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The objective of this study is to utilize the Nasometer to objectively assess velopharyngeal competence, specifically through the quantification of nasalance. Initial calibration of the nasometer was conducted on American adults. The objective of this study was to validate the use of the nasometer for the objective diagnosis of velopharyngeal insufficiency (VPI) in French children born with a total cleft lip and palate and to select relevant verbal stimuli for clinical practice. MATERIAL AND METHODS: The nasalance scores of 42 children aged 8 to 10 years old, born with a cleft lip and palate, were collected and compared with 50 control children. The scores were then analyzed in relation to 31 verbal stimuli from the French corpus created for this study (sentences and syllables). The most relevant threshold values were determined by receiver operating characteristic curves, which exhibited the highest sensitivity and specificity. RESULTS: The results demonstrated statistically significant differences (p < 0.05) in the mean nasalance scores of the control and cleft groups for all verbal stimuli containing oral phonemes. Threshold values with good diagnostic accuracy were defined, and 15 verbal stimuli were selected for use in clinical practice. CONCLUSION: The nasalance threshold values defined in this study can be utilized for the objective diagnosis of velopharyngeal insufficiency (VPI) and the subsequent monitoring of French children aged 8 to 10 years old, born with a cleft lip and palate.

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This study aims to compare the nasalance and nasal airflow between professional singers trained in Carnatic classical singing and non-singers. We also aimed to correlate perceived nasality with objective measurements of nasalance and nasal airflow. A total of 40 female participants (20 to 50 years) were involved in this study. The first group comprised 15 female professional Carnatic singers with a minimum of 10 years of classical training. The second group consisted of 25 non-singer females. These participants were compared on nasalance, nasal airflow and perceived nasality across three sets of stimuli (vowels, oral non-words, and nasal non-words) and three pitch-conditions (low, mid, and high). Correlations were also made between objective measures of nasalance and nasal airflow and perceived nasality. Mixed ANOVA showed a significant (P < 0.05) interaction in nasalance between pitch conditions and groups. Group differences were also observed in the nasalance scores of vowels, oral non-words, nasal non-words. There was a significant difference (P < 0.05) in nasalance with ascending pitch in singers and non-singers. A comparison of aerodynamic analysis of vowels, oral non-words, and nasal non-words between singers and non-singers suggested that nasal airflow was higher in singers. Perceptual nasality was significantly lower (P < 0.05) in Carnatic singers than non-singers. Correlations between objective measures of nasalance and nasal airflow and perceived nasality were not observed. Despite an increased airflow, nasality was lower in trained Carnatic singers than non-singers. Current findings suggest that vocal training impacts nasalance, nasal airflow and perceived nasality.

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The goal of the present research study was to investigate possible differences in nasalance scores between different Nasometer headgears. Frequency response characteristics of microphone pairs in a Nasometer model 6200, a model 6450 and two model 6500 headsets were compared using long-term average spectra of white noise and multi-speaker babble signals. Prerecorded sound files from a male and a female speaker were used to record nasalance scores with the four Nasometer headsets and to calculate cumulative absolute differences within and between the headsets. The main outcome measures were the cumulative absolute differences between the decibel (dB) values in the frequency bins from 300 to 750 Hz for the nasal and oral channels of each microphone pair. Cumulative absolute differences between nasalance scores of repeated stimuli within and across Nasometer headsets were tabulated. Results showed that cumulative absolute differences for the frequency range 300-750 Hz were between 6.58 and 7.68 dB. Within headsets, 95.6% to 100% of measurements of all four Nasometer headsets were within 3 nasalance points, although test-retest differences of up to 6 nasalance points were found. Between headsets, 56.1% to 98.9% of measurements were within 3 nasalance points, with the single largest difference of 8 nasalance points. In conclusion, differences between repeated nasalance scores obtained with the same and different headsets were noted. Clinicians should allow a margin of error of ±6 to 8 nasalance points when interpreting scores from different Nasometer headsets.

