus, left medial superior frontal gyrus, and right angular gyrus. Furthermore, there was no significant difference between hypernasal speech and typical speech. In conclusion, the typical listener would initiate different neural processes to perceive cleft-related speech. Our findings lay a foundation for exploring the perceptual pattern of patients with repaired cleft palate. Full article

A comprehensive assessment of the treatment outcome in cleft lip and palate involves evaluating speech and the impact of speech-correcting surgical interventions. This retrospective case–control study compared the speech outcomes of 37 boys and 19 girls with unilateral cleft lip and palate (UCLP) who underwent one-stage cleft repair at an average age of 8.1 months and alveolar bone grafting either before or after 6 years of age, with a non-cleft control group at an average age of 10 years. Two experienced speech and language pathologists conducted perceptual speech assessments using a specialized test of 27 sentences designed for Polish-speaking cleft patients. The results revealed that 5.3% had severe hypernasality, 1.8% had severely impaired speech intelligibility, 10.7% exhibited retracted compensatory articulations, and 7.1% displayed facial grimacing. Mild hyponasality was observed in 12.3% of patients, while 16.1% exhibited voice abnormalities. Additionally, 12.5% of patients required orofacial fistula repairs, 3.6% underwent pharyngoplasties, and 28.6% received ear ventilation tube insertions. The study indicates that speech abnormalities in UCLP patients were relatively infrequent and not highly severe, suggesting that the primary UCLP repair method presented effectively reduced the need for further surgical interventions, leading to positive speech outcomes. Full article

Velopharyngeal insufficiency (VPI) is a type of pharyngeal function dysfunction that causes speech impairment and swallowing disorder. Speech therapists play a key role on the diagnosis and treatment of speech disorders. However, there is a worldwide shortage of experienced speech therapists. Artificial intelligence-based computer-aided diagnosing technology could be a solution for this. This paper proposes an automatic system for VPI detection at the subject level. It is a non-invasive and convenient approach for VPI diagnosis. Based on the principle of impaired articulation of VPI patients, nasal- and oral-channel acoustic signals are collected as raw data. The system integrates the symptom discriminant results at the phoneme level. For consonants, relative prominent frequency description and relative frequency distribution features are proposed to discriminate nasal air emission caused by VPI. For hypernasality-sensitive vowels, a cross-attention residual Siamese network (CARS-Net) is proposed to perform automatic VPI/non-VPI classification at the phoneme level. CARS-Net embeds a cross-attention module between the two branches to improve the VPI/non-VPI classification model for vowels. We validate the proposed system on a self-built dataset, and the accuracy reaches 98.52%. This provides possibilities for implementing automatic VPI diagnosis. Full article

Objective: The objective of this systematic review was (a) to explore the current clinical applications of AI/ML (Artificial intelligence and Machine learning) techniques in diagnosis and treatment prediction in children with CLP (Cleft lip and palate), (b) to create a qualitative summary of results of the studies retrieved. Materials and methods: An electronic search was carried out using databases such as PubMed, Scopus, and the Web of Science Core Collection. Two reviewers searched the databases separately and concurrently. The initial search was conducted on 6 July 2021. The publishing period was unrestricted; however, the search was limited to articles involving human participants and published in English. Combinations of Medical Subject Headings (MeSH) phrases and free text terms were used as search keywords in each database. The following data was taken from the methods and results sections of the selected papers: The amount of AI training datasets utilized to train the intelligent system, as well as their conditional properties; Unilateral CLP, Bilateral CLP, Unilateral Cleft lip and alveolus, Unilateral cleft lip, Hypernasality, Dental characteristics, and sagittal jaw relationship in children with CLP are among the problems studied. Results: Based on the predefined search strings with accompanying database keywords, a total of 44 articles were found in Scopus, PubMed, and Web of Science search results. After reading the full articles, 12 papers were included for systematic analysis. Conclusions: Artificial intelligence provides an advanced technology that can be employed in AI-enabled computerized programming software for accurate landmark detection, rapid digital cephalometric analysis, clinical decision-making, and treatment prediction. In children with corrected unilateral cleft lip and palate, ML can help detect cephalometric predictors of future need for orthognathic surgery. Full article

