Prevalence and Effects

from Seminars in Hearing

ABSTRACT
Permanent unilateral hearing loss (UHL) of any degree and mild bilateral hearing loss (MBHL) are common conditions of childhood. When left undetected and in the absence of intervention, both UHL and MBHL can adversely affect development and can result in difficulties in speech, language, behavior, and academic achievement for some children. This article describes the prevalence of UHL and MBHL among newborns and school-aged children, the definitions of UHL and MBHL, and provides an overview of the effects of these hearing losses on children’s development. The article concludes that some children with UHL and MBHL are more at risk for problems than are others. Important questions for future research studies to ask are what subgroups of children with UHL and MBHL are likely to have difficulties with speech, language, reading, academic performance, and behavior; how do we identify these children; and what kinds of interventions are most appropriate for them?

Proposals and Research

from Seminars in Hearing

ABSTRACT
Although questions remain concerning the impact of permanent unilateral hearing loss (UHL) and mild bilateral hearing loss (MBHL) on child development, there is nonetheless evidence that at least some children experience measurable problems, particularly at school age (e.g., grade retention; need for support services). After evidence-supported oral presentations and discussions among clinical experts during the 2005 National Workshop on Mild and Unilateral Hearing Loss, a series of recommendations was developed regarding (1) early identification (hearing screening), (2) audiologic assessment, (3) hearing technologies, and (4) early intervention needs of infants and young children with UHL and MBHL.

Screening

from Seminars in Hearing

ABSTRACT
Most hearing screening programs have historically targeted children with moderate or more severe bilateral hearing loss. Children with unilateral or mild bilateral permanent hearing loss represent a substantial proportion of all children with hearing loss, and there are serious negative consequences for these children if they are not identified early and given appropriate help. Many children, particularly those with unilateral or mild bilateral hearing loss, acquire hearing loss after the newborn period. Although virtually all newborns are now screened for hearing loss before leaving the hospital, there are very few opportunities for periodic hearing screening after the newborn period. Effectively identifying those children who have late-onset loss or who are missed during newborn hearing screening will require modifying some of the procedures currently employed in hospital-based newborn hearing screening programs, as well as establishing better hearing screening procedures for early childhood and elementary school programs. Existing state Early Hearing Detection and Intervention systems are a resource for establishing and improving screening programs for infants and children with unilateral or mild bilateral hearing loss.

Articulatory Configuration and Pitch in a Classically Trained Soprano Singer

from the Journal of Voice

Summary
Previous studies suggest that singers modify articulation to avoid that the pitch frequency F0 exceeds the normal value of the first formant F1Normal. Using magnetic resonance imaging at a rate of 5 frames/s, articulation was analyzed in a professional soprano singing an ascending triad pattern from C4 to G5 (262–784Hz) on the vowels /i, e, u, o, a/. Lip and jaw opening and tongue dorsum height were measured and analyzed as function of pitch. Four or five semitones below the pitch where F0=F1Normal the tongue dorsum height was reduced in /i, e, u, a/, whereas in /o/ the lip opening was widened and in /a/ also the jaw opening was widened. At higher pitches, the jaw opening was widened in all vowels. These articulatory maneuvers are likely to raise F1 in these vowels.

Stockholm, Sweden

Correlation between Functional MRI And Voice Improvement Following Type I Thyroplasty in Unilateral Vocal Fold Paralysis—A Case Study

from the Journal of Voice

Summary
The objectives of this study are to describe central nervous system modulation associated with voice improvement following Type I thyroplasty in a patient with glottic insufficiency secondary to unilateral vocal fold paralysis. Serial functional magnetic resonance imaging scans were performed before as well as one and six months after thyroplasty. Paradigms consisting of four voice production tasks and a motor control task were completed. Volumes of activation within regions activated during each task were measured. Acoustic and aerodynamic measures were also obtained. A widespread network of neural activations was shown for all tasks. Differences in volumes of activation 1-month postsurgery positively correlated with acoustic and aerodynamic improvements. Sixth months following medialization, lesser volumes of activation were observed in all regions. Prior to this session, however, the patient’s mediastinal disease progressed, leading to a significant deterioration in voice. Functional differences between patient brain maps yield new information about the central nervous system’s ability to reorganize sensorimotor representations associated with voice improvement following Type I thyroplasty in a patient with glottic insufficiency secondary to unilateral vocal fold paralysis (UVFP).

