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Copyright of Canadian Journal of Bioethics / Revue canadienne de bioéthique is the property of Ecole de Sante Publique de l'Universite de Montreal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Feeding difficulties are extremely common in children with Down Syndrome (DS), often leads to nutritional deficiencies as well as affecting the child's overall development. Underlying sensory motor issues of oral peripheral mechanism cause poor lip seal, chewing issues and swallowing difficulties, which direct towards the need of oral sensory and motor based intervention for this population. Reviewing of case history was employed for 3 female children in the age range of 3-5 years diagnosed with DS which involved demographic information, clinical examinations, medical history, and Oral Placement Therapy (OPT) based feeding therapy to improve oral sensorimotor skills and feeding difficulties and the remarkable positive effects on oral awareness and sensitivity, tongue jaw dissociation, grading and fixing on the feeding skills. The study concluded the effect of OPT on feeding therapy and an effective means of dealing with feeding issues in children with Down syndrome. The research study also highlighted the need for further research to evaluate the long-term sustainability of the effect by using the intervention strategies based on individual needs. [ABSTRACT FROM AUTHOR]

The inaugural total laryngectomy in history was conducted by Billroth in 1873. Nevertheless, significant enhancements to the technique were achieved through the contributions of Gluck, Sorensen, and various other surgeons. Throughout the twentieth century, advancements in anesthesia, infectious disease, hospital hygiene, antibiotic therapy, resuscitation, and the expertise of numerous laryngologists elevated total laryngectomy to a pivotal surgical intervention in head and neck surgery. The latter half of the twentieth century witnessed a paradigm shift with the emergence of organ preservation protocols. Total laryngectomy became the preferred choice for patients experiencing radiotherapy failure. However, the widespread use of laryngeal conservative treatments appears to be correlated with a decline inoverall survival rates in theUnited States and Europe. The evolutionof new minimally invasive surgical approaches in the twenty-first century may usher in a revolutionary era in the management of laryngeal carcinoma, offering the potential for improved survival and functional outcomes. [ABSTRACT FROM AUTHOR]

Previous studies have reported that adults who stutter demonstrate significant gains in communication competence, per self-ratings and clinician-ratings, upon completion of a communication-centered treatment, or CCT. The purpose of this social validation study was to determine whether communication competence ratings reported by untrained observers are consistent with client and clinician judgments of communication competence gains following CCT. Eighty-one untrained observers completed an online survey that required each to view one of two videos depicting an adult who stutters during a mock interview recorded prior to CCT or after CCT. Observers were then asked to rate the communication competence of the interviewee on a 100-point visual analog scale and provide additional demographic information. Communication competence of the adult who stutters who had completed CCT was rated significantly higher in their post-treatment video. Upon controlling for two demographic factors found to be associated with observer ratings (years of education, years the observers had known an adult who stutters), significantly higher ratings of communication competence for the post-treatment video were maintained. These preliminary findings provide social validity for CCT by demonstrating that the gains in communication competence reported in previous studies through clinician and client observations are also reported by untrained observers who are not familiar with CCT. [ABSTRACT FROM AUTHOR]

In human speech, the close back rounded vowel /u/ (the vowel in "boot") is articulated with the tongue arched toward the dorsal boundary of the hard palate, with the pharyngeal cavity open. Acoustic and perceptual properties of chimpanzee (Pan troglodytes) hoo's are similar to those of the human vowel /u/. However, the vocal tract morphology of chimpanzees likely limits their phonetic capabilities, so that it is unlikely, or even impossible, that their articulation is comparable to that of a human. To determine how qualities of the vowel /u/ may be achieved given the chimpanzee vocal tract, we calculated transfer functions of the vocal tract area for tube models of vocal tract configurations in which vocal tract length, length and area of a laryngeal air sac simulacrum, length of lip protrusion, and area of lip opening were systematically varied. The method described is principally acoustic; we make no claim as to the actual shape of the chimpanzee vocal tract during call production. Nonetheless, we demonstrate that it may be possible to achieve the acoustic and perceptual qualities of back vowels without a reconfigured human vocal tract. The results, while tentative, suggest that the production of hoo's by chimpanzees, while achieving comparable vowel-like qualities to the human /u/, may involve articulatory gestures that are beyond the range of the human articulators. The purpose of this study was to (1) stimulate further simulation research on great ape articulation, and (2) show that apparently vowel-like phenomena in nature are not necessarily indicative of evolutionary continuity per se. [ABSTRACT FROM AUTHOR]

