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The obturator prosthesis is the main method for the rehabilitation of large maxillary defects. With the purpose to close the defect, separate the oral cavity from the nasal cavity, prevent hypernasal speech, nasal regurgitation of food and liquids and provide support for the facial profile. This article aims to report a case of rehabilitation with maxillary obturator prosthesis after partial maxillectomy. A 72-year-old female patient, diagnosed with adenoid cystic carcinoma in the palate region, underwent partial maxillectomy that resulted in extensive maxillary defect and bucco-sinus communication. After anamnesis, extra, intraoral and radiographic exams, the construction of a palatal plate was planned to be used with the nasogastric tube and during the healing process, to improve swallowing and speech. Then, the manufacture of a maxillary obturator prosthesis and a lower removable partial prosthesis. The palatal plate was made and used until the tube was removed and the insertion of the prostheses. After the impressions, master casts were made and mounted on an articulator after adjustment of wax occlusion rims and registration of the maxillo-mandibular relations. Functional elements of speech, occlusion, and appearance were evaluated during the try-in of the provisional set-up and adjusts were made. After the acrylization, the prostheses were inserted and the occlusal adjustment performed. To obtain satisfactory retention and stability when using the maxillary obturator prosthesis, it was suggested to use denture adhesive. Three post-insertions visits were carried out. The obturator prosthesis rehabilitated aesthetics, phonetics, masticatory function and swallowing, restoring the patient's self-esteem and improving social life.

Postoperative hemimaxillectomy defects cause the patient to develop conditions such as nasal discharge (hypernasal speech), leakage of fluid in the nasal cavity, and deterioration of masticatory function. Thus, comprehensive rehabilitation is required to improve mastication, speech function and normal orofacial appearance. Successful prosthetic rehabilitation of postoperative hemimaxillectomy defect is a challenging procedure that requires multidisciplina- ry expertise to achieve acceptable esthetics, functional speech and swallowing outcomes. This case report describes clinical steps and laboratory procedures involved in prosthetic rehabilitation of an Aramany Class IV hemimaxillectomy patient with framework obturator.

God has given beautiful face and smile to human being. It is right of every individual to look good. If an individual lost his/her facial part due to certain cause, it has to be restored immediately. Patient will face severe mental trauma and functional disability after maxillofacial structure loss. Post-surgical maxillary defects pre-dispose the patient to hypernasal speech, fluid leakage into the nasal cavity, and impaired masticatory function. Such defects need special prosthesis to establish oro-nasal seal and rehabilitate the patient. After maxillectomy, the prosthodontist treats the defect with obturator. The obturator takes the retention from remaining teeth, undercut areas and scar bands around the defect. In this article, a technique for creating an interim maxillary hollow bulb obturator that engages the remaining teeth, undercut areas and scar band around the defect is described. Keywords: Maxillectomy, Obturator, Oroantral communication, Interim obturator, Pre-maxilla defect.

Patient Palatal lift prostheses (PLPs) are used for dysarthria caused by velopharyngeal incompetence (VPI) and improving hypernasal speech. In this case, we used a PLP with a flexible lift (f-PLP) in a patient with dysphagia associated with VPI due to right-sided cranial nerve injuries after a skull base surgery. We examined its efficacy in swallowing biomechanics and swallowing function using high-resolution manometry (HRM) and videofluoroscopic examination of swallowing (VF). The patient felt that it was easier to swallow with f-PLP. Furthermore, VF indicated that the pharyngeal residue with f-PLP was less than without it. HRM showed that velopharyngeal pressure and intrabolus pressure (IBP) with f-PLP were higher than those without it. Additionally, the upper esophageal sphincter (UES) relaxation time and UES nadir pressure on the patient's healthy left side compared to the right side improved with f-PLP. Discussion We discovered two clinical outcomes. First, the f-PLP ensured velopharyngeal closure and an increase in the hypopharyngeal IBP, which potentially improved the UES opening on the healthy side. Second, the f-PLP improved pharyngeal clearance, and the patient felt that it was easier to swallow with the f-PLP. This implies that an f-PLP potentially exhibits a positive effect on swallowing. Conclusions In this case, the f-PLP contributed to improving the pharyngeal passage of a bolus. We suggest that f-PLPs can be used for patients with dysarthria and those with dysphagia with VPI.

Hypernasality in the speech of children with cleft palate is a consequence of velopharyngeal insufficiency. The spectral analysis of hypernasal speech shows the presence of nasal formants and anti-formants in the spectrum which affects the harmonic-intensity. The nasal formants increase whereas the anti-formants decrease the magnitude of harmonics around its location of addition. Hence, the spectrum of hypernasal and normal speech is different from each other. To capture the spectral difference, three features namely, normalized harmonic amplitude (NHA), harmonic amplitude ratio (HAR), and prominent harmonics frequency (PHF) are proposed in this work. NHA feature is the magnitude of harmonics after their normalization with respect to the maximum magnitude, HAR feature is the relative magnitude of harmonics with respect to their previous harmonics, and the PHF feature is the frequencies of prominent harmonics in the spectrum. The combination of three features gives an accuracy of 82.46%, 87.89%, 84.25% for /a/, /i/ and /u/ vowels respectively for the detection of hypernasality using support vector machine classifier.

The speech of the individuals with cleft palate (CP) is generally characterized by the presence of abnormal nasal resonances during the production of voiced sounds, primarily in vowels, and is called hypernasality. Hypernasality is present in more than 50% of the individuals with CP, and it often results in degraded speech, both in quality and intelligibility. The current work describes the signal processing based enhancement of CP speech, where specifically hypernasal speech modification is addressed. The hypernasal speech’s residual and vocal tract system characteristics are analyzed using an extended weighted linear prediction (XLP) method. The enhancement is performed for three different variants: XLP residual weighting in the time domain, Gaussian mixture model-based spectral conversion in the frequency domain, and combined modification of the XLP residual and vocal tract system characteristics. The modified hypernasal speech achieved by the proposed method is evaluated using different objective and subjective measures for the vowel /a/, /i/, and /u/. The evaluation results indicate that the combination of XLP residual and vocal tract system characteristics modification yields better results than XLP residual or vocal tract system characteristics modification alone.

BackgroundVelopharyngeal insufficiency is the inability to close the velopharyngeal port during speech and swallowing, leading to hypernasal speech and food regurgitation.ObjectiveThis study aimed to explore the aetiological factors contributing to the development of velopharyngeal insufficiency in a non-cleft paediatric population, especially following adenoidectomy.MethodsA retrospective case review was conducted of all children without a known cleft palate, born between 2000 and 2013, who were referred to a tertiary cleft centre with possible velopharyngeal insufficiency.ResultsThe data for 139 children diagnosed with velopharyngeal insufficiency following referral to the cleft centre were analysed. Thirteen patients developed the condition following adenoidectomy; only 3 of these 13 had a contributing aetiological factor.ConclusionVelopharyngeal insufficiency is a rare but significant complication of adenoidectomy. The majority of patients who developed velopharyngeal insufficiency following adenoidectomy did not have an identifiable predisposing factor. This has important implications for the consent process and when planning adenoidectomy.

Hypernasality is a common characteristic symptom across many motor-speech disorders. For voiced sounds, hypernasality introduces an additional resonance in the lower frequencies and, for unvoiced sounds, there is reduced articulatory precision due to air escaping through the nasal cavity. However, the acoustic manifestation of these symptoms is highly variable, making hypernasality estimation very challenging, both for human specialists and automated systems. Previous work in this area relies on either engineered features based on statistical signal processing or machine learning models trained on clinical ratings. Engineered features often fail to capture the complex acoustic patterns associated with hypernasality, whereas metrics based on machine learning are prone to overfitting to the small disease-specific speech datasets on which they are trained. Here we propose a new set of acoustic features that capture these complementary dimensions. The features are based on two acoustic models trained on a large corpus of healthy speech. The first acoustic model aims to measure nasal resonance from voiced sounds, whereas the second acoustic model aims to measure articulatory imprecision from unvoiced sounds. To demonstrate that the features derived from these acoustic models are specific to hypernasal speech, we evaluate them across different dysarthria corpora. Our results show that the features generalize even when training on hypernasal speech from one disease and evaluating on hypernasal speech from another disease (e.g. training on Parkinson's disease, evaluation on Huntington's disease), and when training on neurologically disordered speech but evaluating on cleft palate speech., 12 pages, 9 figures, 2 tables

The presence of hypernasality in repaired cleft palate (CP) speech is a consequence of velopharyngeal insufficiency. The coupling of the nasal tract with the oral tract adds nasal formant and antiformant pairs in the hypernasal speech spectrum. This addition deviates the spectral and linear prediction (LP) residual characteristics of hypernasal speech compared to normal speech. In this work, the vocal tract constriction feature, peak to side-lobe ratio feature, and spectral moment features augmented by low-order cepstral coefficients are used to capture the spectral and residual deviations for hypernasality detection. The first feature captures the lower-frequencies prominence in speech due to the presence of nasal formants, the second feature captures the undesirable signal components in the residual signal due to the nasal antiformants, and the third feature captures the information about formants and antiformants in the spectrum along with the spectral envelope. The combination of three features gives normal versus hypernasal speech detection accuracies of 87.76%, 91.13%, and 93.70% for /a/, /i/, and /u/ vowels, respectively, and hypernasality severity detection accuracies of 80.13% and 81.25% for /i/ and /u/ vowels, respectively. The speech data are collected from 30 control normal and 30 repaired CP children between the ages of 7 and 12.

Children with infantile-onset Pompe disease (IOPD) demonstrate hypernasality. This study aimed to evaluate whether continuous positive airway pressure (CPAP) training may reduce hypernasality in children with IOPD. Five children with IOPD were enrolled in a single-subject experimental design of type A-B-A′. The intervention comprised an 8-week, 6-day-per-week regimen of CPAP training at home. Participants continued traditional speech therapy once per week throughout the 24-week study duration. The outcome measurements included the degree of hypernasality (DH), the percentage of consonants correct (PCC), and the speech intelligibility score (SIS). C-statistic analysis with an α of 0.05 was used along with visual analysis to assess speech changes. Three patients completed the study. During the CPAP training phase, the DH, PCC, and SIS were significantly improved compared with the baseline (p p

Background Cleft palate patients have inability to produce adequate velopharyngeal closure, which results in hypernasal speech. In clinic, hypernasal speech is assessed through subject assessment by speech language pathologists. Automatic hypernasal speech detection can provide aided diagnoses for speech language pathologists and clinicians. Objectives This study aims to develop Long Short-Term Memory (LSTM) based Deep Recurrent Neural Network (DRNN) system to detect hypernasal speech from cleft palate patients, thus to provide aided diagnoses for clinical operation and speech therapy. Meanwhile, the feature mining and classification abilities of LSTM-DRNN system are explored. Methods The utilized speech recordings are 14,544 vowels in Mandarin. Speech data is collected from 144 children (72 children with hypernasality and 72 controls) with the age of 5–12 years old. This work proposes a LSTM based DRNN system to achieve automatic hypernasal speech detection, since LSTM-DRNN can learn short-time dependences of hypernasal speech. The vocal tract based features are fed into LSTM-DRNN to achieve deep mining of features. To verify the feature mining ability of LSTM-DRNN, features projected by LSTM-DRNN are fed into shallow classifiers instead of the following two fully connected layers and a softmax layer. And the features without the projecting process of LSTM-DRNN are directly fed into shallow classifiers as a comparison. Hypernasality-sensitive vowels (/a/, /i/, and /u/) are analyzed for the first time. Results This LSTM-DRNN based hypernasal speech detection method reaches higher detection accuracy than that using shallow classifiers, since LSTM-DRNN mines features through time axis and network depth simultaneously. The proposed LSTM-DRNN based hypernasality detection system reaches the highest accuracy of 93.35%. According to the analysis of hypernasality-sensitive vowels, the experimental result concludes that vowels /i/ and /u/ are the most sensitive vowels to hypernasal speech. Conclusions The results show that LSTM-DRNN has robust feature mining ability and classification ability. This is the first work that applies the LSTM-DRNN technique to automatically detect hypernasality in cleft palate speech. The experimental results demonstrate the potential of deep learning on pathologist speech detection.

The surgical approach for the correction of residual velopharyngeal insufficiency requiring secondary surgery at Chang Gung Memorial Hospital is the modified Furlow palatoplasty with pharyngeal flap (mFP-PF). The aim of this study was to describe the mFP-PF technique and to determine the results obtained with regard to improvements in velopharyngeal function in patients undergoing this surgery. This retrospective analysis included 58 non-syndromic patients treated during the period 1992-2015 who complained of hypernasal speech after primary cleft palate repair and failed postoperative speech therapy. All of them underwent mFP-PF surgery. Preoperative and postoperative perceptual speech assessment results were obtained. The male to female ratio in the study group was 1.2:1, and the mean patient age at the time of surgery was 8.27 years. The patients underwent nasoendoscopic examination and the velar closing ratio was categorized as 0.1-0.4 in 53.4% and 0.5-0.7 in 46.6%. The assessment of speech after mFP-PF showed statistically significant changes for all perceptual speech outcomes. The incidence of repeat surgery was 3.4%. This study revealed that 96.6% of patients did not require second surgery for velopharyngeal insufficiency. Further studies on obstructive sleep apnoea in post-mFP-PF patients and improvements to the surgical technique should be considered.

Cocaine abuse is associated with severe local effects on mucosal and osteocartilaginous structures, with a centrifugal spreading pattern from the nose, a condition known as cocaine-induced midline destructive lesions (CIMDL). When the soft or hard palate is affected, a perforation may occur, with subsequent oro-nasal reflux and hypernasal speech. Both diagnosis and therapy (surgical or prosthetic) constitute a serious challenge for the physician. The cases of three patients affected by cocaine-induced palatal perforation and treated with a palatal obturator at San Raffaele Dentistry department between 2016 and 2019 are presented. In addition, the literature was reviewed in search of papers reporting the therapeutic management in patients affected by cocaine-induced palatal perforation. All the patients in our sample suffered from oro-nasal reflux and hypernasal speech, and reported a significant impact on interpersonal relationships. The results at the delivery of the obturator were satisfactory, but the duration of such results was limited in two cases, as the progression of the disease necessitated continuous modifications of the product, with a consequent increase in costs and a reduction in patient satisfaction. In conclusion, the therapy for palatal defects in CIMDL includes both reconstructive surgery and prosthetic obturators, the latter being the only possibility in the event of active disease. It successfully relieves symptoms, but the long-term efficacy is strongly related to the level of disease activity.

Children with infantile-onset Pompe disease (IOPD) demonstrate hypernasality. This study aimed to evaluate whether continuous positive airway pressure (CPAP) training, effective in reducing hypernasality in subjects with velopharyngeal insufficiency, may reduce hypernasality in children with IOPD. Five children with IOPD were enrolled to partake in an 8-week, 6-day-per-week regimen of CPAP training at home, involving 8 week baseline, 8 week CPAP training, and 8 week follow-up outcome assessment combined with regular speech therapy once per week. The outcomes included the degree of hypernasality (DH), the percentage of consonants correct (PCC), and the speech intelligibility score (SIS). C-statistic analysis with an α of .05 (z ≥ 1.645) and visual analysis were used to assess speech changes. Three patients completed the study. During the CPAP training phase, the DH, PCC, and SIS were significantly improved compared with the baseline (p ≤ .05). At the follow-up phase, both DH and SIS were improved compared with the baseline (p ≤ .05), but the PCC had returned to the baseline level (p ≥ .05). CPAP training demonstrated effectiveness in reducing nasal sounds in IOPD patients. Further studies involving training younger children with normal hearing may help elucidate the persistence of the effects in children with IOPD.

Background. Hemimaxillectomy of acquired palatal defects may predispose the patient to hypernasal speech, leakage of fluids into the nasal cavity, impaired masticatory function, and swallowing difficulties leading to a detrimental impact on the quality of life. Sequentially, it can also affect individual character and trust in social life, leading to social phobia and anxiety. This article presents prosthodontic management of a young male patient with deformation of the entire right half of the face due to surgical removal of odontogenic myxoma. It describes a method where the clinician utilized a simple, noninvasive, and cost-effective technique to cut the weight of the obturator and to attain aesthetics, utilizing a detachable lip and cheek plumper. Case Presentation. A 19-year-old male attended the Prosthodontic Clinics at Faculty of Dentistry, the University of Khartoum, eight months after the surgical removal of a tumor. The chief complaint was difficulty eating or drinking. Furthermore, he dropped out of school because of his facial deformity and his indistinct voice. Medical and dental history revealed surgical resection of the entire right half of the maxillary alveolar bone due to myxoma. Intraoral examination revealed a well-healed surgical defect in the maxillary right buccal vestibule creating an oroantral communication. A treatment plan was formulated, keeping the patient’s demand in mind. The decision was made to treat the patient with a maxillary obturator that would gain its support from the remaining teeth and tissues with a detachable cheek and lip plumper. The use of dental magnets as a means of attachment was elected. Conclusion. This article has described a simple, noninvasive, and cost-effective method to improve facial appearance in patients with hollow faces. The plumper prosthesis successfully improved the patient’s appearance to the extent that comfort and function would permit and encourage self-esteem.

Submucosal Cleft Palate A 25-year-old man presented to the otolaryngology clinic with hypernasal speech and regurgitation of food into the nasal cavity. Physical examination revealed a bifid uvula ...

Despite uneventful primary surgery, patients with cleft palate may experience velopharyngeal insufficiency (VPI) and hypernasal speech. Videoradiography of velopharynx is a commonly used method to visualize velopharyngeal function and a velopharyngeal flap is often used to counteract VPI. The aim of this study was to investigate whether the frontal projection on videoradiography plays a role in the decision-making about velopharyngeal flap surgery, or possibly the width and orientation of the flap. A secondary aim was to evaluate the effect of the flap in improving velopharyngeal function. Between 2007 and 2016, 75 patients had received a flap at our department. During the same period of time, 41 patients who had undergone videoradiography did not receive a flap. Medical records, particularly regarding speech assessments, videoradiography statements and operating records, were scrutinised to seek information about the factors leading up to the decision about whether or not to perform a flap. In only one instance, reduced lateral pharyngeal wall movement found on the frontal projection was clearly taken into account when deciding to refrain from performing a velopharyngeal flap. Only a slight agreement was found between pre-operative speech assessment and findings in videoradiography. Hypernasality was reduced by flap surgery in 97% of the patients. We conclude the frontal projection of the videoradiographic examination seems to have no crucial role in the decision-making on performing a velopharyngeal flap or not in patients with cleft palate. Even with reduced lateral pharyngeal wall movement, a velopharyngeal flap effectively reduces hypernasality and VPI.

Multiple anterior surgical approaches are available to obtain access to the nasopharynx, clivus, and craniocervical junction. These include the direct and transoral robotic surgery transpalatal, maxillary swing, and endoscopic endonasal approaches. In this article, we describe the indications for these techniques, surgical steps, and associated morbidities. This article is a PubMed literature review. A review of the literature was conducted to assess the techniques, surgical steps, and associated morbidities with transpalatal approaches to the skull base and nasopharynx. The transpalatal approach has been traditionally utilized to obtain surgical access to the nasopharynx, clivus, and craniocervical junction. Morbidity includes velopalatine insufficiency due to shortening of the soft palate from scar contraction or neuromuscular damage, thus leading to hypernasal speech and dysphagia. Middle ear effusion and oronasal or oronasopharyngeal palatal fistula are additional potential morbidities. The choice of surgical approach depends on a variety of factors including the disease location and extent, surgeon experience, and available resources.

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 de concordância interpretados como melhores estímulos para identificação da hipernasalidade. Resultados Índices de concordância intra-avaliadores de estímulos de fala vozeados foram significativamente menores do que outros estímulos. Índices de concordância entre os pares de fonoaudiólogas variaram de 0,11 (concordância estímulos plosivos vozeados) a 0,57 (12 frases, uma com cada consoante de alta pressão), com média de 0,47 entre as três avaliadoras, indicando concordância moderada para identificação da hipernasalidade. Conclusão Gravações de fala obtidas durante a produção de estímulos mais longos, incluindo 12 frases, uma com cada consoante de pressão, podem favorecer a concordância interavaliador na identificação da hipernasalidade.

Objective Speech intelligibility is fundamental to social interactions and a critical surgical outcome in patients with cleft palate. Online crowdsourcing is a burgeoning technology, with potential to mitigate the burden of limited accessibility to speech-language-pathologists (SLPs). This pilot study investigates the concordance of online crowdsourced evaluations of hypernasality with SLP ratings of children with cleft palate. Methods Six audio-phrases each from children with cleft palate were assessed by online crowdsourcing using Amazon Mechanical Turk (MTurk), and compared to SLP’s gold-standard hypernasality score on the Pittsburgh Weighted Speech Score (PWSS). Phrases were presented to MTurk crowdsourced lay-raters to assess hypernasality on a Likert scale analogous to the PWSS. The survey included clickable reference audio samples for different levels of hypernasality. Results 1,088 unique online crowdsourced speech ratings were collected on 16 sentences of 3 children with cleft palate aged 4–8 years, with audio averaging 6.5 years follow-up after cleft palate surgery. Patient 1 crowd-mean was 2.62 (SLP rated 2–3); Patient 2 crowd-mean 2.66 (SLP rated 3); and Patient 3 crowd-mean 1.76 (SLP rated 2). Rounded for consistency with PWSS scale, all patients matched SLP ratings. Different sentences had different accuracies compared to the SLP gold standard scores. Conclusion Online crowdsourced ratings of hypernasal speech in children with cleft palate were concordant with SLP ratings, predicting SLP scores in all 3 patients. This novel technology has potential for translation in clinical speech assessments, and may serve as a valuable screening tool for non-experts to identify children requiring further assessment and intervention by a qualified speech language pathology expert.

Chromosome 22q11.2 deletion syndrome (22q11.2DS) is one of the most common genetic syndromes. The varying presentation and severity of this syndrome result in diagnostic delays, especially in patients without cardiac malformation or characteristic features. We report a noncardiac case of 22q11.2DS with white matter abnormalities and velopharyngeal insufficiency. The recognition of white matter abnormalities as a feature of 22q11.2DS contributed to early diagnosis. Diagnostic delay could lead to inappropriate management and unfavorable outcomes. Increased awareness of the various minor features of 22q11.2DS may enable clinicians to diagnose this syndrome earlier and provide appropriate medical management.

Objective Intranasal substance abuse with cocaine or opioids can result in complications involving the midline nasal and oral structures. When the defect involves the velopharyngeal musculature, this leads to velopharyngeal dysfunction (VPD). This article aims to illustrate this clinical entity through a series of four patients and a review of the literature. Methods A series of four cases of VPD due to intranasal narcotic use and their management are discussed. A comprehensive search in PubMed was conducted for cases of VPD associated with intranasal drug use in the English-language literature. Results Four female patients presented with symptoms of VPD, including worsening nasal regurgitation, poor speech intelligibility, and hypernasal speech. One patient presented with nasopharyngeal stenosis. All patients admitted to intranasal cocaine, methamphetamine, and/or prescription narcotics use prior to the onset of symptoms. The diagnosis was confirmed with abnormal velopharyngeal musculature seen on nasopharyngoscopy. Both conservative and surgical treatment options were proposed. A literature review identified nine cases of VPD. Erosion of the velum was seen in all cases. Reported treatments included obturator prosthetic, local flap, and free flap. Ancillary investigations were not consistently pursued to rule out other etiologies to VPD. Conclusion Intranasal illicit drug use can result in destructive changes leading to VPD. This is the largest case series to date of this difficult clinical problem. Management principles including options for conservative and surgical interventions are summarized. Level of evidence 4 Laryngoscope, 128:2721-2725, 2018.

Background Myotonic dystrophy type 1 (DM1) is a slowly progressive multi-systemic disease with an autosomal-dominant inheritance caused by a mutation on chromosome 19 (19q13.3). Aims To explore speech characteristics in a group of individuals with the congenital and childhood-onset forms of DM1 in terms of intelligibility, speech-sound production, nasality and compensatory articulation. A further aim was to analyse whether speech characteristics were correlated to subforms of DM1 and if speech outcome could be related to muscle strength. Methods & procedures Fifty native Swedish speakers (7-29 years old) with the congenital and childhood-onset forms of DM1 and 13 healthy controls participated in the study. The intelligibility of spontaneous speech, speech-sound production - single-word and sentence repetition - including percentage consonants correct (PCC) and compensatory articulation, were evaluated by speech-language pathologists from video recordings. A nasometer and lip-force meter were used for objective evaluations of nasality and orofacial strength. Outcomes & results In severe (n = 9) and mild congenital DM1 (n = 13), all participants had impaired intelligibility to some degree, while this applied to 79% of those with childhood DM1 (n = 28). PCC for bilabials were 53.9% in severe congenital DM1, 57.4% in mild congenital DM1 and 85.3% in childhood DM1; the corresponding results for dentals were 69.3%, 59.2% and 87.3%. Bilabials were most often compensated for with interdental or labiodental articulation. Dentals were substituted with interdental articulation. Velars were seldom affected. The mean nasalance score was high in the study group compared with controls and with normative data and the majority had weak lips. Maximum lip force, as well as the mean nasalance score, correlated significantly with the intelligibility score. Conclusions & implications The deviant production of bilabial consonants, interdental articulation and hypernasal speech are characteristic features of dysarthria in congenital and childhood DM1. Dysarthria is more frequent and more severe in congenital DM1 compared with childhood DM1. Most individuals with congenital DM1 and childhood-onset DM1 will need speech therapy from a young age. For some children with incomprehensible speech or severe neurodevelopmental disorders, alternative and augmentative ways of communication will be part of the treatment.

Oropharyngeal stenosis (OPS) is a rare postoperative complication of adenotonsillectomy that can be a source of considerable patient distress and morbidity. Circumferential scarring of the soft palate and tonsillar pillars leads to narrowing of the oropharyngeal aperture. This case report describes the novel use of bilateral buccal myomucosal flaps for the repair of postoperative OPS in a 20-year-old woman presenting with dysphagia, odynophagia, dyspnea, and intermittent hypernasal speech. Postoperatively, the patient noted immediate improvement of her symptoms. At 1-month follow-up, she noted complete resolution of her symptoms with no dysphagia, nasal regurgitation, speaking difficulty, dyspnea, or gagging. The buccal flaps were well healed and completely intact, maintaining appropriate height of the tonsillar pillars. The buccal myomucosal flap is an effective tool for numerous palatal and oropharyngeal abnormalities and, as described in this case study, is a reliable, safe, and effective technique that can be considered for the reconstruction of postsurgical OPS.

Introduction There is change in nasalance post endonasal surgery which is not permanent. Objectives The objective of this study is to evaluate the long-term nasalance changes following different types of endonasal surgeries. Methods We included in this study patients who underwent sinonasal surgery at the Otorhinolaryngology Department in Zagazig University Hospitals from February 2015 until March 2016. We divided the patients into two groups according to the surgeries they underwent: Group (A) was the FESS group and group (B), the septoturbinoplasty group. We checked nasalance using a nasometer before and after the sinonasal surgery. Results Nasalance increased at one month after the operation in both groups. However, it returned to nearly original levels within three months postoperatively. Conclusion FESS, septoplasty, and turbinate surgery may lead to hypernasal speech. This hypernasal speech can be a result of change in the shape and diameter of the resonating vocal tract. Hypernasal speech in these circumstances may be a temporary finding that can decrease with time. Surgeons should inform their patients about the possibility of hypernasality after such types of surgery, especially if they are professional voice users.

Sino-orbital fistulas can occur after orbital exenteration. Chronic nonhealing fistulas lead to bothersome symptoms including malodorous discharge, hypernasal speech, crusting, wound breakdown, or inability to wear an ocular prosthesis. Reconstruction can be difficult due to the complexity of the defects and the multitude of treatments patients often undergo for the management of the primary disease. Prior radiation, lack of available local tissue, or compromised blood supply are some of the issues that make successful fistula closure problematic. This report describes a method for autologous vascularized tissue coverage using a contralateral nasoseptal flap to successfully close a sino-orbital fistula.

Opioids are becoming more common in the treatment of chronic nonmalignant pain. With increased availability of opioids for chronic pain we may expect an increased misuse of these as analgesics as well. The authors describe the case report of a young woman with chronic back pain and intranasal abuse of prescribed hydrocodone/acetaminophen who was diagnosed after presenting for hypernasal speech and foreign body in the nose. This case report highlights the need for vigilance on the part of the physician for any aberrant drug-related behaviors. Any unusual symptoms or signs such as hypernasal speech, chronic nasal infection, or unexplained foreign body sensation in the nose should be thoroughly investigated.

A 6-year-old girl with acute pharyngitis presented with complaints of hypernasal speech and double vision. Examination revealed a bilateral abduction deficit associated with soft palate palsy causing rhinolalia aperta. Cerebrospinal fluid analysis showed albuminocytologic dissociation. Her sister also suffered from the same disorder, albeit milder, 1 month before. After treatment with intravenous immunoglobulin and steroids, the patient made a full recovery. After the case report, a brief discussion of Miller Fisher syndrome, Guillan–Barré syndrome, and their variants is made. This case highlights that bilateral sixth nerve palsy and rhinolalia aperta in the absence of ataxia should still raise suspicion for these autoimmune conditions that may rarely and atypically present in siblings.

Hypernasal speech is a common symptom across several neurological disorders; however it has a variable acoustic signature, making it difficult to quantify acoustically or perceptually. In this paper, we propose the nasal cognate distinctiveness features as an objective proxy for hypernasal speech. Our method is motivated by the observation that incomplete velopharyngeal closure changes the acoustics of the resultant speech such that alveolar stops /t/ and /d/ map to the alveolar nasal /n/ and bilabial stops /b/ and /p/ map to bilabial nasal /m/. We propose a new family of features based on likelihood ratios between the plosives and their respective nasal cognates. These features are based on an acoustic model that is trained only on healthy speech, and evaluated on a set of 75 speakers diagnosed with different dysarthria subtypes and exhibiting varying levels of hypernasality. Our results show that the family of features compares favorably with the clinical perception of speech-language pathologists subjectively evaluating hypernasality.

BACKGROUND: Cleft palate, due to damage of the soft palate, leads to dysfunction, i.e., inappropriate closure of the velopharynx during speech production, thus resulting in velopharyngeal insufficiency which characterises with hypernasal speech and nasal air loss/emission during speech production. AIM: To establish the relationship between the type of cleft according to the Veau classification and the degree of nasal air emission in the speech of patients with cleft using auditory-visual perceptual assessment procedures. MATERIAL AND METHODS: A group of 40 patients with irregular speech aged 4 to 7, out of which 20 with cleft palate or cleft lip and palate, participated in the research. The Veau classification was used to classify the cleft severity, while an indirect instrumental examination was conducted with the See-Scape instrument to detect nasal air emission during the speech. RESULTS: The respondents with cleft palate or cleft lip and palate of higher Veau class had a greater degree of nasal air emission during the speech. There is a positive, statistically significant correlation between the results obtained with the Veau classification of cleft lip and palate, and the degree of nasal air emission. The value of Spearman’s coefficient of correlation is R = 0.46, and the calculated p-value is p = 0.04. CONCLUSION: A more severe cleft type is associated with an increased degree of nasal air emission during the speech, and vice versa.

Hypernasality is a speech deficit that affects children with cleft lip and palate (CLP). It is characterized by the lack of control of the velum, which causes problems when controlling the amount of air passing from the oral to the nasal cavity while speaking. The automatic evaluation of hypernasality could help in the monitoring of speech-language therapies and in the design of better oriented exercises. Several articulation features have been used for the automatic detection of hypernasal speech. This paper evaluates the suitability of classical articulation features for the automatic classification of hypernasal and healthy speech recordings. Two different databases are considered with recordings collected under different acoustic conditions and with different audio settings. Besides the evaluation of the proposed approach upon each database separately, non-parametric statistical tests are performed to evaluate the possibility of merging features from the two databases with the aim of finding more robust systems that could be used in different acoustic conditions. The results indicate that the proposed approach has a high sensitivity, which indicates that it is suitable to detect hypernasal speech samples. We believe that promising results could be obtained with this approach in future experiments where the degree of hypernasality is evaluated.

Nasometry is a method of measuring the acoustic correlates of resonance through a computer-based instrument called nasometer. High nasalance scores in comparison to normative data suggest hypernasality and/or other nasality disorders, while low scores suggest hyponasality. Normative values of nasalance for Egyptian Arabic speakers were established using the Arabic SNAP (Simplified Nasometric Assessment Procedures) test. Objectives to evaluate the diagnostic accuracy of Arabic SNAP test to allow for its use in the differentiation between normal and hypernasal speech in Egyptian Arabic-speaking children. Methods Nasalance scores of normal children (n = 92) on Arabic SNAP test were compared to those of 30 children with velopharyngeal insufficiency due to cleft palate. Receiver operating characteristic (ROC) curve was used to determine cutoff points with the highest sensitivity and specificity. Results Statistically significant differences were found between both groups for all items in nasometric evaluation (p 0.05). Cutoff points were determined and certain items were selected for routine nasometric evaluation. Conclusion The Arabic SNAP test is a sensitive and specific tool for evaluation of children with hypernasality and can be used for both diagnosis and follow up of these cases.

A palatal lift prosthesis (PLP) is an intraoral device that provides lift for the soft palate. The usual purpose of a PLP is to reduce nasopharyngeal reflux and the hypernasal speech caused by velopharyngeal incompetence. However, for this patient, the main purpose was to relieve a functional blockage at the oropharyngeal isthmus by suspending the soft palate. A PLP with soft and flexible lift was applied in a patient with a traumatic brain injury and dysphagia. The PLP improved oropharyngeal bolus transit time by relieving the blockage at the oropharyngeal isthmus. This type of PLP may help to improve bolus transport for patients with dysphagia.

The objective was to describe the use of a maxillary obturator supported by dental implants and ball abutments in an adult edentulous unilateral cleft patient. Adult edentulous cleft patients who have had no corrective surgeries or failed attempts at cleft repair in childhood suffer from oronasal communication resulting in hypernasal speech, dysphagia, and compromised masticatory ability. Tissue-supported obturator prostheses in such patients provide for compromised function due to instability and lack of retention. The treatment using fibromucosal-supported obturators is well established in the literature; few articles have also described osseointegrated implants supporting the prosthesis in adult cleft patients supported by bar attachments and magnets; however, reports of implant-supported maxillary obturators retained by ball/stud attachments are scarce. The implants provided retention and stability to the prosthesis, simplifying the laboratory procedure using ball abutments, improving swallowing, speech, and the patient's general quality of life. This article reports the rehabilitation of an adult cleft palate patient with a totally edentulous maxilla using an implant-retained prosthesis.

Due to velopharyngeal incompetence, airflow overflows from the oral cavity to the nasal cavity, which results in hypernasality. Hypernasality greatly reduces speech intelligibility and affects the daily communication of patients with cleft palate. Accurate assessment of hypernasality grades can provide assisted diagnosis for speech-language pathologists (SLPs) in clinical settings. Utilizing a support vector machine (SVM), this paper classifies speech recordings into four grades (normal, mild, moderate and severe hypernasality) based on vocal tract characteristics. Linear prediction (LP) analysis is widely used to model the vocal tract. Glottal source information may be included in the LP-based spectrum. The stabilized weighted linear prediction (SWLP) method, which imposes the temporal weights on the closed-phase interval of the glottal cycle, is a more robust approach for modeling the vocal tract. The extended weighted linear prediction (XLP) method weights each lagged speech signal separately, which achieves a finer time scale on the spectral envelope than the SWLP method. Tested speech recordings were collected from 60 subjects with cleft palate and 20 control subjects, and included a total of 4640 Mandarin syllables. The experimental results showed that the spectral envelope of normal speech decreases faster than that of hypernasal speech in the high-frequency part. The experimental results also indicate that the SWLP- and XLP-based methods have smaller correlation coefficients between normal and hypernasal speech than the LP method. Thus, the SWLP and XLP methods have better ability to distinguish hypernasal from normal speech than the LP method. The classification accuracies of the four hypernasality grades using the SWLP and XLP methods range from 83.86% to 97.47%. The selection of the model order and the size of the weight function are also discussed in this paper.

Objectives Velopharyngeal insufficiency (VPI) may be due to functional or anatomic causes, and can lead to speech deficits, communication difficulty, and emotional strain on patients and their caregivers. The VPI Effects on Life Outcomes (VELO) instrument quantifies quality of life outcomes in VPI patients both before and after VPI surgery. This study aims to identify pre-operative patient characteristics associated with better post-operative quality of life. Methods This study is a retrospective chart review of 51 patients who underwent VPI surgery between 2009 and 2018 at a tertiary free-standing children's hospital. A 26-item parent-proxy VELO questionnaire was administered by telephone to parents to assess their child's quality of life post-VPI surgery. Results Twenty-seven parents responded to the VELO questionnaire. Average post-operative VELO score was significantly higher in non-syndromic patients as compared with syndromic patients. Average post-operative VELO score was not significantly different between patients with and without submucous cleft (SMC) or those with mild to moderate versus severe pre-operative hypernasality. On multivariate analysis, absence of genetic syndrome, lack of submucous cleft, and presence of severe-pre-operative hypernasality were significantly and positively associated with increased post-operative VELO scores. Conclusion Children who undergo VPI surgery are more likely to have better post-operative quality of life outcomes if their VPI was not associated with a genetic syndrome or submucous cleft. Non-syndromic and non-SMC patients with severe pre-operative hypernasality may benefit significantly from VPI surgery and have improved post-operative quality of life.

Nasal tract is an important part of our vocal tract system. It provides major impact for production of nasalised and hypernasal speech. Despite it's huge importance, the effect of nasal tract is not yet largely studied. This work is done with a motivation that, understanding characteristics of nasalised vowels and nasal filter will help in detecting nasalised speech. We have designed a device to separate nasal murmur from oral speech, when nasalised speech is spoken. In this work we have analysed speech data collected from different speakers. Firstly we have analysed nasalised vowels and found a novel feature for nasalised vowels. Then, various signal processing techniques are used to analyse the variability of nasal filter for different nasalised vowels. It is found that the nasal filter, which is the reason for nasalisation of vowels, is invariant across different nasalised vowels. Nasalised speech are produced when the nasal tract gets coupled with vocal tract. When the effect of coupling is experimented from a signal processing point of view, we found that it has an effect of addition.

Made available in DSpace on 2019-10-05T05:45:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 MITACS GlobaLink Research Award Social Sciences and Humanities Council Research Insight Development Grant Background/Purpose: Anecdotal clinical reports have stated that hypernasal speech sounds monotonous. However, the relationship between the perception of intonation (i.e., the fundamental frequency variation across an utterance) and hypernasality (excessive nasal resonance during the production of non-nasal sounds) has not been investigated in research. We hypothesized that auditory-perceptual ratings of intonation would be significantly lower for more hypernasal stimuli. Methods: One male and one female voice actor simulated 3 levels of intonation (monotone, normal, and exaggerated) at 4 different levels of hypernasality (normal, mild, moderate, and severe). Thirty participants listened to the simulations and rated the intonation on a visual analogue scale from 0 (monotone) to 100 (exaggerated). Results: A mixed-effects ANOVA revealed main effects of intonation (F-2 = 236.46, p < 0.001), and hypernasality (F-3 = 159.89, p < 0.001), as well as an interaction between the two (F-6 = 28.35, p < 0.001). Post hoc analyses found that speech was rated as more monotonous as hypernasality increased. Summary/Implications: The presence of hypernasality in speech can lead listeners to perceive speech as more monotonous. Instrumental measures should be used to corroborate auditory-perceptual evaluations of speech features like intonation. (c) 2018 S. Karger AG, Basel Univ Toronto, Toronto, ON, Canada Sao Paulo State Univ, Marilia, Brazil Montclair State Univ, Montclair, NJ USA Sao Paulo State Univ, Marilia, Brazil MITACS GlobaLink Research Award: IT09603 Social Sciences and Humanities Council Research Insight Development Grant: 430-2016-00253

In this work, a database collected from two different Filipino Cleft Palate patients was used to identify the discriminative features for hypernasal speech. Data from the Filipino Speech Corpus (FSC) were used as normal speech samples. The features identified were based from three feature extraction algorithms, Mel Frequency Cepstrum Coefficient (MFCC), Perceptual Linear Prediction (PLP), along with a MFCC-PLP hybrid feature extraction method, which was introduced in this study. Intraclass and interclass correlation among the speech samples, separating the two hypernasal speech samples and along with the normal speech samples were computed to determine the correlation of the speech samples to each other. This paper will also compare the differences between the extracted MFCC features, PLP features and a hybrid of MFCC and PLP features to determine the most discriminative features from hypernasal speech compared with normal speech and the most discriminative features from hypernasal speech obtained from different study volunteers through Analysis of Variance (ANOVA) statistical analysis. The p-values obtained from the ANOVA test will be the basis to determine which features provide a certain degree of significant difference between speech samples. The paper will also present and determine the most optimal and conclusive feature extraction method in analyzing speech samples using MATLAB and through correlation analysis.

BACKGROUND The safety, efficacy, and direct comparison of various surgical treatments for velopharyngeal insufficiency (VPI) associated with occult submucous cleft palate (OSMCP) are poorly characterized. The aim of this study was to report and analyze the safety and efficacy of Furlow palatoplasty (FP) versus radical intravelar veloplasty (IVV) for treatment of VPI associated with OSMCP. METHODS A retrospective review of one institution's experience treating VPI associated with OSMCP using IVV (group 1) or FP (group 2) during 24 months was performed. Statistical significance was determined by Wilcoxon matched-pair, Independent-Samples Mann-Whitney U, and analysis of variance (SPSS 20.0.0). RESULTS In group 1 (IVV), 18 patients were identified from August 2010 to 2011 (12 male and 6 female patients; average age, 5.39 years). Seven patients were syndromic and 11 were nonsyndromic. In group 2 (FP), 17 patients were identified from August 2009 to 2011 (8 male and 9 female patients; average age, 8.37 years). Three patients were syndromic and 14 patients were nonsyndromic. There was statistical significance between the average pretreatment Pittsburgh Weighted Speech Score (PWSS) of the 2 groups (group 1 and 2 averages 19.06 and 11.05, respectively, P=0.002), but there was no statistical significance postoperatively (group 1 and 2 averages 4.50 and 4.69, respectively, P=0.405). One patient from each group required secondary speech surgery. Average operative time was greater for FP (140 minutes; range, 93-177 minutes) compared to IVV (95 minutes; range, 58-135 minutes), P

Objective Oronasal fistula represents a functional problem, as it may result in nasal regurgitation of food and fluids and it also leads to hypernasal speech. Many methods have been proposed for its closure with a high recurrence rate. The aim of this study was to assess the efficacy of closure of hard palate fistula by two layers of mucoperiosteal flaps. Methods Eighteen patients with fistula of the hard palate were included. The fistula was repaired by two layers of mucoperiosteal flaps; the first layer was created from the mucoperiosteum surrounding the fistula as bilateral hinge flaps and the second layer was formed of a rotational flap based on the greater palatine artery. Pre- and postoperative clinical assessment was performed. Results The etiology of fistulas was previous cleft palate repair in 13 patients, previous nasal septal surgery in 3 patients, and untreated sharp accidental trauma to the palate in 2 patients. All patients presented with nasal regurgitation and hypernasal speech. Complete closure of all fistulas was achieved at first attempt, with no recurrence through the follow up period. Conclusions Closure of oronasal fistula by two layers of mucoperiosteal flaps is an effective method and it has neither complications nor recurrence.