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The primary aim of the study was to develop phonemically balanced passage, Oral passage and Nasal passage in Punjabi language. Development of the passage: The words in the passage were chosen to represent the way sounds are distributed in spoken Punjabi language, and the relative phonemic distribution of each word inside each paragraph matched how frequently each sound occurs in Punjabi. The paragraph was constructed using words that were rated as extremely familiar and familiar. The developed passages were given to five speech-language pathologists for the purpose of content validation. 100 people with normal hearing between the ages of 18 and 25 were enrolled in the study (50 female and 50 male). Each subject's nasalence was measured using a Nasometer. The individuals were given passages written in Punjabi to read, and their nasalence scores for each text were recorded. The nasalance mean for Punjabi phonemically balanced passage was 36.41 ± 4.61% and 38.57 ± 4.22% in male and female subjects. The Punjabi oral passage mean were 27.36 ± 4.14% and 28.46 ± 4.01% in male and female subjects. The means for Punjabi nasal passage were 46.15 ± 4.09% in male subjects and 47.04 ± 4.91% in the female subjects. The Intraclass correlation coefficient for Female and male subjects for the Punjabi Phonemically balanced passage, Punjabi oral passage, Punjabi nasal passage were 0.904, 0.945; 0.807, 0.909, and 0.956, 0.913 respectively. The developed passages have good test retest reliability and their normative scores can be used for assessment of different resonance disorders.

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To investigate the relationship between auditory-perceptual ratings of resonance and nasometry scores in children with cleft palate. Factors which may impact this relationship were examined including articulation, intelligibility, dysphonia, sex, and cleft-related diagnosis.Retrospective, observational cohort study.Outpatient pediatric cranio-facial anomalies clinic.Four hundred patients <18 years of age identified with CP ± L, seen for auditory-perceptual and nasometry evaluations of hypernasality as well as assessments of articulation and voice.Relationship between auditory-perceptual ratings of resonance and nasometry scores.Pearson's correlations indicated that auditory-perceptual resonance ratings and nasometry scores were significantly correlated across oral-sound stimuli on the picture-cued portion of the MacKay-Kummer SNAP-R Test (r values .69 to.72) and the zoo reading passage (r = .72). Linear regression indicated that intelligibility (p ≤ .001) and dysphonia (p = .009) significantly impacted the relationship between perceptual and objective assessments of resonance on the Zoo passage. Moderation analyses indicated that the relationship between auditory-perceptual and nasometry values weakened as severity of speech intelligibility increased (P < .001) and when children presented with moderate dysphonia (p ≤ .001). No significant impact of articulation testing or sex were observed.Speech intelligibility and dysphonia alter the relationship between auditory-perceptual and nasometry assessments of hypernasality in children with cleft palate. SLPs should be aware of potential sources of auditory-perceptual bias and shortcomings of the Nasometer when following patients with limited intelligibility or moderate dysphonia. Future study may identify the mechanisms by which intelligibility and dysphonia affect auditory-perceptual and nasometry evaluations.

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OBJECTIVE: This study investigated the immediate effects and their persistence (at 15 minutes) of various durations of semi-occluded vocal tract exercise (SOVTE) (standard tube into water and modified mask+tube into water exercises) as measured by electroglottographic (EGG) and nasometric parameters. METHODS: The study included 30 women aged 19 through 28 years with healthy voices, and it comprised five randomly implemented procedures (Ps): P1-tube phonation into water for 5 minutes; P2-tube phonation into water for 10 minutes; P3-tube+ventilation mask phonation into water for 5 minutes; P4-tube+ventilation mask phonation into water for 10 minutes; P5-phonation with ventilation mask for 5 minutes. Fifteen-minute voice rest breaks were provided between each procedure. Nasometric and electroglottographic measurements were taken before, during, immediately after and at 5, 10, and 15 minutes after the exercises, and the recorded measurements were analyzed. RESULTS: The immediate effects of P3 and P4 on voice quality showed better performance than the other procedures. Among all the procedures, P1 had the smallest effect on voice quality in terms of nasometric and EGG parameters and the least degree of effect permanence. In all the fluctuating SOVTE procedures except P1, the nasalance scores decreased (P1, P2, P3, and P4: fluctuating SOVTE; P5: steady SOVTE). CONCLUSION: The tube phonation exercises modified by the addition of a ventilation mask were highly advantageous in terms of EGG parameters. In addition to this, regardless of the mode of application of the retention time, it was observed that the positive effect (ie, lower vertical laryngeal position) of the exercises applied for 10 minutes was higher than the exercises applied for 5 minutes.