Background: Historically, South African plastic surgeons (PSs) have been managing cleft lip/ palate (CLP) and craniofacial anomalies (CA). PS lead CL/P teams globally where the need arises. The complex, lengthy nature of CL/P management requires holistic services and collaboration between disciplines. Academic education should provide in‑depth knowledge, interdisciplinary participation, and clinical exposure to field experts. Objectives: An investigation into exposure and knowledge of South African PS regarding management of CL/P. An opinion from practicing PS about academic educational needs for working with CL/P patients. Methods: Online survey and telephone interviews (a structured questionnaire) investigating opinions of PS in CL/P to determine satisfaction with the adequacy of academic education and perceived needs. Results: The questionnaire was completed by 41% of practicing PS from Medpages health‑care provider database. Most respondents (63.3%) were between 30 and 49. Of them, 74% showed good general knowledge of CL/P. However, 76.5% acknowledged limited clinical training and exposure in this field, preventing them from adequate services provision to CL/P patients. Only 41% offered primary and/or secondary treatment to CL/P patients and 40% had participated in interdisciplinary teams. All agreed on the need for a dedicated training program(s) in CL/P management. The majority recommended subspeciality training through a clinical fellowship or a degree course. Conclusion: PS postgraduate academic training and clinical exposure are limited in the CL/P field. An educational strategy should be established to meet the needs of PS providing CL/P care. Part‑time clinical fellowship and/or degree courses would prepare them adequately for a career managing CL/P and CA patients. [ABSTRACT FROM AUTHOR]

Patients with schizophrenia have a flat and monotonous intonation. The purpose of the study was to find the variables of flat speech that differed in patients from those in healthy controls in Danish. We compared drug-naïve schizophrenic patients 5 men, 13 women and 18 controls, aged 18–35 years, which had all grown up in Copenhagen speaking modern Danish standard (rigsdansk). We used two different tasks that lay different demands on the speaker to elicit spontaneous speech: a retelling of a film clip and telling a story from pictures in a book. A linguist used the computer program Praat to extract the phonetic linguistic parameters. We found different results for the two elicitation tasks (Task 1: a retelling of a film clip, task 2: telling a story from pictures in a book). There was higher intensity variation in task one in controls and higher pitch variation in task two in controls. We found a difference in intensity with higher intensity variation in the stresses in the controls in task one and fewer syllables between each stress in the controls. We also found higher F1 variation in task one and two in the patient group and higher F2 variation in the control group in both tasks. The results varied between patients and controls, but the demands also made a difference. Further research is needed to elucidate the possibilities of acoustic measures in diagnostics or linguistic treatment related to schizophrenia. [ABSTRACT FROM AUTHOR]

Introduction: In Laryngopharyngeal Reflux (LPR), refluxate rich in acid, pepsin, and bile regurgitates above the upper oesophageal sphincter onto the laryngeal mucosa. However, not all patients with LPR present with subjective voice changes. This may be due to a gradual change in voice that remains unnoticed. The clinical subtlety is important for diagnosis or at least awareness for better treatment and care. Aim: To objectively determine preclinical acoustic changes in patients with LPR who have not reported any voice complaints. Materials and Methods: This cross-sectional study was conducted on adult patients visiting the Out-patient department of a Tertiary Care Teaching Institute in Northern India, from September 2022 to October 2022. Patients with LPR but without voice changes were included in the study. They underwent multidimensional voice analysis during the phonation of the vowel /a/. Mean fundamental frequency (MF0), absolute jitter, absolute shimmer, and Soft Phonation Index (SPI) were analysed for the sample and compared to the gender-specific mean values provided by the software used. Statistical significance was determined using the one-sample t-test. Results: A total of 27 participants (20 females, 7 males) completed the study. In the female group, the mean MF0 (204.30±32.49 Hz) was significantly lower, absolute jitter (92.41±87.93 μs), absolute shimmer (0.38±0.31 dB), and SPI (25.62±15.24) were significantly higher than the reference mean. In the male group, the mean MF0 (138.03 Hz), absolute jitter (104.01±84.28 μs), and absolute shimmer (0.34±0.16 dB) were not significantly different from the reference mean. However, SPI (25.09±16.95) remained significantly higher than the reference mean. Conclusion: Increased jitter, shimmer, and SPI are primary acoustic changes observed in patients with LPR. These changes appear even before patients experience any voice changes. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of laryngeal pathology in children presenting with cleft palate with or without cleft lip (CP ± L) who underwent nasoendoscopy to assess palatal function. A secondary aim was to determine the relationship between patient demographics, resonance, articulation, and prevalence of laryngeal pathology in this population. Design: Retrospective, observational cohort study Setting: Outpatient pediatric cranio-facial anomalies clinic Patients: Children ≤18 years of age presenting with CP ± L (N = 215) who underwent nasoendoscopy, speech language pathology, plastic surgery, and otolaryngological evaluations between 2009 and 2020. Main Outcome Measure: Laryngeal diagnosis by pediatric otolaryngologists. Results: 21.9% of children presented with laryngeal pathology. Diagnoses included benign vocal fold lesions and laryngeal edema sufficiently severe to alter vocal fold edge contour. Likelihood of laryngeal pathology increased by approximately 12% with every increase of 1 year in age (P =.001, OR = 1.12). Children with laryngeal pathology were 50% more likely to have undergone palatal repair (P <.001, OR = 1.50). In addition, children with severely hypernasal resonance were 78% less likely to present with laryngeal pathology (P =.046, OR = 0.22). Conclusions: This population is at increased risk for laryngeal pathologies as determined by nasoendoscopy. This finding underscores the importance of careful laryngeal imaging in assessing these children. Additional research is warranted to identify the mechanisms underlying the increased risk for morphological vocal fold changes. [ABSTRACT FROM AUTHOR]

