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Evaluation of nasal speech: a study of assessments by speech-language pathologists, untrained listeners and nasometry
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Excessive nasal resonance in speech (hypernasality) is a disorder which may have negative communicative and social consequences for the speaker. Excessive nasal resonance is often associated with cleft lip and palate, velopharyngeal impairment, dysarthria or hearing impairment. Evaluation of hypernasality has proved to be a challenge in the clinic and in research. There are questions regarding the accuracy and reliability of auditory perceptual evaluations of nasal speech, and whether instrumental measures can be used to improve the reliability of clinical evaluation. There is also the question of whether clinical evaluation reflects the impact of hypernasality in a speaker’s everyday life.

The purpose of this thesis was to evaluate the extent of reliability problems connected with auditory perceptual assessment of nasality in speech, to explore whether they might interfere with treatment decisions or have an impact in the everyday life of patients, and whether they can be effectively diminished by the use of nasometry.

Speakers with cleft lip and palate or velopharyngeal impairment formed the basis of the clinical population used in this study. Speech samples from 52 of these speakers, along with samples from a reference population of 21 speakers who did not have cleft palate, velopharyngeal impairment or speech disorders were used in perceptual evaluation tasks. Fourteen speakers from the clinical population and 11 from the reference population also underwent nasometric evaluation. A further reference population of 220 children from three Swedish cities, whose ages were consistent with those used for clinical checks of children born with cleft palate were assessed with nasometry to establish normative data for the Nasometer™. Perceptual speech assessments were conducted on hyper- and hyponasality, as well as audible nasal air emission and/or nasal turbulence, using 5-point ordinal scales. Listeners were SLPs experienced in the evaluation of cleft palate speech, non-expert SLPs and untrained listeners. Listening assessments were performed from audio recorded speech samples assembled in random order. Nasometry measures were made on three speech passages each with specific phonetic content, using the Nasometer™, model II.

Perceptual evaluation Results showed that for hypernasality assessment, 15% of hypernasality assessments had disagreements between expert SLPs that were potentially important for clinical decisions, as did 6% of assessments for audible nasal air emission and/or nasal turbulence. For nasality problems, a comparison of expert and untrained listeners showed that they generally agreed on which speakers were hypernasal and on the ranking of nasal speakers. All speakers that had been rated with moderate to severe hypernasality by expert listeners were considered by the untrained listeners as having a serious enough speech disorder to call for intervention. However, in the case of audible nasal air emission and/or nasal turbulence the expert listeners were more prone to notice this feature than the untrained listeners.

Instrumental evaluation The development of normative values for the three Swedish passages for the NasometerTM (comparable to normative values in other languages) has provided a basis for use of instrumental measures in Swedish clinics, oral sentences mixed sentences nasal sentences. The measures showed no significant differences due to city, gender or age within an age range of 4-10 years. When nasometry measures were compared with perceptual evaluation of speech samples from the same speakers, all correlations were moderate to good for expert SLPs and non-expert SLPs. The difference between correlations was significantly higher for expert SLPs than for untrained listeners.

Reliability figures for perceptual assessments for expert SLP listeners indicated that there were some cases where lack of reliability could affect clinical decision making. However, in the main, judgements of nasality problems made by clinicians had everyday validity. They reflected the impressions of the everyday listener, especially in regard to the need for intervention. The study also indicates that now that Swedish norms are available, the Nasometer™ might be useful as a complement to auditory perceptual clinical speech assessments in Swedish cleft palate clinics in order to improve reliability of clinical assessment.

Place, publisher, year, edition, pages
Umeå: Klinisk vetenskap , 2008. , 55 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1222
Keyword [en]
hypernasality, auditory perceptual evaluation, reliability, nasometer, nasalance
National Category
Otorhinolaryngology
Identifiers
URN: urn:nbn:se:umu:diva-1938ISBN: 978-91-7264-678-0 (print)OAI: oai:DiVA.org:umu-1938DiVA: diva2:142500
Public defence
2008-12-12, Sal B, 1D, Tandläkarhögskolan, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2008-11-25 Created: 2008-11-25 Last updated: 2011-04-08Bibliographically approved
List of papers
1. A cross-sectional study of speech in 10-year-old children with cleft palate: results and issues of rater reliability
Open this publication in new window or tab >>A cross-sectional study of speech in 10-year-old children with cleft palate: results and issues of rater reliability
2007 (Swedish)In: Cleft Palate Craniofacial Journal, ISSN 1055-6656, Vol. 44, no 1, 33-44 p.Article in journal (Refereed) Published
Abstract [sv]

OBJECTIVES: To describe speech based on perceptual evaluation in a group of 10-year-old children with cleft palate. A secondary aim was to investigate the reliability of speech-language pathologists' perceptual assessment of cleft palate speech. DESIGN: Retrospective cross-sectional study in children with cleft palate. External raters made assessments from randomized speech recordings. SUBJECTS: Thirty-eight children with unilateral cleft lip and palate (UCLP) or cleft palate only (CPO) and 10 children in a comparison group. MAIN OUTCOME MEASURES: Ratings of hypernasality, hyponasality, audible nasal air leakage, weak pressure consonants, and articulation. Exact agreement and weighted kappa values were used for reliability. RESULTS: Hypernasality was found in 25% of children with a cleft of the soft palate (CSP), 33% of children with a cleft of the hard and soft palate (CHSP), and 67% of children with a UCLP. Similar results were found for audible nasal air leakage. Articulation errors were found in 6% of the CHSP group and 25% of the UCLP group, whereas no child in the CSP group had articulation errors. The reliability was moderate to good for different variables, with lowest values for hypernasality. CONCLUSIONS: Speech results in this series seem less satisfactory than those reported in other published international studies, but it is difficult to draw any certain conclusions about speech results because of large methodological differences. Further developments to ensure high reliability of perceptual ratings of speech are called for.

Identifiers
urn:nbn:se:umu:diva-6440 (URN)17214536 (PubMedID)
Available from: 2007-12-12 Created: 2007-12-12 Last updated: 2011-08-29Bibliographically approved
2. Untrained listeners’ ratings of speech disorders in a group with cleft palate: a comparison with speech and language pathologists’ ratings
Open this publication in new window or tab >>Untrained listeners’ ratings of speech disorders in a group with cleft palate: a comparison with speech and language pathologists’ ratings
2009 (English)In: International journal of language and communication disorders, ISSN 1368-2822, E-ISSN 1460-6984, Vol. 44, no 5, 656-674 p.Article in journal (Refereed) Published
Abstract [en]

Background: Hypernasal resonance, audible nasal air emission and/or nasal turbulence, and articulation errors are typical speech disorders associated with the speech of children with cleft lip and palate. Several studies indicate that hypernasal resonance tends to be perceived negatively by listeners. Most perceptual studies of speech disorders related to cleft palate are carried out with speech and language pathologists as listeners, whereas only a few studies have been conducted to explore how judgements by untrained listeners compare with expert assessments. These types of studies can be used to determine whether children for whom speech and language pathologists recommend intervention have a significant speech deviance that is also detected by untrained listeners.

Aims: To compare ratings by untrained listeners with ratings by speech and language pathologists for cleft palate speech.

Methods & Procedures: An assessment form for untrained listeners was developed using statements and a five-point scale. The assessment form was tailored to facilitate comparison with expert judgements. Twenty-eight untrained listeners assessed the speech of 26 speakers with cleft palate and ten speakers without cleft in a comparison group. This assessment was compared with the joint assessment of two expert speech and language pathologists.

Outcomes & Results: Listener groups generally agreed on which speakers were nasal. The untrained listeners detected hyper- and hyponasality when it was present in speech and considered moderate to severe hypernasality to be serious enough to call for intervention. The expert listeners assessed audible nasal air emission and/or nasal turbulence to be present in twice as many speakers as the untrained listeners who were much less sensitive to audible nasal air emission and/or nasal turbulence.

Conclusions & Implications: The results of untrained listeners' ratings in this study in the main confirm the ratings of speech and language pathologists and show that cleft palate speech disorders may have an impact in the everyday life of the speaker.

Place, publisher, year, edition, pages
John Wiley & Sons, 2009
Keyword
cleft palate speech, nasality, perceptual analysis, untrained listeners
Identifiers
urn:nbn:se:umu:diva-3685 (URN)10.1080/13682820802295203 (DOI)18821109 (PubMedID)
Available from: 2008-11-25 Created: 2008-11-25 Last updated: 2017-12-14Bibliographically approved
3. Normative data on nasalance scores for Swedish as measured on the Nasometer™ II: influence of regional dialect, gender and age
Open this publication in new window or tab >>Normative data on nasalance scores for Swedish as measured on the Nasometer™ II: influence of regional dialect, gender and age
2009 (English)In: Clinical linguistics and phonetics, ISSN 1368-2822, Vol. 23, no 1, 58-69 p.Article in journal (Refereed) Published
Abstract [en]

This study was conducted to establish normative nasalance values for Swedish speaking children as measured with the Nasometer™ II, and to investigate differences due to regional dialect, gender, and age. Two hundred and twenty healthy children aged 4-5, 6-7, and 9-11 years were included. Group mean nasalance scores for four speech stimuli were calculated and compared. There were no significant differences due to dialect or gender for children in the study. For age there was a significant difference on nasal sentences between the youngest group of children and the other two groups, age 4-5 vs age 6-7 (t = -2.844, p = .006) and for age 4-5 vs age 9-11 (t = -2.888, p = .005). The results from this study have both clinical significance for Swedish SLPs working with resonance disorders, and theoretical significance for linguists studying features of dialects and languages.

Identifiers
urn:nbn:se:umu:diva-3686 (URN)10.1080/02699200802491074 (DOI)
Available from: 2008-11-25 Created: 2008-11-25 Last updated: 2012-08-14Bibliographically approved
4. Comparison between perceptual judgments of nasality and nasalance scores
Open this publication in new window or tab >>Comparison between perceptual judgments of nasality and nasalance scores
Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-3687 (URN)
Available from: 2008-11-25 Created: 2008-11-25 Last updated: 2010-01-13Bibliographically approved

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