Effect of two isolated vocal facilitating techniques glottal fry and yawn-sigh on the phonation of female speech-language pathology students: A pilot study.

OBJECTIVE: The purpose of this study was to determine the effect of two isolated vocal facilitating techniques, glottal fry and yawn-sigh, on the phonation of vocally healthy female speech-language pathology (SLP) students. STUDY DESIGN: A multigroup pretest-posttest design was used. METHODS: A group of thirty-six healthy female SLP students with a mean age of 18.1 years were assigned into three groups: a glottal fry group (practicing the facilitating technique glottal fry across 18 weeks, n=12), a yawn-sigh group (practicing the facilitating technique yawn-sigh across 18 weeks, n=12) and a control group (receiving no facilitating techniques, n=12). To compare vocal measures before and after this training period, an identical objective voice assessment protocol (maximum performance task, acoustic analysis, voice range profile and Dysphonia Severity Index) was performed in the three groups. Groups were compared over time using linear mixed models. Within-group effects of time were determined using post hoc pairwise comparisons. RESULTS: Glottal fry resulted in a significant decrease in lowest and highest intensity. Yawn-sigh resulted in a significant increase in fundamental frequency, a significant decrease in shimmer and noise-to-harmonic ratio, and a significant increase in highest intensity. CONCLUSIONS: Yawn-sigh may have a positive effect on the phonation of female vocally healthy future SLPs, whereas results are less supportive for using glottal fry in training this population's voice.

Short-term effect of short, intensive speech therapy on articulation and resonance in Ugandan patients with cleft (lip and) palate.

OBJECTIVES: The purpose of the current study was to assess the short-term effectiveness of short and intensive speech therapy provided to patients with cleft (lip and) palate (C(L)P) in terms of articulation and resonance. METHODS: Five Ugandan patients (age: 7.3-19.6 years) with non-syndromic C(L)P received six hours of individualized speech therapy in three to four days. Speech therapy focused on correct phonetic placement and contrasts between oral and nasal airflow and resonance. Speech evaluations performed before and immediately after speech therapy, including perceptual and instrumental assessment techniques, were compared. RESULTS: Post-therapy, improvement of speech was noted for most of the patients, although to varying degrees. Clinically relevant progress of objective nasalance values and/or articulation was obtained in four patients. Overall, two patients showed normal speech intelligibility, while three patients required additional speech therapy. CONCLUSION: These preliminary short-term results demonstrate that short and intensive speech therapy can be effective for patients with C(L)P in countries with limited access to speech-language therapy. However, further research is needed on the long-term effectiveness and the advantages of applying this treatment protocol in countries with good access to speech therapy. LEARNING OUTCOMES: The reader will be able to (1) list the challenges in resource poor-countries to achieve access to speech-language therapy services, (2) describe when the application of speech therapy is appropriate in patients with C(L)P, (3) describe the speech therapy that can be applied to reduce compensatory articulation and resonance disorders in patients with C(L)P, and (4) list the (possible) advantages of short, intensive speech therapy for both resource-poor and developed countries.

Nasalance and nasality in children with cochlear implants and children with hearing aids.

OBJECTIVES: In prelingually deaf children, many speech production aspects including resonance, are known to be problematic. This study aimed to investigate nasality and nasalance in two groups of prelingually hearing impaired children, namely deaf children with a cochlear implant (CI) and moderate-to-severely hearing impaired hearing aid (HA) users. The results of both groups are compared with the results of normal hearing children. Besides, the impact of the degree of hearing loss was determined. METHODOLOGY: 36 CI children (mean age: 9;0y), 25 HA children (mean age: 9;1y) and 26 NH children (mean age: 9;3y) were assessed using objective assessment techniques and perceptual evaluations in order to investigate the nasal resonance of the three groups. Ten HA children had thresholds above 70dB (range: 91dB-105dB) and fifteen below 70dB (range: 58dB-68dB). The Nasometer was used for registration of the nasalance values and nasality was perceptually evaluated by two experienced speech therapists using a nominal rating scale (consensus evaluation). RESULTS: For nasal stimuli, both CI children and HA children showed lower nasalance values in comparison with NH children. The opposite was observed for the oral stimuli. In both hearing impaired groups, cul-de-sac-resonance was observed on a significantly larger scale than in the NH group, and the HA children were judged to be significantly more hypernasal in comparison with NH children. CONCLUSIONS: Despite the fact that a substantial number of the CI and HA children demonstrate normal (nasal) resonance quality, this aspect of speech production is still at risk for hearing impaired children.

Articulation and oromyofunctional behavior in children seeking orthodontic treatment.

OBJECTIVES: The purpose of this controlled study is to document articulation and oromyofunctional behavior in children seeking orthodontic treatment. In addition, relations between malocclusions, articulation, and oromyofunctional behavior are studied. MATERIALS AND METHODS: The study included 56 children seeking orthodontic treatment. The control group, consisting of 54 subjects matched for age and gender, did not undergo orthodontic intervention. To determine the impact of the occlusion on speech, the Oral Health Impact Profile was used. Speech characteristics, intelligibility and several lip and tongue functions were analyzed using consensus evaluations. RESULTS: A significant impact of the occlusion on speech and more articulation disorders for/s,n,l,t/were found in the subjects seeking orthodontic treatment. Several other phenomena were seen more often in this group, namely more impaired lip positioning during swallowing, impaired tongue function at rest, mouth breathing, open mouth posture, lip sucking/biting, anterior tongue position at rest, and tongue thrust. Moreover, all children with a tongue thrust showed an anterior tongue position at rest. CONCLUSIONS: Children seeking orthodontics have articulatory and oromyofunctional disorders. To what extent a combined orthodontic and logopaedic treatment can result in optimal oral health (i.e. perfect dentofacial unit with perfect articulation) is subject for further multidisciplinary research.

