Monthly Archives: March 2009
New Velopharyngeal Measurements at Rest and During Speech: Implications and Applications
Conclusions: This study developed a practical imaging protocol to measure the VP mechanism at rest and during speech productions. New measurements such as the effective VP ratio, pharyngeal constriction ratio, velar stretch ratio, and levator shortening ratio may help to identify the cause of persistent VPI after palatal repair. Implications on the VP surgery were discussed.
from the Journal of Craniofacial Surgery
Objective Assessment of Internal Nasal Dimensions and Speech Resonance in Individuals With Repaired Unilateral Cleft Lip and Palate After Rhinoseptoplasty
The objective of the current study was to analyze the effects of rhinoseptoplasty on internal nasal dimensions and speech resonance of individuals with unilateral cleft lip and palate, estimated by acoustic rhinometry and nasometry, respectively. Twenty-one individuals (aged 15-46 years) with previously repaired unilateral cleft lip and palate were analyzed before (PRE), and 6 to 9 (POST1) and 12 to 18 months (POST2) after surgery. Acoustic rhinometry was used to measure the cross-sectional areas (CSAs) of segments corresponding to the nasal valve (CSA1), anterior portion (CSA2), and posterior portion (CSA3) of the lower turbinate, and the volumes at the nasal valve (V1) and turbinate (V2) regions at cleft and noncleft sides, before and after nasal decongestion with a topical vasoconstrictor. Nasometry was used to evaluate speech nasalance during the reading of a set of sentences containing nasal sounds and other devoid of nasal sounds. At the cleft side, before nasal decongestion, there was a significant increase (P < 0.05) in mean CSA1 and V1 values at POST1 and POST2 compared with PRE. After decongestion, increased values were also observed for CSA2 and V2 at POST2. No significant changes were observed at the noncleft side. Mean nasalance values at PRE, POST1, and POST2 were not different from each other in both oral and nasal sentences. The measurement of CSAs and volumes by acoustic rhinometry revealed that rhinoseptoplasty provided, in most cases analyzed, a significant increase in nasal patency, without concomitant changes in speech resonance, as estimated by nasalance assessment.
from the Journal of Craniofacial Surgery
Phonological awareness predicts activation patterns for print and speech
Abstract Using fMRI, we explored the relationship between phonological awareness (PA), a measure of metaphonological knowledge of the segmental structure of speech, and brain activation patterns during processing of print and speech in young readers from 6 to 10 years of age. Behavioral measures of PA were positively correlated with activation levels for print relative to speech tokens in superior temporal and occipito-temporal regions. Differences between print-elicited activation levels in superior temporal and inferior frontal sites were also correlated with PA measures with the direction of the correlation depending on stimulus type: positive for pronounceable pseudowords and negative for consonant strings. These results support and extend the many indications in the behavioral and neurocognitive literature that PA is a major component of skill in beginning readers and point to a developmental trajectory by which written language engages areas originally shaped by speech for learners on the path toward successful literacy acquisition.
from Annals of Dyslexia
Gradation of Stiffness of the Mucosa Inferior to the Vocal Fold
During phonation, energy is transferred from the subglottal airflow through the air/mucosa interface that results in the propagation of the mucosal wave in the vocal fold. The vocal fold is soft, and the subglottal mucosa is stiff. We hypothesize that it is highly improbable that there is a rigid boundary between the tissue structures, with a sudden drop in stiffness; and that a gradual change would be more likely to support the efficient transfer of energy from the airflow to the mucosal wave. Our objective was to test this hypothesis by quantifying the change in mucosa stiffness with respect to anatomical position. In this initial study, using five pig larynges, a series of point-specific measurements of mucosa stiffness were taken in a line from the midpoint of the vocal fold toward the trachea. A modified linear skin rheometer adapted for laryngeal elasticity measurement applied shear stress to a series of seven positions at 2-mm intervals starting from the midmembranous vocal fold medial surface. A sinusoidal shear force of 1 g was applied at each point, and resultant displacement curve logged. Using a regression algorithm, the stiffness of the tissue was derived in units of grams force per millimeter displacement. Five readings were taken at each position. The results indicate that there is a linear increase in stiffness with respect to position, increasing as the measurements are taken further from the vocal fold. There is a gradual change in stiffness of the subglottal mucosa of a pig larynx.
from the Journal of Voice
Normative Voice Range Profiles in Vocally Trained and Untrained Children Aged Between 7 and 10 Years
Only limited data on normal vocal constitution and vocal capabilities in school-aged children are available. To take better care of children’s voices, it might be helpful to know voice ranges and limits of not only vocally trained but also vocally untrained children. Goal of this study was the evaluation of singing voice capabilities of vocally healthy children with different social and vocal/musical backgrounds using voice range profile measurements (VRP). VRP percentiles that reflect constitutional aspects were suggested. In this cross-sectional study, 186 children (aged between seven and 10 years), attending five schools, were included. VRP measurements were performed under field conditions. Interviews and questionnaires regarding vocal strain and vocal training were applied; the answers were used for classification of singing activity and vocal training (KLASAK). All children reached a mean singing voice range of at least two octaves. By using the answers of interviews and questionnaires, the children could be classified according to vocal strain and vocal training. The groups showed no significant differences regarding VRP measurements. In the following step, percentiles were calculated. Twenty-five percent of all children (P25) reached a minimum voice range of almost two octaves, namely, 22 semitones (ST) from 220 to 784 Hz with soft and loud singing. Half of the children (P50) had a voice range of 24 ST (2 octaves), while soft singing and a larger voice range of 26 ST while loud singing. The measurements of third quartile (P75) revealed that 25% of children have even a larger voice range than 29 dB (from 196 Hz/g to 1047 Hz/c3) and can sing at most frequencies louder than 90 dB. P90 demonstrated that 10% of the children can sing even lower or higher than the frequency range between 196 Hz/g and 1319 Hz/e3 analyzed. The voice range seems not to be constrained by social but by voice/musical background: children of vocally/musically encouraged schools had wider voice ranges. This underlines the necessity of regular singing lessons already in primary schools. The percentile VRP introduced might help to evaluate the vocal constitution and vocal capabilities of a child.
from the Journal of Voice
Auditory Influences on Non-Auditory Cortices
Although responses to auditory stimuli have been extensively examined in the well-known regions of auditory cortex, there are numerous reports of acoustic sensitivity in cortical areas that are dominated by other sensory modalities. Whether in ‘polysensory’ cortex or in visual or somatosensory regions, auditory responses in non-auditory cortex have been described largely in terms of auditory processing. This review takes a different perspective that auditory responses in non-auditory cortex, either through multisensory subthreshold or bimodal processing, provide subtle but consistent expansion of the range of activity of the dominant modality within a given area. Thus, the features of these acoustic responses may have more to do with the subtle adjustment of response gain within a given non-auditory region than the encoding of their tonal properties.
from Hearing Research
Self-Regulation and the Writing Process: Enhancing the Performance of Students With Language and Learning Difficulties
This article first provides an overview of components of self-regulation in writing and specific examples of each component are given. The remainder of the article addresses common reasons why struggling learners experience trouble with revising, followed by evidence-based practices to help students revise their papers more effectively.
Sentence Combining: Assessment and Intervention Applications
Clinicians can use sentence combining tasks to assess students’ written language needs in the area of syntax and also as a context for language intervention. In this brief article, we describe current efforts to develop a formal standardized measure of written syntactic development and offer suggestions for using sentence combining as a context for intervention targeting higher level syntactic complexity.
The Nature of Writing Difficulties in Students With Language/Learning Disabilities
Students with language/learning disabilities very often struggle with writing and tend to find the process very frustrating. Their difficulties with transcription, sentence structure, cohesive ties, self-regulated learning, and genre knowledge all play a role in this challenging experience. An understanding of the nature of these difficulties can help us as speech-language pathologists better facilitate students’ written language success, thereby helping them meet the writing demands of the classroom.
They Have a Write to Go To College Too: Challenges for Secondary Level Students
Children with language disabilities at the secondary level experience significant difficulty in all components of the writing process. This article discusses issues contributing to student’s difficulty in writing as well as suggestions for how to support written language development in this population.
Cochlear reimplantations: technical and surgical failures
Conclusion. Cochlear implant surgeons should have a good knowledge of how to diagnose device failures and how to deal with medical complications related to cochlear implantation. Electrode array misplacement may be due to unidentified inner ear malformation. Use of peroperative telemetry and radiographic examination should help to avoid such complications. Objectives. To review our experience of cochlear implant revision surgery and to compare our series to the literature. To report two cases of electrode array misplacement into the vestibular system and to discuss how to prevent this complication. Subjects and methods. This was a retrospective review of cochlear implant revision surgery in a tertiary reference center. Results. Of 487 cochlear implantations, 3.8% of adults and 4.5% of children underwent a revision surgery. The mean time to device failure was 7.6 years in children and 1.5 year in adults. Causes of revision were seven hard failures, four soft failures, and nine medical reasons. Among the medical reasons, four patients had skin flap infection associated with an extended endaural approach. Audiologic performances were stable or improved following reimplantation in 90% of cases. We had two cases of electrode array misplaced into the vestibular system.
Is there a difference in activation or in inhibition of cortical auditory centers depending on the ear that is stimulated?
Conclusions.1.With auditory stimuli cortical activation of Brodmann’s areas 39 and 40 and inhibition of area 38 is bilateral. Inhibitory and excitatory relays play a role in the auditory pathways. 2. A statistically significant increased activation on the left side in areas 39 and 40, regardless of the stimulated ear, is suggestive that pure tones are preferably processed in the left hemisphere. 3. The significant difference in central inhibition depending on which ear is stimulated is supportive of the idea of a leading ear. Objectives: The objectives were to determine cortical activation/inhibition, ipsi/contralateral in response to monaural stimulation with pure tones, and if the response differs for right/left ear stimulation. Subjects and methods: Tc99m-HMPAO brain perfusion SPECT was done during monaural stimulation with pure tones in 10 volunteers. Ears were tested independently. Results: During auditory stimulation perfusion increased in both hemispheres in Brodmann’s areas 39-40 and decreased in area 38,>2 SD above and below the normal mean respectively, in both hemispheres, regardless of which side was stimulated. A significantly more intense response was seen in left versus right in areas 39 and 40. In area 38 there was bilateral inhibition, significantly more intense in response to left than right ear stimulation.
Performance of speech perception after cochlear implantation in DFNB1 patients
Conclusion: There were no apparent differences in speech performance after cochlear implantation between patients with biallelic GJB2 and/or GJB6 mutations and those with deafness of unknown aetiology. These data have important implications for the selection of prognostic indicators of the outcome of cochlear implantation. Objective: To compare performance after cochlear implantation in children with mutations in GJB2 (connexin 26) and/or GJB6 (connexin 30) and children with deafness of unknown aetiology. Subjects and methods: Genetic analysis and speech performance evaluation was determined in 24 patients with (n=11) and without (n=13) biallelic GJB2 and/or GJB6 mutations who underwent cochlear implantation. Speech perception skills were measured 12 and 24 months after surgery. Each patient was classified in accordance with the speech perception category (SPC). Results: Overall, the two groups showed similar significant improvement in speech perception after implantation.
Simultaneous and non-simultaneous dual electrode stimulation in cochlear implants: evidence for two neural response modalities
Conclusion: There are two modalities of dual electrode stimulation: a shifting, continuous excitation, which is the desired effect, and a split excitation with considerable variation in loudness. The first one most likely occurs in the basal turn, with adjacent contacts, stimulated simultaneously rather than sequentially. Objectives: This study examines the effects on place pitch and loudness of simultaneous current steering and sequential stimulation. These can give cochlear implant patients access to more perceptual channels than physical contacts in the electrode array. Materials and methods: For both lateral wall and perimodiolar electrodes, simultaneous current steering as well as sequential stimulation, place pitch and loudness of the percept were predicted with a computational model of the implanted human cochlea. The loudness predictions were validated with psychophysical loudness balancing experiments. Results: Simultaneous stimulation with adjacent electrode contacts in the basal end of the cochlea was generally able to produce a single, gradually shifting intermediate pitch percept. Simultaneous stimulation beyond the first cochlear turn, sequential stimulation and simultaneous stimulation with non-adjacent electrode contacts often produced two regions of excitation. In the case of sequential stimulation the total amount of current to reach most comfortable loudness was raised, both in the model and in the patients.
Spontaneous otoacoustic emissions in two infants
Conclusion: We regard spontaneous otoacoustic emission (SOAE) as a unique phenomenon due to spontaneous outer hair cell hyperactivity during the infantile period in these two infants. Objectives: We report the cases of SOAEs in two infants, which were audible to their parents. We were able to hear continuous sounds from these two infants’ ears. We studied their hearing and the emitted sounds objectively. Patients and methods: Patient 1 was a 5-month-old girl and patient 2 was an 11-month-old girl. Their parents heard continuous sounds emanating from their infants’ ears. Audiological examinations and frequency analysis were conducted. Results: The distortion-product otoacoustic emissions (DPOAEs) and auditory brainstem responses (ABRs) of the two patients were normal. Analysis of the continuous sounds demonstrated frequencies of 4.2 and 6.5 kHz for patient 1 and 6.7 kHz for patient 2. These audible sounds were diagnosed as SOAEs. The SOAEs in these infants did not disappear with their development in the last 2 years.