Introduction: Research reveals the clinical efficacy of both verbal and written stuttering disclosure statements provided by a child who stutters (CWS) and his advocates (i.e., mother or teacher) [Lang Speech Hear Serv Sch. 2020 Jul;51(3):745–60 and Lang Speech Hear Serv Sch. 2021 Aug;52(4):1031–1048]. Although existing data reveal that both the source (i.e., self- vs. advocate disclosure) and modality (i.e., verbal or written) of stuttering disclosure yields significant improvements in the perceptions of speech skills and personality characteristics of CWS, there is a paucity of research directly comparing the modality (verbal vs. written) and source (self, mother, teacher) of disclosure statements. Accordingly, this study analyzes listeners' perceptions of a 12-year-old male CWS' speech skills and personal characteristics, as a function of both the source and modality of factual stuttering disclosure statements [Lang Speech Hear Serv Sch. 2020 Jul;51(3):745–60 and Lang Speech Hear Serv Sch. 2021 Aug;52(4):1031–1048]. Methods: A total of 641 college-aged adults participated in this analysis; study participants reported their perceptions of speech skills and personality characteristics of a 12-year-old CWS as a function of stuttering disclosure. Participants were randomly assigned to view one video containing one of two disclosure modalities (verbal or written), one of three stuttering disclosure source conditions (self-disclosure, mother disclosure, and teacher disclosure), or a no-disclosure control condition. Participants in the control group viewed a brief video of a 12-year-old CWS reciting a short reading passage; participants in the experimental groups viewed their assigned disclosure statement followed by the same video used in the control condition. Immediately following the video, all participants completed a survey quantifying their perceptions of the CWSs relative to his speech skills and personal characteristics. Results: Results reveal optimal results via verbal self-disclosure and verbal teacher disclosure. A limited number of nominally positive perceptual differences were noted within the written mother disclosure group, while written CWS self-disclosure yielded significantly negative perceptions of the CWS. Overall, verbal disclosures yield far more significant and desirable perceptions of CWS' speech skills and personal characteristics when compared to written stuttering disclosure. Discussion: Results of this analysis reveal that verbal stuttering disclosure is significantly more effective in improving listeners' perceptions of a CWS, when compared to written stuttering disclosures. Despite the widespread adoption of written communication over digital media (e.g., email and text messages), these data support the notion that face-to-face or video verbal stuttering disclosure provides the most desirable perceptual benefits for CWS. Within verbal stuttering disclosure, verbal self-disclosure appears to be the single best overall disclosure methodology relative to clinical application. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Health Sciences / Türkiye Klinikleri Sağlık Bilimleri Dergisi is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Two experiments were conducted to test the role of participant factors (i.e., musical sophistication, working memory capacity) and stimulus factors (i.e., sound duration, timbre) on auditory recognition using a rapid serial auditory presentation paradigm. Participants listened to a rapid stream of very brief sounds ranging from 30 to 150 milliseconds and were tested on their ability to distinguish the presence from the absence of a target sound selected from various sound sources placed amongst the distracters. Experiment 1a established that brief exposure to stimuli (60 to 150 milliseconds) does not necessarily correspond to impaired recognition. In Experiment 1b we found evidence that 30 milliseconds of exposure to the stimuli significantly impairs recognition of single auditory targets, but the recognition for voice and sine tone targets impaired the least, suggesting that the lower limit required for successful recognition could be lower than 30 milliseconds for voice and sine tone targets. Critically, the effect of sound duration on recognition completely disappeared when differences in musical sophistication were controlled for. Participants' working memory capacities did not seem to predict their recognition performances. Our behavioral results extend the studies oriented to understand the processing of brief timbres under temporal constraint by suggesting that the musical sophistication may play a larger role than previously thought. These results can also provide a working hypothesis for future research, namely, that underlying neural mechanisms for the processing of various sound sources may have different temporal constraints. [ABSTRACT FROM AUTHOR]

Purpose: This study employed acoustic measures as well as auditory‐perceptual assessments to examine the effects of voice therapy in children presenting with benign vocal fold lesions. Methods: A retrospective, observational cohort design was employed. Sustained vowels produced by 129 children diagnosed with benign vocal fold lesions were analyzed, as well as connected speech samples produced by 47 children. Treatment outcome measures included Consensus of Auditory‐Perceptual Evaluation of Voice (CAPE‐V), jitter, shimmer, Noise‐to‐Harmonic Ratio (NHR), cepstral peak prominence (CPP), and Low‐to‐High Ratio (LHR) on sustained vowels, and CPP and LHR on connected speech. Results: Following voice therapy, significant improvements in CAPE‐V ratings (p < 0.001) were observed. Additionally, jitter (p = 0.041), NHR (p = 0.019), and CPP (p < 0.01) on sustained vowels, and CPP (p = 0.002), and LHR (p = 0.008) on connected speech significantly improved following voice therapy. CPP increased with age in males but did not change in females. CAPE‐V ratings and perturbation measures indicated that dysphonia was more severe in younger children pre and post‐therapy. Conclusions: Auditory‐perceptual and acoustic measures demonstrated improved voice quality following voice therapy in children with dysphonia. CPP effectively quantified voice therapy gains and allowed for analysis of connected speech, in addition to sustained vowels. These findings demonstrate the value of CPP as a tool in assessing therapy outcomes and support the efficacy of voice therapy for children presenting with vocal fold lesions. Level of Evidence: 4 Laryngoscope, 133:977–983, 2023 [ABSTRACT FROM AUTHOR]

Introduction: Financial incentive schemes have been commonly used by the hearing aid industry as a way of encouraging device sales. These schemes can lead to a conflict of interest as the hearing device dispenser is torn between personal reward over the best interests of their client. This conflict of interest has the potential for the dispenser to develop "moral distress", a negative state of mind when an individual's ethical values contrast with those of the employing organization. The purpose of this study was to investigate if there was a relationship between financial incentives and moral distress in Australian audiologists and audiometrists. Methods: An online survey was distributed to all members of Audiology Australia and the Australian College of Audiology via email. Participants rated their perceived moral distress from 0 to 10 on the Moral Distress Thermometer and answered four questions about financial incentives in their respective workplace. Results: A total of 65 participants, 42 females and 23 males, completed the online survey. A quarter of participants rated their moral distress corresponding to levels of uncomfortable or above. A statistically significant association was found between financial incentives, sales target setting, and higher perceived moral distress in participants. Conclusions: For our sample, the implementation of financial incentives created ethical challenges for practicing audiologists and audiometrists. Modifications to employee rewards programs as well as a regulation of device sales are recommended. [ABSTRACT FROM AUTHOR]

Much work has been conducted that reports on the strong relationships between speech production and reading behaviour. However, disentangling the relative contribution of the various underlying speech mechanisms (i.e., articulation, somatosensory and/or auditory) that contribute to this relationship remains unknown. Oral stereognosis refers to the ability to discriminate shapes using our tongue/mouth, in the absence of seeing the shape beforehand, and is a measure of the somatosensory sub-system of the speech mechanism. In this work, we aimed to address the extent to which oral stereognosis predicted visual word recognition. Methods: Healthy participants ranging from 18 to 51 years old (N = 60; Mage = 22.7) completed the Florida Oral Recognition Measurement (FORM) task and two visual word recognition tasks. The FORM required participants to identify carrots that were cut into the following letters' shapes: E, R, T, S, L, N, O, V. Carrot letters were randomly presented to participants. With respect to the visual word recognition tasks, participants were required to press a button: 1) if the letter string spelled a word or 2) if the letter string sounded like a word. Response time and accuracy were measured for all tasks. Results: Participants were divided into high (accuracy >50%) vs. low (accuracy ≦ 50%) oral stereognosis recognition groups. For the high FORM group, oral stereognosis recognition predicted visual word recognition in the spell task (Adj R2 =.114). For the low FORM group, oral stereognosis recognition predicted visual word recognition in the sound task (Adj R2 =.307). Together, these findings provide evidence that oral stereognosis is predictive of word recognition performance, and that performance on the FORM differentially predicts word recognition tasks (spell vs. sound). Overall, these findings inform current print-to-speech frameworks by identifying a relationship between sensorimotor information, specifically, oral stereognosis ability, and reading performance. [ABSTRACT FROM AUTHOR]

The objective of the present study was to find out the current practices in evaluating and managing vestibular disorders across the country by Audiologists in India. An e-survey was performed. A total of 31 questions were prepared for the survey. The survey questionnaire was circulated among 400 Audiologists. Out of 400 participants, 248 participants responded to the survey. Out of 248 participants, 111 participants reported performing vestibular testing. Most of the professionals worked in a corporate setup. Total patients with vestibular disorders reported to these setups ranged from 1-2 per month to 100–120 patients/month. Regarding the clinical tests, most participants reported performing the Romberg test, Fukuda stepping test, tests for cerebellar functioning and HINTS/HINTS plus in their setup for vestibular assessment and management. Regarding the barriers to vestibular assessment and management, most participants indicated that the lack of necessary training and experience to conduct vestibular assessment and management procedures was significant. There is a lot of variability in assessment and management procedures among the professionals. There is a need to make uniform protocol across the country, and the vestibular assessment and management should be included as a separate course in their curriculum. [ABSTRACT FROM AUTHOR]

Human voice is an extremely important biological signal which contains information about sex, age, emotional state, health and physical features of a speaker. Estimating a physical appearance from a vocal cue can be an important asset for sciences including forensics and dietetics. Although there have been several studies focused on the relationships between vocal parameters and ratings of height, weight, age and musculature of a speaker, to our knowledge, there has not been a study examining the assessment of one's BMI based on voice alone. The purpose of the current study was to determine the ability of female "Judges" to evaluate speakers' (men and women) obesity and body fat distribution from their vocal cues. It has also been checked which voice parameters are key vocal cues in this assessment. The study material consisted of 12 adult speakers' (6 women) voice recordings assessed by 87 "Judges" based on a 5-point graphic scale presenting body fat level and distribution (separately for men and women). For each speaker body height, weight, BMI, Visceral Fat Level (VFL, InBody 270) and acoustic parameters were measured. In addition, the accuracy of BMI category was verified. This study also aimed to determine which vocal parameters were cues for the assessment for men and women. To achieve it, two independent experiments were conducted: I: "Judges" had to choose one (obese) speaker from 3 voices (in 4 series); II: they were asked to rate body fat level of the same 12 speakers based on 5-point graphic scale. Obese speakers (i.e., BMI above 30) were selected correctly with the accuracy greater than predicted by chance (experiment I). By using a graphic scale, our study found that speakers exhibiting higher BMI were rated as fatter (experiment II). For male speakers the most important vocal predictors of the BMI were harmonics-to-noise ratio (HNR) and formant dispersion (Df); for women: formant spacing (Pf) and intensity (loudness). Human voice contains information about one's increased BMI level which are hidden in some vocal cues. [ABSTRACT FROM AUTHOR]

Stuttering is a puzzling disorder which involves voluntary repetition, prolongation along with blocking and other interruptions to the flow of speech. Stuttering impacts on quality of life of individuals with difficulties in overall social behavior and performance. The present study focuses on perception of stuttering by individual with stuttering and their experiences toward their stuttering among family and society. The present study was carried out in two phases. Phase 1 included the development of questionnaire and phase 2 incorporated the administration of questionnaire and analysis of the results. Total of 20 participants (16 males and 4 females) between the age ranges of 15–50 years (SD = 8.33) were included in the study. The results of present study consisted of perception of the individual with stuttering, their family members and other people regarding the probable cause, effects and treatment of stuttering. The causes were than categorized into psychological, superstitious, genetic, physiological and unknown. Likewise the treatment was categorized into speech therapy, medical treatment, self management strategies, superstitious beliefs and unknown. Many of the participants, their family members and other people had inappropriate, irrational and superstitious believes about the cause and treatment of stuttering due to which they faced many difficulties in their life. Hence from this study we conclude that there is requirement of awareness regarding the etiologies of stuttering and its consequences in hazarding the quality of life. It was also observed the urgent need of awareness regarding the speech therapy and its beneficial outcome in enhancing the fluency of individuals with stuttering, therefore, avoiding the consequence of the condition in their life. [ABSTRACT FROM AUTHOR]

The frequency of cleft lip with/without palate (CL/P) in the Mongolian population is approximately 1 in 1314 live births. This research aims to disseminate information about this congenital disability to the public to better understand CL/P, and people's fissures, and review administrative measures, as there is a lack of research in this area. A questionnaire survey was conducted using Google Forms, with 1000 Mongolian participants. Most participants (86.7%) said they had knowledge of the word, whereas 86.2% said they had knowledge of the condition. Most participants' answers were question-related disadvantages of CL/P patients, including statements such as "It's uncomfortable in human relationships" and "It makes an uncomfortable impression on the person you meet the first time." The results of this study revealed that most Mongolians were aware of CL/P and are concerned about patients. However, the causes of CL/P in the general population remain unknown, and further research is needed in this area., (© 2024 Japanese Teratology Society.)

The aim of the present study was to provide normative data in Greek, regarding sequential motion rate (SMR) and oral reading rate (ORR), and to show the sensitivity of both tasks to predict Parkinson's disease (PD). The speech rate of sixty-five healthy control participants was recorded and analyzed using speech acoustics. The speech rate of a subsample of 20 healthy control participants was compared to the speech rate of 20 pair-matched dysarthric parkinsonian participants. All participants produced the syllables /pataka/ (SMR task) as quickly as possible and read aloud a standard Greek passage (ORR task). In normative data, the mean score for the SMR variable was 4.91 syllables per second (SD = 0.73) and for the ORR variable was 4.42 syllables per second (SD = 0.87). The Mann–Whitney test showed significant differences between the two groups of participants in the SMR (U = 64.000, Z = –4.60, p <.001) and ORR (U = 77.000, Z = –4.36, p <.001). Multiple binary logistic regression analysis examined the combined effect of ORR and SMR on the occurrence of the disease. The sensitivity of both tasks to predict PD was found to be 0.88 and the specificity 0.90. The optimal screening cutoff point was found to be 4.66 syllables/second for the SMR task and 2.79 syllables/second for the ORR task. This study provided Greek normative data in SMR and ORR tasks. Both tasks showed high sensitivity and specificity to predict PD in the Greek sample of participants. [ABSTRACT FROM AUTHOR]

Velopharyngeal insufficiency (VPI), which is the incomplete closure of the velopharyngeal valve during speech, is a typical poor outcome that should be evaluated after cleft palate repair. The interpretation of VPI considering both imaging analysis and perceptual evaluation is essential for further management. The authors retrospectively reviewed patients with repaired cleft palates who underwent assessment for velopharyngeal function, including both videofluoroscopic imaging and perceptual speech evaluation. The final diagnosis of VPI was made by plastic surgeons based on both assessment modalities. Deep learning techniques were applied for the diagnosis of VPI and compared with the human experts' diagnostic results of videofluoroscopic imaging. In addition, the results of the deep learning techniques were compared with a speech pathologist's diagnosis of perceptual evaluation to assess consistency with clinical symptoms. A total of 714 cases from January 2010 to June 2019 were reviewed. Six deep learning algorithms (VGGNet, ResNet, Xception, ResNext, DenseNet, and SENet) were trained using the obtained dataset. The area under the receiver operating characteristic curve of the algorithms ranged between 0.8758 and 0.9468 in the hold-out method and between 0.7992 and 0.8574 in the 5-fold cross-validation. Our findings demonstrated the deep learning algorithms performed comparable to experienced plastic surgeons in the diagnosis of VPI based on videofluoroscopic velopharyngeal imaging., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD.)

Investigations of neuromuscular control of voice production have primarily focused on the roles of muscle activation levels, posture, and stiffness at phonation onset. However, little work has been done investigating the stability of the phonation process in regards to spontaneous changes in vibratory mode of vocal fold oscillation as a function of neuromuscular activation. We evaluated 320 phonatory conditions representing combinations of superior and recurrent laryngeal nerve (SLN and RLN) activations in an in vivo canine model of phonation. At each combination of neuromuscular input, airflow was increased linearly to reach phonation onset and beyond from 300 to 1400 mL/s. High-speed video and acoustic data were recorded during phonation, and spectrograms and glottal-area-based parameters were calculated. Vibratory mode changes were detected based on sudden increases or drops of local fundamental frequency. Mode changes occurred only when SLNs were concurrently stimulated and were more frequent for higher, less asymmetric RLN stimulation. A slight increase in amplitude and cycle length perturbation usually preceded the changes in the vibratory mode. However, no inherent differences between signals with mode changes and signals without were found. [ABSTRACT FROM AUTHOR]

Introduction: Factors such as teachers' appropriate support and social interactions have an impact on the academic performance of children with cleft lip and/or palate (CL/P). This study was designed to investigate the perceptions of the teachers and the general public about the academic and cognitive performance of individuals with CL/P. Methods: This study was included 360 (male/female = 102/258) teachers and 640 (male/female = 259/381) participants that represent the general public. Anonymized web-based and paper-and-pencil self-administered questionnaire that included multiple-choice and yes/no questions were administered. Within-group differences and intergroup differences were analyzed in terms of academic and cognitive performance. Results: Most of the teachers and the general public indicated that the academic and cognitive performance of individuals with CL/P is the same as their unaffected peers. A significantly higher proportion of the teachers indicated that the academic performance of children with CL/P is the same as their unaffected peers than the general public. Conclusion: Considering that the general public's attitudes and appropriate teacher support are crucial to prevent adverse impacts on the lives of individuals with CL/P, it is important to support teachers with the appropriate information and to encourage the public to recognize that everybody with a facial difference should be treated as an individual rather than a disability. [ABSTRACT FROM AUTHOR]