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OBJECTIVE: Within the scope of semi-occluded vocal tract exercises (SOVTEs), we aimed to examine the effects of four exercise combinations, which involved various fluid densities and tube submersion depths, on acoustic and electroglottographic (EGG) parameters. METHODS: Four procedures (P) were applied consecutively to 30 female participants with normal voices using different tube submersion depths and fluid densities, including P1 (2 cm, water), P2 (2 cm, nectar), P3 (10 cm, water), and P4 (10 cm, nectar). Nasometric (Nasometer II model 6450) and EGG (Electroglottograph model 6103) measurements were taken before the procedures were initiated (pre-test) and at the end of each procedure. In addition, EGG measurements were taken for each procedure during the application. RESULTS: For all three velar positions (oral passage, oro-nasal passage, nasal passage), the only procedure that caused a significant change compared to the pre-test stage in regard to nasalance score was P2 (2 cm nectar) in common. All other procedures except P1 (2 cm water) significantly increased velar closure compared to pre-test levels. However, when the differences between the exercises were examined, the least velar closure, compared to the other procedures, was obtained after P4 (10 cm nectar). While there was no significant difference between the procedures in the EGG measurements during the exercise, a significantly higher tendency to contact was observed after the procedures with a denser consistency, and an increase in the fundamental frequency (fo) values occurred in the pairwise comparisons of the procedures in the measurements after the exercises. CONCLUSION: In SOVTEs in which water phonation is performed with a tube, the use of a fluid with a consistency denser than water can be considered a particularly promising approach. In addition, exercises performed with increasing consistencies in 2 cm depth can provide more vocal cord and velopharyngeal port closure by increasing EGG-CQ and nasalance score values. However, more care should be taken while increasing the consistency at a submersion depth of 10 cm.

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Nasometry is used to assess nasality in speech but it is unclear whether overly frequent recalibration of the instrument adds measurement errors. The goal of the present research study was to describe the effect of the Nasometer 6450 calibration on the nasalance scores of repeated recordings. In a first experiment, the Nasometer calibration values stored in the computer's registry were manipulated to investigate the impact on nasalance scores. In the second experiment, a set of pre-recorded speech samples was re-recorded 40 times with a Nasometer 6450 in 4 different calibration regimens: Short-term repeated recordings without (R1) and with recalibration (R2C), and long-term repeated recordings over 10 days without (R3) and with recalibration (R4C). The first experiment showed that, compared to a calibration value of 1.0, a value of 0.9 resulted in nasalance scores that were on average 3 points lower while a calibration value of 1.1 resulted in scores that were 0.5 points higher. The results of the second experiment showed test-retest differences of less than 2 nasalance points for 91% of the data for a non-nasal stimulus. For a nasal stimulus, 91% of data were within 5 points for R3 and R4C. The results suggested that frequent recalibration of the Nasometer may slightly increase test-retest differences of nasalance scores. An alternative procedure for verifying microphone balance without recalibration is suggested.

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OBJECTIVE: To establish nasalance score norms for adolescent and young adult native speakers of American English and also determine age-group and gender differences using the Simplified Nasometric Assessment Procedures (SNAP) Test-R and Nasometer II. DESIGN: Prospective study using a randomly selected sample of participants. SETTING: Greater Cincinnati area and Miami University of Ohio. PARTICIPANTS: Participants had a history of normal speech and language development and no history of speech therapy. Participants in the adolescent group were recruited from schools in West Clermont and Hamilton County, whereas the young adults were recruited from Miami University of Ohio. The participants of both groups were residents of Cincinnati, Ohio or Oxford, Ohio and spoke midland American English dialect. OUTCOME MEASURES: Mean nasalance scores for the SNAP Test-R. RESULTS: Normative nasalance scores were obtained for the Syllable Repetition/Prolonged Sounds, Picture-Cued, and Paragraph subtests. Results showed statistically significant nasalance score differences between adolescents and young adults in the Syllable Repetition, Picture-Cued, and Paragraph subtests, and between males and females in the Syllable Repetition and the Sound-Prolonged subtests. A significant univariate effect was found for the syllables and sentences containing nasal consonants and high vowels compared to syllables and sentences containing oral consonants and low vowels. Across all the SNAP Test-R subtests, the females' nasalance scores were higher than the males. A significant univariate effect was also found across nasal syllables, and high vowels such that the females' nasalance scores were higher than the males. Tables of normative data are provided that may be useful for clinical purposes. CONCLUSION: Norms obtained demonstrated nasalance score differences according to age and gender, particularly in the Syllable Repetition/Prolonged Sound subtest. These differences were discussed in light of potential reasons for their existence and implications for understanding velopharyngeal function. In addition, nasalance scores are affected by the vowel type and place of articulation of the consonant. These facts should be considered when nasometry is used clinically and for research purposes.

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BACKGROUND AND AIM: Surgical procedures involving the manipulation of the airway structure have the potential to affect the quality of voice by changing the resonance properties. Regarding this, the present study was conducted to investigate the effect of rhinoplasty on the voice of professional voice users. METHODS AND MATERIALS: This cohort study was conducted on 30 professional voice users. For the purpose of the study, the patients completed the Voice Handicap Index (VHI). In addition, they were subjected to voice analysis that included the measurement of nasality in speech production (i.e., nasalance), using the nasometer II. Computerized speech lab was also utilized to examine vowels /e/ and /a/, each of which was sustained for 5 sec by the participants. RESULTS: The mean VHI scores were 8.5 ± 1.98 and 7.36 ± 1.71 before and after the surgery, respectively, indicating no significant difference between the two investigated stages (Z = - 0.53, P = 0.59). However, there was a significant difference between the patients with and without preoperative obstruction in terms of the VHI score (χ2 = 11.06, P = 0.004). With regard to orality, it had the mean values of 16.86 ± 7.45 and 15.22 ± 7.37 before and after the surgery, respectively. Furthermore, the mean values of nasality at the pre- and post-operation stages were 59.42 ± 6.04 and 56.28 ± 10.07, respectively. The comparison between the pre- and post-surgical orality and nasality revealed no significant difference (t = 1.226, P = 0.23 and t = 0.93, P = 0.36, respectively). CONCLUSION: Although rhinoplasty is supposed to affect voice and vocal resonation, the induced changes are not problematic for the professional voice users. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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ABSTRACT@#Soft palate tumors pose the challenge during reconstructive and rehabilitating procedures. Surgical resection of these tumors leads to velopharyngeal insufficiency (VPI). The primary effects of VPI are hypernasality and air-flow escape, while the secondary effects are abnormalities in speech articulation. Surgical revision along with speech therapy is a common approach to the treatment of VPI. Prosthetic management by means of speech aid prosthesis helps to reduce resonance, nasal emission and consonants errors. This clinical report describes the different stages of rehabilitation of velopharyngeal insufficiency defect following resection of malignant melanoma of left posterior alveolar ridge and soft palate. The speech aid prosthesis helped to rehabilitate the velopharyngeal insufficiency defect and aided in the diagnosis of extent of speech function improvement by perceptual and objective methods.

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The present study aims to evaluate the effect of timing of cleft palate repair on speech results by using objective assessment tools, under standardized variables. The patients included in the study were divided into three groups according to their age of palatal repair. Velopharyngeal closure was evaluated anatomically by nasopharyngoscopy, and the nasalance values were recorded and evaluated objectively by nasometer. Also, the rate of secondary surgical intervention and fistula rate was analyzed for each group. Nasalance values and nasopharyngoscopic evaluation results were statistically similar between group 1 and group 2. However, there was a statistically significant difference between these groups compared with group 3 in the nasalance value of all speech samples and terms of the velopharyngeal complete closure (p = 0.022). The rate of fistula and secondary surgical intervention was statistically similar between the groups (p = 0.080). In secondary surgical intervention rates, the difference between group 1 and group 3 was statistically significant (p = 0.016). The present study confirms the importance of the 18th month as a cut-of time in palatal repair for improved speech results by using objective assessment tools.

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OBJECTIVE: The aim of this study was to adapt the Simplified Nasometric Assessment Procedures-Revised (SNAP-R) [1] to Turkish, gather norms from Turkish speakers, and test the sensitivity and specificity of the adapted test. Finally, this study was designed to determine if there are any differences in average nasalance scores due to age, gender, and vowel content of the passage. METHODS: 240 children without any known speech, language or hearing disorders and 40 children with cleft palate participated in the study. