Folia Phoniatrica et Logopaedica最新文献

Introduction: This study aimed to validate three age-adjusted versions of a Hearing Screening Questionnaire for Preschoolers, in Brazilian Portuguese, based on parents' perception of their children's hearing and oral language.

Methods: Psychometric validation was conducted on three questionnaires, each comprising nine items with yes/no responses. Three items focused on hearing screening at birth, and six assessed hearing and oral language. The study included 152 parents and their children, who attended daycare centers in Belo Horizonte, Brazil. The children were categorized into three age bands: 12-18 months, 19-35 months, and 36-48 months. Audiological assessments, including tympanometry, transient-evoked otoacoustic emissions (TEOAE), and pure-tone audiometry (when applicable), were performed on the children. In case of abnormal findings in the previous exams, auditory brainstem response (ABR) testing was conducted. Descriptive data, false alarm, and false-negative analyses were carried out.

Results: Considering any type of hearing loss, whether unilateral or bilateral, the questionnaires showed a false-negative rate of 41.17% (7/17 children). However, when considering only bilateral hearing loss, the questionnaire showed a false alarm rate of 31.69% (45/142) and a false-negative rate of 30.0% (3/10). When focusing exclusively on sensorineural hearing loss, the questionnaire identified two children (1.31%), with a false-negative rate of 0% but a false-positive rate of 33.33%.

Conclusion: Language-development-oriented questionnaires allowed quick screening of potential hearing loss in preschoolers. This study found a robust hit rate with these questionnaires. Their validation signifies a promising and cost-effective tool for conducting hearing screenings in preschool children, especially in nations lacking a comprehensive school screening policy. The validated questionnaire affords an easy-to-apply, low-cost, and effective instrument for preschool hearing screening.

Introduction: Flamenco is a traditional music originally from Andalusia in southern Spain. Some of the vocal resources used in Flamenco have components of voice distortion and other voice qualities that could sound like hyperfunctional voice productions. The present study aimed at observing supraglottic activity in flamenco singers while engaged in singing at various degrees of pitch and loudness and while engaged in realizing phonatory tasks.

Methods: A total of eighteen flamenco singers with at least 5 years of voice training were recruited. Flexible endoscopic voice evaluations were recorded and edited to provide samples of different pitches, loudness levels, and phonatory tasks. Sound was removed from video samples. Two blinded laryngologists were asked to assess antero-posterior compression, medial compression, pharyngeal compression, and VLP for every sample, using a visual analog scale.

Results: Significantly higher values were found for medial compression, anterior-posterior compression, VLP and pharyngeal compression during high loudness levels when compared to medium and low loudness. Overall, medial compression was lower than anterior-posterior compression.

Conclusion: Supraglottic activity is present in flamenco singing in the four laryngoscopic variables. It seems to be that supraglottic activity increases with loudness level and pitch. This behavior could be a natural and necessary aspect of flamenco singing present during both sustained vowels and song.

Introduction: The Speech Efficiency Score (SES) serves as an acoustic metric for assessing fluency in conversational speech within the temporal domain. This study leverages SES to investigate conversational speech efficiency among native speakers of American English (AE) compared to speakers of Mandarin-accented English (MAE).

Methods: SES, speaking rate, articulation rate, and vocabulary diversity were measured and compared between two groups: native AE speakers and MAE speakers. The study utilized conversational speech samples collected from both groups to analyze these metrics.

Results: Findings indicate a disparity in speaking rate and articulation rate between the AE and MAE groups, with the AE group exhibiting significantly faster speech. However, no significant differences were observed in SES and vocabulary diversity between the two groups.

Conclusion: The results are discussed in the context of the interplay between speaking rate, speech fluency, and vocabulary diversity. These findings shed light on the maintenance of speech efficiency among bilingual speakers, suggesting that despite differences in speaking rate and articulation rate, SES and vocabulary diversity remain comparable between native AE speakers and MAE speakers.

Introduction: Effortful swallow (ES) is a widely used technique in dysphagia management, believed to strengthen oropharyngeal muscles and enhance swallowing safety and efficiency. Although its impact on the oral phase of swallowing is well documented, its effects on pharyngeal swallowing physiology remain inconsistent. This study aimed to elucidate the effects of ES on swallowing kinematics and timing, addressing existing inconsistencies in the literature.

Methods: This study involved 22 healthy adults using archived videofluoroscopic swallowing studies. Participants performed three swallow trials of 10 mL puree under regular conditions and with the ES maneuver. The outcome measures comprised swallow timing and kinematic measures. Swallow timing parameters included time to maximum hyoid and laryngeal excursion, laryngeal vestibule closure (LVC) reaction and duration, pharyngeal constriction duration, pharyngoesophageal segment (PES) opening duration, and swallow duration. Swallow kinematic parameters encompassed hyoid and laryngeal excursions, pharyngeal constriction ratio, and maximum PES width. All variables were analyzed via videofluoroscopy. Paired t tests were used to examine the effect of ES on each outcome measure, with a significance threshold set at p < 0.004.

Results: The ES maneuver significantly increased the duration of LVC, pharyngeal constriction, PES opening, and overall swallow duration. It also improved the pharyngeal constriction ratio. However, there were no significant changes in hyoid and laryngeal excursions. Submental muscle activity showed a notable increase during ES.

Conclusion: The study demonstrates that ES can effectively modify certain temporal and kinematic aspects of swallowing, particularly by prolonging key phases and enhancing pharyngeal constriction. These findings suggest the potential utility of ES in dysphagia rehabilitation, especially in cases that require prolonged pharyngeal constriction, LVC, and PES opening. However, the limited impact on hyoid and laryngeal excursions along with LVC reaction time indicates that ES may not address all aspects of dysphagia. The findings highlight the need for tailored therapeutic approaches in dysphagia management, considering individual physiological impairment profiles.

Introduction: This study investigated the effects of suspension pharyngeal flap surgery for velopharyngeal insufficiency (VPI) due to cleft palate.

Methods: Ten Filipino individuals (mean age = 20.63 years, range = 8.4-34.9 years) with a cleft palate who underwent suspension pharyngeal flap surgery for VPI were included in this study. Perceptual and instrumental speech assessments were conducted at two different time points: before surgery (data point 1) and after surgery (data point 2, range = 4-26 weeks postoperatively). Speech intelligibility in different contexts and satisfaction with speech were assessed by the participants themselves using a self-report questionnaire. Additionally, the risk for obstructive sleep apnea was assessed using the Berlin Questionnaire.

Results: Velopharyngeal gap size significantly decreased after the surgery. Additionally, significant improvements in speech understandability and acceptability were observed following the suspension pharyngeal flap procedure. Besides, a significant reduction in hypernasality, nasal emission, and the occurrence of passive articulation errors was seen. No difference in the occurrence of active articulation errors was observed when comparing data pre- and post-surgery. The ten individuals reported to be significantly more intelligible in different contexts after surgery.

Conclusion: Improved speech was observed in individuals who received the suspension pharyngeal flap procedure. This procedure also positively influences an individual's intelligibility in different contexts in daily life. In individuals with persisting active articulation errors, post-surgery speech therapy will still be necessary.

Introduction: Anticipation is a covert aspect of stuttering that plays a crucial role in the lives of adults who stutter (AWS). It can influence anxiety levels or provide an opportunity for self-regulation. For assessing anticipation in stuttering, the Stuttering Anticipation Scale (SAS) was developed. This study aimed to develop a Turkish version of the SAS (SAS-TR) and evaluate its validity and reliability.

Method: Ninety-four AWS (aged 18-40 years) participated in the study. They completed SAS-TR and demographic information form either face-to-face or online. The internal consistency, test-retest reliability, and construct validity of the SAS-TR were assessed. Exploratory factor analysis (EFA) was also conducted as part of the construct validity evaluation.

Results: The SAS-TR scale demonstrated high internal consistency (Cronbach's alpha = 0.947) and high test-retest reliability (ICC = 0.973). SAS-TR total score and its subdimensions showed acceptable to high positive correlations among themselves (ranging from r = 0.209 to r = 0.962). Factor loadings for the SAS-TR items ranged between 0.572 and 0.899, exceeding 0.300 and indicating suitability for EFA.

Conclusion: The SAS-TR exhibits valid and reliable properties for Turkish-speaking AWS. It is recommended for use in both research and clinical settings to enhance understanding of anticipatory behaviors in this population.

Introduction: Social participation for emerging symbolic communicators on the autism spectrum is often restricted. This is due in part to the time and effort required for both children and partners to use traditional augmentative and alternative communication (AAC) technologies during fast-paced social routines. Innovations in artificial intelligence provide the potential for context-aware AAC technology that can provide just-in-time communication options based on linguistic input from partners to minimize the time and effort needed to use AAC technologies for social participation.

Methods: This preliminary study used an alternating treatment design to compare the effects of a context-aware AAC prototype with automated cloze phrase response options to traditional AAC for supporting three young children who were emerging symbolic communicators on the autism spectrum in participating within a social routine.

Results: Visual analysis and effect size estimates suggest the context-aware AAC condition resulted in increases in linguistic participation, vocal approximations, and visual attention for all three children.

Conclusion: While this study was only an initial exploration and results are preliminary, context-aware AAC technologies have the potential to enhance participation and communication outcomes for young emerging symbolic communicators on the autism spectrum and more research is needed.

Introduction: The aim of this study was to assess the contribution of voice therapy (VT) to management of patients following surgery for vocal fold polyps.

Methods: In this prospective study, two groups were created by randomizing patients diagnosed with vocal fold polyps. Group 1 received only phonosurgery, and group 2 received phonosurgery followed by VT. Subjective test methods conducted before and after treatment were evaluated comparatively. Videolaryngostroboscopy, the Voice Handicap Index-10 (VHI-10), and voice analysis parameters, including fundamental frequency variation (vF0), jitter percent (Jitt%), shimmer percent (Shim%), noise-to-harmonic ratio, and maximum phonation time (MPT), were compared before and after treatment.

Results: The data of 40 patients, 15 (37.5%) women and 25 (62.5%) men, were examined in this study. Significant reductions were observed in the pre- and post-treatment values in the Voice Handicap Index-10 and GRBAS scale (p < 0.001). In terms of aerodynamic analysis, a decrease was observed in the S/Z ratio in both groups after treatment. Regarding MPT, a statistically significant increase was observed following treatment in (1) both groups (p < 0.001) and (2) group 2 versus group 1 (p < 0.001). In terms of acoustic voice analysis, both groups showed an increase in fundamental frequency (F0) and a statistically significant decrease in jitter and shimmer values. When comparing these parameter changes, it was observed that group 2 had a statistically significant difference compared to group 1 (F0: p = 0.082; Jitt: p = 0.014; Shim: p = 0.035, respectively).

Conclusion: In this study comparing the outcomes of vocal fold polyp treatment using only surgery versus surgery combined with VT, it was found that the addition of VT to endolaryngeal phonosurgery provided a significant positive contribution.

Introduction: Acquired swallowing impairment is a major public health issue that often leads to increased morbidity and slower recovery. Speech and language therapists (SLTs) have taken the lead in the assessment and treatment of dysphagia, which is reflected in guidelines where early intervention is recommended. This is in addition to the central role that SLTs play in the management of acquired communication impairments since research indicates that patients with communication difficulties benefit from early and intensive therapy by SLTs. This increasing demand for SLTs is expected to cause conflicting pressures in their workload and, therefore, beneficial to consider workforce planning. The aim of this study was to examine real-world data in the UK to investigate this issue regarding changes in referral patterns of patients with dysphagia and/or communication disorders to SLTs over time, to assist with workforce planning.

Methods: We interrogated the Royal College of Speech and Language Therapists Online Outcome Tool, a national database, in this retrospective cohort study. We included patients evaluated between 2018 and 2022. We performed a subgroup analysis of patients aged ≥40 years who had a primary medical diagnosis of stroke. Data on age, primary diagnosis, time on caseload, primary Therapeutic Outcome Measure (TOM) scale and initial TOM score on impairment were examined.

Results: From the database of 44,444 referrals to speech and language therapy, 5,254 referrals were included in the stroke and overall subgroup analyses. Referrals were 55.1% male, with a median age of 71 years. More than half (56.1%) of these referrals were for dysphagia. Referrals decreased during the COVID-19 pandemic but began to recover from 2021 onwards. The time on the SLT caseload has increased over the years from a median of 14 days (interquartile range [IQR] 0-56) in 2018 to 20 days (IQR: 3-81) in 2022. While there were more referrals to SLT services for assessment and management of dysphagia than for communication in the overall population, in the stroke subgroup, referrals for communication disorders outnumbered referrals for dysphagia from 2020 onwards. Additionally, the severity of impairment on referral increased over the years.

Conclusion: Real-world data indicates that referrals to SLT services are changing over time to include more complex and severely impaired patients, with a demand for both swallowing and communication disorders. These findings should inform staff allocation and remodelling of education/training for SLTs to better meet clinical and public health needs. The retrospective nature of this study limits the strength and generalisability of these data, and this topic warrants further investigation.