Perceptions of audible nasal emission in speakers with cleft palate: a comparative study of listener judgments.

OBJECTIVE: Audible nasal emission is a common speech distortion observed in persons with cleft palate. This study examined the validity and reliability of perceptual judgments of audible nasal emission using interval scaling and magnitude estimation techniques. PARTICIPANTS: Speech samples were collected from six adolescents with repaired cleft palate, all of whom demonstrated audible nasal emission. A total of 31 adults performed rating tasks in which they judged the severity of audible nasal emission in speech samples. MEASURES: Occurrences of audible nasal emission in speech samples were identified using visual and auditory inspection. Using an acoustic modification technique, samples were digitally modified to amplify perceived occurrences of audible nasal emission to create three stimulus conditions. The original recording of the speech samples served as a control condition. The severity of audible nasal emission in the samples was judged by multiple listeners using interval scaling and magnitude estimation without a modulus. Statistical analysis included analysis of variance, regression, and curve-fitting methods. RESULTS: Magnitude-estimation ratings demonstrated stronger evidence of validity and reliability than interval scaling. A curvilinear relationship was found between the sets of ratings. CONCLUSIONS: The results of this study suggest that audible nasal emission may be a prothetic or ratio-level perceptual continua. Listeners should consider using magnitude estimation or other ratio-based methods for perceptual judgments of audible nasal emission.

Structural and functional causes of hypernasality in velocardiofacial syndrome. A pilot study.

OBJECTIVE: Hypernasality in velocardiofacial syndrome (VCFS) is more severe, persistent, and difficult to manage compared to other populations with cleft palate or velopharyngeal (VP) dysfunction. This pilot study investigated why children with VCFS have more severe hypernasality. METHODS: Pressure-flow methodology indirectly measured VP orifice size and VP closure timing during speech in a group of 5 children with VCFS, 5 children with cleft palate, and 6 normal children. RESULTS: Children with VCFS demonstrated significant differences in VP closure timing and hypernasality. There were no significant group differences in VP orifice size. Duration of nasal airflow was the strongest predictor of judgments of hypernasality. CONCLUSION: This study provides preliminary evidence that VP closure timing may account for the more severe hypernasality in children with VCFS, compared to structural factors alone.

Permanent tooth development in children with cleft lip and palate.

PURPOSE: The purposes of this study were to: (1) quantify and compare permanent tooth development of cleft lip and palate (CLP) patients to age- and gender-matched controls; (2) relate these findings to cleft type and severity; and (3) examine delays in individual permanent maxillary teeth related to their proximity to the cleft. METHODS: Standardized methods using panoramic radiographs were employed to stage dental development and dental age for 49 children with clefts and 49 matched controls. Data were analyzed with a mixed linear model. RESULTS: Analyses indicated a correlation between delayed permanent tooth development and CLP with an overall delay of 0.52 years (P = .02) and with boys accounting for all the delay. No differences were found between subjects with unilateral or bilateral clefts. A nonsignificant trend was noted for greater delay in subjects with clefts of the primary and secondary palates vs primary palate alone. Teeth most often affected by the delay were maxillary first and second premolars and maxillary second molars. CONCLUSIONS: While permanent tooth development is delayed in cleft lip and palate patients, this delay is: found in boys only; is independent of the cleft type and severity; and is not correlated with proximity to the cleft.

Factors affecting articulation skills in children with velocardiofacial syndrome and children with cleft palate or velopharyngeal dysfunction: a preliminary report.

OBJECTIVE: To examine the influence of speech perception, cognition, and implicit phonological learning on articulation skills of children with velocardiofacial syndrome (VCFS) and children with cleft palate or velopharyngeal dysfunction (VPD). DESIGN: Cross-sectional group experimental design. PARTICIPANTS: Eight children with VCFS and five children with nonsyndromic cleft palate or VPD. METHODS AND MEASURES: All children participated in a phonetic inventory task, speech perception task, implicit priming nonword repetition task, conversational sample, nonverbal intelligence test, and hearing screening. Speech tasks were scored for percentage of phonemes correctly produced. Group differences and relations among measures were examined using nonparametric statistics. RESULTS: Children in the VCFS group demonstrated significantly poorer articulation skills and lower standard scores of nonverbal intelligence compared with the children with cleft palate or VPD. There were no significant group differences in speech perception skills. For the implicit priming task, both groups of children were more accurate in producing primed nonwords than unprimed nonwords. Nonverbal intelligence and severity of velopharyngeal inadequacy for speech were correlated with articulation skills. CONCLUSIONS: In this study, children with VCFS had poorer articulation skills compared with children with cleft palate or VPD. Articulation difficulties seen in the children with VCFS did not appear to be associated with speech perception skills or the ability to learn new phonological representations. Future research should continue to examine relationships between articulation, cognition, and velopharyngeal dysfunction in a larger sample of children with cleft palate and VCFS.