Respiratory failure, malnutrition, aspiration pneumonia, and dehydration are the precursors to mortality in ALS. Loss of natural communication is considered one of the worst aspects of ALS. This first study to test the feasibility of a music therapy protocol for bulbar and respiratory rehabilitation in ALS employs a mixed-methods case study series design with repeated measures. Newly diagnosed patients meeting the inclusion criteria were invited to participate, until the desired sample size (n = 8) was achieved. The protocol was delivered to participants in their homes twice weekly for six weeks. Individualised exercise sets for independent practice were provided. Feasibility data (recruitment, retention, adherence, tolerability, self-motivation and personal impressions) were collected. Bulbar and respiratory changes were objectively measured. Results. A high recruitment rate (100%), a high retention rate (87.5%) and high mean adherence to treatment (95.4%) provide evidence for the feasibility of the study protocol. The treatment was well tolerated. Mean adherence to the suggested independent exercise routine was 53%. The outcome measurements to evaluate the therapy-induced change in bulbar and respiratory functions were defined. Findings suggest that the protocol is safe to use in early- and mid-stage ALS and that music therapy was beneficial for the participants’ bulbar and respiratory functions. Mean trends suggesting that these functions were sustained or improved during the treatment period were observed for most outcome parameters: Maximal Inspiratory Pressure, Maximal Expiratory Pressure, Peak Expiratory Flow, the Center for Neurologic Study—Bulbar Function Scale speech and swallowing subscales, Maximum Phonation Time, Maximum Repetition Rate—Alternating, Maximum Repetition Rate—Sequential, Jitter, Shimmer, NHR, Speaking rate, Speech–pause ratio, Pause frequency, hypernasality level, Time-to-Laryngeal Vestibule Closure, Maximum Pharyngeal Constriction Area, Peak Position of the Hyoid Bone, Total Pharyngeal Residue C24area. Conclusion. The suggested design and protocol are feasible for a larger study, with some modifications, including aerodynamic measure of nasalance, abbreviated voice sampling and psychological screening. Full article

Significant treatment variation exists in the Netherlands between teams treating patients with cleft lip, alveolus, and/or palate, resulting in a confusing and undesirable situation for patients, parents, and practitioners. Therefore, to optimize cleft care, clinical practice guidelines (CPGs) were developed. The aim of this report is to describe CPG development, share the main recommendations, and indicate knowledge gaps regarding cleft care. Together with patients and parents, a multidisciplinary working group of representatives from all relevant disciplines assisted by two experienced epidemiologists identified the topics to be addressed in the CPGs. Searching the Medline, Embase, and Cochrane Library databases identified 5157 articles, 60 of which remained after applying inclusion and exclusion criteria. We rated the quality of the evidence from moderate to very low. The working group formulated 71 recommendations regarding genetic testing, feeding, lip and palate closure, hearing, hypernasality, bone grafting, orthodontics, psychosocial guidance, dentistry, osteotomy versus distraction, and rhinoplasty. The final CPGs were obtained after review by all stakeholders and allow cleft teams to base their treatment on current knowledge. With high-quality evidence lacking, the need for additional high-quality studies has become apparent. Full article

Automatic tools to detect hypernasality have been traditionally designed to analyze sustained vowels exclusively. This is in sharp contrast with clinical recommendations, which consider it necessary to use a variety of utterance types (e.g., repeated syllables, sustained sounds, sentences, etc.) This study explores the feasibility of detecting hypernasality automatically based on speech samples other than sustained vowels. The participants were 39 patients and 39 healthy controls. Six types of utterances were used: counting 1-to-10 and repetition of syllable sequences, sustained consonants, sustained vowel, words and sentences. The recordings were obtained, with the help of a mobile app, from Spain, Chile and Ecuador. Multiple acoustic features were computed from each utterance (e.g., MFCC, formant frequency) After a selection process, the best 20 features served to train different classification algorithms. Accuracy was the highest with syllable sequences and also with some words and sentences. Accuracy increased slightly by training the classifiers with between two and three utterances. However, the best results were obtained by combining the results of multiple classifiers. We conclude that protocols for automatic evaluation of hypernasality should include a variety of utterance types. It seems feasible to detect hypernasality automatically with mobile devices. Full article