Normative nasalance data in Ugandan english-speaking children.

AIMS: The aim of this study was to obtain normative nasalance values for typically developing Ugandan English-speaking children as a reference point for clinical practice and further research. METHODS: Sixty-nine typically developing Ugandan children (35 males and 34 females, 2.7-13.5 years of age) participated in the study. Nasalance scores were obtained with the Nasometer while children repeated 4 sustained sounds, 14 repeated syllables, 15 sentences (12 oral, 3 nasal) and 2 texts ('Rainbow Passage' and 'Zoo Passage'). Data were analyzed for gender and age dependence. RESULTS: No significant effects of age or gender on nasalance values were obtained; hence, normative values for the overall group were reported. The average nasalance scores for Ugandan English-speaking children were 17 and 64% for the oral and nasal sentences and 33 and 14% for the oronasal and oral text, respectively. CONCLUSION: The normative values are important as a reference point to assess the impact of several surgical procedures and several surgical timing strategies on speech in Uganda.

The impact of menopause and hormone therapy on voice and nasal resonance.

In an initial study it was shown that (without hormonal influences) middle-aged (premenopausal) women show a smaller frequency and intensity range and a lower fundamental frequency of the voice compared to young women. To investigate the impact of menopause on voice and nasal resonance a cross-sectional non-randomized study design was used. Vocal characteristics and nasal resonance in premenopausal and postmenopausal women without hormone therapy (HT) were compared. Postmenopausal women without HT showed a significantly lower speaking fundamental frequency (SFF) and were able to phonate lower compared to postmenopausal women with HT. The mean difference in SFF was 14 Hz. HT can also counteract the menopausal changes in SFF. The lower SFF did not result in vocal complaints. Further research about the impact of menopause and HT on voice should concentrate on elite professional voice users.

The impact of the menopause on the voice

During lifetime the female larynx is very sensitive tosex hormone fluctuations. In the menopause the serum levels of estrogens and progesterone decrease dramatically so that the ratio of estrogens-progesterone to androgens changes in aid of the last hormone. This article gives an overview of the recent literature about the impact of the menopause on the larynx and the vocal quality. Secondly the effect of hormone replacement therapy in the menopause on the larynx and the vocal performance is discussed. Most research in postmenopausal women show that the larynx is an estrogen-target. In the larynx of postmenopausal women mucosal changes are observed. These laryngeal changes can result in altered acoustic characteristics of the voice. The most important acoustic characteristics of the voice are changes in the fundamental frequency and the frequency range of the voice. The first reports in the literature about the role of hormone replacement therapy in the larynx point out a tendency of a positive, organ-conserving effect of hormone treatment on the larynx and probably the voice. However, more research is necessary to confirm these findings. A better understanding of the relation between sex hormones and the female larynx will make it possible to develop strategies to improve the vocal quality of postmenopausal women (AU)

A lo largo de la vida, la laringe femenina es muy sensible a fluctuaciones sexuales hormonales. En la menopausia los valores de estrógenos y de progesterona disminuyen drásticamente, de tal modo que la relación de estrógenos-progesterona en andrógenos cambia en beneficio de esta última. En primer lugar, este artículo da una descripción de la literatura reciente sobre el impacto de la menopausia en la laringe y en la calidad vocal. En segundo lugar, analiza el efecto de la terapia hormonal de reemplazo de la menopausia en la laringe y en el funcionamiento vocal. La mayoría de investigaciones en mujeres posmenopáusicas muestran que la laringe es un estrógeno. En la mucosa de la laringe de las mujeres posmenopáusicas se observan cambios. Estos cambios pueden causar una alteración de las características acústicas de la voz. Estas alteraciones son cambios en la frecuencia en general y en la gama de frecuencias de la voz. Los primeros informes en la literatura sobre el papel de la terapia hormonal de reemplazo en la laringe indican una tendencia aun efecto positivo que conserva órganos de tratamiento hormonal en la laringe y, probablemente, en la voz. Sin embargo, son necesarias más investigaciones para confirmar estos hallazgos. Un mejor entendimiento de la relación entre hormonas sexuales y la laringe femenina permitirá desarrollar estrategias para mejorar la calidad vocal de las mujeres posmenopáusicas (AU)

Vocal quality in university teachers: a pilot study.

OBJECTIVE: The main purpose of this study was to determine the vocal quality of 20 male and 9 female university teachers using a multi-parameter approach. Secondly, the effect of an academic lecture on the voice profiles of the university teachers was measured. METHODOLOGY: All groups underwent subjective voice evaluations (perceptual evaluation, Voice Handicap Index, anamnesis of vocal complaints and vocal abuse) and objective voice evaluations (aerodynamic and acoustic parameters, vocal performance, and the Dysphonia Severity Index). The same voice assessment was performed after an academic lecture with a mean length of one and a half hours. RESULTS: The mean DSI score was + 2.2 for the male teachers and + 4.0 for the female teachers. The mean VHI score was 13. Perceptually, all voice parameters were rated as normal. The questionnaire revealed a relatively high amount of vocal abuse. No changes in the objective vocal parameters were found after the lecture. Perceptually, however, the voices of the university teachers were significantly less instable after the lecture. Although no negative changes in objective vocal quality were observed, 48% of the university teachers experienced subjective vocal changes. CONCLUSION: The authors concluded that university teachers are professional voice users with good vocal quality who suffer no handicapping effect from possible voice disorders. No important changes in the vocal profile after a teaching activity of one and a half hours were found, despite the high prevalence of voice complaints.