Maria Pegoraro-Krook

We thank Drs Siamak Sabour and Mehdi Naderi for their interest in our paper “Nasalance-Based Preclassification of OralNasal Balance Disorders Results in Higher Agreement of Expert Listeners’ Auditory-Perceptual Assessments: Results of a Retrospective Listening Study” (de Boer et al., 2020). In this paper, we investigated whether nasalance-based preclassification of oral–nasal balance disorders improves listener agreement. Three expert listeners took part in 2 listening studies. The speakers with cleft palate were preclassified as normal, hypernasal, hyponasal, or mixed based on their nasalance scores. In a first round of the experiment, the listeners independently categorized the speakers’ oral–nasal balance. The agreement between the listeners’ diagnostic category and the nasalance-based category was 45.1% and the interlistener agreement was 36.7%, which were rather low level of agreements. In a second experiment 6 months later, the listeners relistened to the samples but this time, they had a spreadsheet indicating the nasalance-based categories for the oral–nasal balance. Some of the samples were deliberately misclassified to ensure listener attentiveness to the task. The listeners confirmed, or rejected and corrected, the nasalance-based preclassifications. In this second experiment, the listeners’ agreement was 75% for the correct nasalance-based categories, and interlistener agreement was 85.4%. We concluded from these results that a preclassification of oral–nasal balance disorders based on nasalance scores could help listeners achieve higher diagnostic accuracy and agreement. This could have implications for clinical practice: Currently, speech-language pathologists tend to do their auditoryperceptual assessments of oral–nasal balance disorders first and then use nasalance scores to corroborate their findings. However, if nasalance-based preclassification of oral–nasal balance disorders results in better listener agreement, as our research suggested, then it may make sense for clinicians to flip the order of events and use nasalance scores to scaffold their auditory-perceptual assessments, which would be a departure from the current processes. In their letter to the editor, Drs Sabour and Naderi disagree with the use of the k statistic in our study and suggest that weighted k coefficients should have been used. We would like to address the 3 points of contention put forth. First, Drs Sabour and Naderi point out that the magnitude of the k depends on the data distributions in each group. This is inarguable but not particularly specific to the study at hand. Second, the authors then make a case that weighed k coefficients are preferable for ordinal scale data with 3 or more categories. However, this misses the point of the auditoryperceptual categories that were investigated. Our categories were normal, hypernasal, hyponasal, and mixed, which are not categories that can be scaled on a single ordinal scale according to increasing severity. Watson and Petrie (2010) give the following advice regarding weighted ks: “The weighted kappa generally gives a better indication of the agreement but can only be used with data that are ranked on an ordinal scale and contain at least three categories.”

TEMA: articulação compensatória na fissura palatina. OBJETIVO: contribuir para o aprofundamento de informações sobre os tipos de articulação compensatória descritos na literatura e, ainda, discutir as implicações e contribuições da avaliação clínica e instrumental na identificação destas produções. CONCLUSÃO: as articulações compensatórias merecem a atenção de clínicos e pesquisadores que atuam no Brasil, já que estas alterações são encontradas com grande freqüência em crianças e adultos com fissura palatina ou disfunção velofaríngea, o que compromete a qualidade de vida destes sujeitos. Os fonoaudiólogos devem aprofundar seus conhecimentos sobre os tipos de articulação compensatória e os procedimentos de avaliação, bem como devem estabelecer programas preventivos que favoreçam a aquisição fonológica sem o desenvolvimento dessas compensações.

Most patients who have undergone resection of the maxillae due to benign or malignant tumors in the palatomaxillary region present with speech and swallowing disorders. Coupling of the oral and nasal cavities increases nasal resonance, resulting in hypernasality and unintelligible speech. Prosthodontic rehabilitation of maxillary resections with effective separation of the oral and nasal cavities can improve speech and esthetics, and assist the psychosocial adjustment of the patient as well.The objective of this study was to evaluate the efficacy of the palatal obturator prosthesis on speech intelligibility and resonance of 23 patients with age ranging from 18 to 83 years (Mean = 49.5 years), who had undergone inframedial-structural maxillectomy. The patients were requested to count from 1 to 20, to repeat 21 words and to spontaneously speak for 15 seconds, once with and again without the prosthesis, for tape recording purposes. The resonance and speech intelligibility were judged b...

RESUMO Objetivo Investigar a influência de estímulos de fala distintos na identificação perceptivo-auditiva da hipernasalidade em indivíduos com fissura labiopalatina operada (FLP). Método Foram editadas amostras de fala gravadas em áudio de 80 indivíduos com FLP unilateral operada, de ambos os sexos, com idades entre 9 e 17 anos (média=12 anos e 7 meses). As amostras foram gravadas durante a produção de 9 estímulos de fala distintos: contagem de números e conjuntos de frase orais, sendo 1 constituído por consoantes de baixa pressão e 7 constituídos por consoantes de alta pressão. Três fonoaudiólogas identificaram a presença ou ausência da hipernasalidade ao analisarem 864 gravações (80 indivíduos X 9 estímulos + 144 gravações repetidas para análise de concordância intra-avaliador). Os índices de concordância intra e interavaliadores foram estabelecidos para todos os 9 estímulos de fala e comparados entre si por meio do Teste Z, com nível de significância de 5%, com maiores índices ...

Objetivo: Estabelecer um banco de amostras de referência constituído por gravações de fala de indivíduos com história de fissura labiopalatina, julgadas, por múltiplos avaliadores, como representativas do uso da oclusiva glotal. Método: Três fonoaudiólogas experientes julgaram 480 frases compostas por sons oclusivos e fricativos, quanto à identificação da oclusiva glotal. As frases foram julgadas individualmente e aquelas que não apresentaram consenso inicial foram novamente julgadas de maneira simultânea pelas mesmas avaliadoras. As amostras julgadas com consenso pelas avaliadoras, com relação à presença ou ausência da oclusiva glotal durante a produção dos sons oclusivos e fricativos, foram selecionadas para estabelecer o banco de amostras de referência. Resultados: Os julgamentos realizados evidenciaram consenso das avaliadoras em 352 amostras. Destas, 120 frases eram representativas da produção adequada para os 12 sons de interesse e 232 eram representativas do uso da oclusiva g...

Objective: Reliable perceptual and instrumental assessment of oral–nasal balance disorders is a persistent problem in speech-language pathology. The goal of the study was to evaluate whether nasalance-based preclassification of oral–nasal balance disorders improves listener agreement. Design: Retrospective listening study. Setting: Tertiary university hospital. Participants: Fifty-four randomly selected recordings of patients with repaired unilateral cleft lip and palate (UCLP). Three experienced speech-language pathologists participated as expert listeners. Interventions: Two listening experiments were based on nasalance scores and audio recordings of speakers with repaired UCLP. The speakers were preclassified as normal, hypernasal, hyponasal, or mixed based on their nasalance scores. Initially, the listeners determined the diagnostic category of the oral–nasal balance for 62 audio recordings (8 repeats). Six months later, they listened to 38 of the recordings (6 repeats) along wi...

To describe the speech of a patient with Pierre Robin Sequence (PRS) and severe speech disorders before and after participating in an Intensive Speech Therapy Program (ISTP). The ISTP consisted of two daily sessions of therapy over a 36-week period, resulting in a total of 360 therapy sessions. The sessions included the phases of establishment, generalization, and maintenance. A combination of strategies, such as modified contrast therapy and speech sound perception training, were used to elicit adequate place of articulation. The ISTP addressed correction of place of production of oral consonants and maximization of movement of the pharyngeal walls with a speech bulb reduction program. Therapy targets were addressed at the phonetic level with a gradual increase in the complexity of the productions hierarchically (e.g., syllables, words, phrases, conversation) while simultaneously addressing the velopharyngeal hypodynamism with speech bulb reductions. Re-evaluation after the ISTP re...

 To describe and compare measures of velar length, velar thickness, and depth of the nasopharynx between two groups of patients with velopharyngeal dysfunction after primary palatoplasty: one received the modified Langenbeck procedure and the other the Furlow procedure.  Comparative study involving a convenience sample of videofluoroscopic films established prospectively.  Surgeries and videofluoroscopic assessments were conducted at a craniofacial center.  Exams from 90 participants were used: 27 (30%) operated with Furlow and 63 (70%) with Langenbeck. Three speech-language pathologists (SLPs) traced the images of the velopharyngeal port to determine the measures of interest.  Intrajudge agreement for the SLPs ranged between 0.85 and 0.53, while interjudge agreement ranged between 0.44 and 0.51. The overall measure of velar length was significantly larger (P = .042) for the Furlow group (mean = 26.5) than the Langenbeck group (mean = 24.2 mm). There was no significant difference in velar thickness or depth of the nasopharynx between the two procedures. Although no significant difference was found between the current findings and Subtelny's norms for length, thickness, and depth, the patients presented with an overall depth:length ratio (0.89) significantly greater than…

RESUMO Objetivo: O objetivo deste trabalho é apresentar e discutir a elaboração e a avaliação de material multimídia, destinado à orientação dos cuidadores de bebês com fissura labiopalatina, mais especificamente orientação sobre a velofaringe, palatoplastia primária e fala com relação às fissuras labiopalatinas. Métodos: A elaboração do material envolveu interdisciplinarmente as áreas de Fonoaudiologia, Odontologia e Arte. Permeados por princípios da arte-educação, houve definição e execução dos seguintes aspectos: caracterização do público alvo, caracterização do conteúdo, identificação e elaboração de ilustrações didáticas, caracterização da abordagem educacional, elaboração do texto/narração, definição da sequência audiovisual e conversão em vídeo. A avaliação do material foi conduzida com a participação de 41 cuidadores de pacientes com fissura labiopalatina e envolveu a comparação dos conhecimentos dos participantes por meio de um roteiro avaliativo, aplicado antes e depois da...

PURPOSE: To compare the nasoendoscopic findings related to the velopharyngeal gap among patients with cleft palate who underwent the Furlow (F) technique and those who underwent the von Langenbeck (vL) technique for primary palatal surgery, who remained with velopharyngeal insufficiency (VPI).METHODS: The analyzed data were retrieved from the institution's data of recordings of nasoendoscopic exams. The sample comprised 70 recorded nasoendoscopic exams obtained from 22 patients who underwent the F technique and from 48 who underwent the vL technique during primary palatoplasty, who remained with VPI after surgery and were submitted to nasoendoscopy, between the ages of 5 and 15 years (mean age: 8 years), for definition of the best treatment for VPI. The images were edited into a DVD in a randomized sequence to be assessed by three experienced speech language pathologists regarding displacement and excursion of the soft palate; displacement and excursion of lateral pharyngeal&#39...

Objetivo Descrever os resultados da nasalidade de fala de indivíduos com fissura labiopalatina e comparar os achados de nasalidade estabelecidos por meio do julgamento perceptivo-auditivo realizado ao vivo com os achados estabelecidos por análise de gravações por juízes, em dois tipos de amostras de fala. Métodos O estudo envolveu a análise retrospectiva dos resultados de avaliações perceptivo-auditivas da nasalidade de fala realizadas ao vivo por uma fonoaudióloga e o julgamento prospectivo, por consenso de juízas de 100 gravações de amostras de fala, obtidas durante a produção de dois conjuntos de estímulos de fala: um com consoantes de alta pressão (CAP, n=100) e outro com consoantes de baixa pressão (CBP, n=100). Os dados pertenciam a pacientes de ambos os gêneros, com idades entre 5 e 12 anos, que tiveram a fissura labiopalatina operada por um mesmo cirurgião. Resultados A ausência de hipernasalidade foi constatada em 69% dos julgamentos ao vivo. Quando presente, a hipernasalid...

The size control of velopharyngeal opening is an important variable for the acoustic profile characterization of hypernasal speech. To investigate frequency spectral aspects of F1, F2, F3, nasal formant (FN) and anti-formant, in Hertz, for vowels [a] and [ã] at different velopharyngeal openings produced in the bulb of a palatal prosthesis replica used by a patient with velopharyngeal insufficiency. Speech recordings were obtained for four words ("pato/mato" and "panto/manto") produced within a carrier phrase in 5 conditions of velopharyngeal functioning: prosthesis with no openings (control condition: CC); prosthesis with bulb opening of 10 mm² (experimental condition with 10 mm² opening: EC10), prosthesis with a 20 mm² opening (EC20), prosthesis with a 30 mm² opening (EC30), and without the prosthesis (ECO). Five speech-language pathologists made a live rating of speech nasality during the reading of an oral passage. The recordings were used for spectral analysi...