New York, New York

Efficient and Effective Extraction of Vocal Fold Vibratory Patterns from High-Speed Digital Imaging

from the Journal of Voice

Summary
High-speed digital imaging can provide valuable information on disordered voice production in voice science. However, the large amounts of high-speed image data with limited image resolutions produce significant challenges for computer analysis, and thus effective and efficient image edge extraction methods allowing for the batch analysis of high-speed images of vocal folds is clinically important. In this paper, a novel algorithm for automatic image edge detection is proposed to effectively and efficiently process high-speed images of the vocal folds. The method integrates Lagrange interpolation, differentiation, and Canny edge detection, which allow objective extraction of aperiodic vocal fold vibratory patterns from large numbers of high-speed digital images. This method and two other popular algorithms, histogram and active contour, are performed on 10 sets of high-speed video data from excised larynx experiments to compare their performances in analyzing high-speed images. The accuracy in computing glottal area and the computation time of these methods are investigated. The results show that our proposed method provides the most accurate and efficient detection, and is applicable when processing low-resolution images. In this study, we focus on developing a method to effectively and efficiently process high-speed image data from excised larynges. However, in addition we show the clinical potential of this method by use of example high-speed image data obtained from a patient with vocal nodules.The proposed automatic image-processing algorithm may provide a valuable biomedical application for the clinical assessment of vocal disorders by use of high-speed digital imaging.

Madison, Wisconsin

Electroglottography in Elderly Patients with Vocal-Fold Palsy

from the Journal of Voice

Summary
The incidence of dysphonia in healthy elderly people is high. In individuals with iatrogenic vocal-fold paresis following thyroid surgery, serious aggravation of vocal skills contributes to impaired quality of life and requires proper management. Electroglottography is a common method for providing noninvasive measurements of glottal activity, yielding reliable indicators of glottal closing instants. The purpose of the study was to determine how electroglottography measures change with voice recovery in elderly speakers with vocal-fold palsy, compared with healthy elderly individuals, and which coefficient best represents dysphonia. An electroglottograph with Speech Studio 1.04 software was used to record and analyze the data. Electroglottography data were collected from 12 patients aged 65–78 years (mean=71.3, S.D.=3.8, median=71) and 10 healthy speakers aged 65–77 years (mean=70.9, S.D.=3.9, median=72). The findings show that the distribution of values of % irregularity differs between the groups of patients and controls. % Irregularity and closing quotient significantly correlate with the perceptual degree of dysphonia. Electroglottography can objectify dysphonia in elderly patients with vocal-fold palsy and is a suitable noninvasive tool for tracking the elderly patients’ long-term progress. % Irregularity best represents the vocal-fold dysfunction in elderly patients with a vocal-fold palsy.

Kraków, Poland

Perturbation and Nonlinear Dynamic Analysis of Different Singing Styles

from the Journal of Voice

Summary
Previous research has used perturbation analysis methods to study the singing voice. Using perturbation and nonlinear dynamic analysis (NDA) methods in conjunction may provide more accurate information on the singing voice and may distinguish vocal usage in different styles. Acoustic samples from different styles of singing were compared using nonlinear dynamic and perturbation measures. Twenty-six songs from different musical styles were obtained from an online music database (Rhapsody, RealNetworks, Inc., Seattle, WA). One-second samples were selected from each song for analysis. Perturbation analyses of jitter, shimmer, and signal-to-noise ratio and NDA of correlation dimension (D2) were performed on samples from each singing style. Percent jitter and shimmer median values were low normal for country (0.32% and 3.82%), musical theater (MT) (0.280% and 2.80%), jazz (0.440% and 2.34%), and soul (0.430% and 6.42%). The popular style had slightly higher median jitter and shimmer values (1.13% and 6.78%) than other singing styles, although this was not statistically significant. The opera singing style had median jitter of 0.520%, and yielded significantly high shimmer (P=0.001) of 7.72%. All six singing styles were measured reliably using NDA, indicating that operatic singing is notably more chaotic than other singing styles. Median correlation dimension values were low to normal, compared to healthy voices, in country (median D2=2.14), jazz (median D2=2.24), pop (median D2=2.60), MT (median D2=2.73), and soul (mean D2=3.26). Correlation dimension was significantly higher in opera (P<0.001) with median D2=6.19. In this study, acoustic analysis in opera singing gave significantly high values for shimmer and D2, suggesting that it is more irregular than other singing styles; a previously unknown quality of opera singing. Perturbation analysis also suggested significant differences in vocal output in different singing styles. This preliminary study using acoustic analysis with nonlinear dynamic measures and perturbation measures may represent a valuable procedure in quantitatively describing the properties of the singing voice. Further research with human test subjects may allow us to characterize singing styles and diagnose vocal dysfunction in the singing voice.

Madison, Wisconsin

Use of Narrative-Based Language Intervention With Children Who Have Cochlear Implants

from Topics in Language Disorders

Narrative-based language intervention (NBLI) is a 6-week production-based intervention approach that targets grammatical structure as well as narrative content and form. Story grammar components and syntactic forms specifically chosen for each individual are taught via story retell and story-generation techniques. Previous research has shown NBLI to be an effective intervention to increase the narrative skills of children with specific language impairment. In the present study, the use of NBLI was examined with 3 children who have cochlear implants. Modifications in NBLI for children with hearing loss included acoustic highlighting of the syntactic target. Gains in narrative quality as well as syntax were observed in children with severe-profound to profound hearing loss supporting the feasibility of NBLI for multiple populations.

Personal Narratives: Cultural Differences and Clinical Implications

from Topics in Language Disorders

Narrative production, especially personal narrative discourse, is a critical aspect of communicative competence. It is important for children in relating to peers and adults, acquiring literacy, receiving medical care, or testifying in legal situations. This article focuses on personal narratives, including their structure, development, and impairments. The Narrative Assessment Profile and high-point analysis are described to show how personal narratives can be assessed and how cultural differences can be contrasted from discourse impairments. The aim of these analyses is to show how misdiagnosis of cultural difference deficits can be prevented and how mistaking deficits in narrative production for cultural differences can be avoided. Implications for intervention are also presented.

Narratives Twenty-Five Years Later

from Topics in Language Disorders

This article discusses the potential value of working with school-aged children to increase their competence with narrative forms. With illustrations from current research, it argues that increased knowledge of, and experience with, narrative should have positive effects on comprehension of classroom language, selective listening, peer relations, and literacy. Narrative interventions can also be incorporated into dynamic assessment protocols and can help us identify children with limitations in language processing.

Narrative Transcription Accuracy and Reliability in Two Languages

from Topics in Language Disorders

Recent research documents the power of oral narrative language samples to predict reading achievement in both Spanish and English in English language learners (ELLs; J. ). To document their clinical utility, this article addresses issues of accuracy and reliability for transcription and analysis of oral narratives elicited from Spanish–English bilingual children. We first reviewed the unique considerations that must be made when transcribing narratives elicited from ELLs. To demonstrate that narrative transcription is clinically feasible, we documented that a single clinician can accurately transcribe children’s oral narratives and that the measures acquired from these samples are reliable. Forty oral narratives were first transcribed by a single transcriber, and then checked and retranscribed by additional transcribers. High levels of accuracy and agreement between transcribers were observed across both the English and the Spanish transcripts. Test–retest reliability was documented for 241 transcripts produced by the ELL children. Significant correlations were observed between Time 1 and Time 2 for 4 narrative measures. These data demonstrate that oral narrative data from ELL children can be accurately transcribed and the narrative measures are stable over time, providing the research foundation for clinical use of narrative language samples.

Narrative Abilities: Advances in Research and Implications for Clinical Practice

from Topics in Language Disorders

The development of narrative abilities is an important achievement, and narratives play a significant role in academic success. Children with language impairments experience significant challenges in connected discourse: difficulties that continue to characterize their linguistic abilities into adolescence. Recent research investigating narrative abilities has important theoretical and clinical implications for speech–language pathologists. This article highlights key findings in recent research addressing narrative abilities in children with and without language impairments. Implications of research findings for narrative assessment and intervention are discussed.

Emerging Procedures in Narrative Assessment: The Index of Narrative Complexity

from Topics in Language Disorders

This article summarizes norm-referenced and criterion-referenced measures of narration and introduces a new criterion-referenced narrative scoring system called the Index of Narrative Complexity (INC). The INC was designed to be used as a progress-monitoring tool. A preliminary study of the use of this scoring system is reported that yielded evidence suggesting that the INC can be scored consistently, yields similar scores across five elicitation formats, is sensitive to change after intervention, and correlates highly with the Test of Narrative Language. These results support the use of the INC as a clinical tool for evaluating the outcomes of narrative intervention.

Assessing Story Comprehension in Preschool Children

from Topics in Language Disorders

Many of the foundational abilities that are necessary for learning to read emerge in preschool children’s oral language in advance of formal literacy instruction. This is not only true of phonemic awareness skills but also true of oral language comprehension, particularly of stories. Thus, clinical evaluation of preschoolers’ story comprehension abilities is an important part of a preliteracy assessment. Ensuring that the outcomes of these evaluations accurately reflect children’s abilities and lead to optimal clinical decisions requires familiarity with the available tools, their task demands, and psychometric properties. To provide clinicians with information necessary for making evidence-based choices in their assessment of story comprehension, we review the development of story comprehension in young children with and without language impairment. We then describe the procedures, both traditional and novel, that have been used to measure early story comprehension, assessing strengths and limitations.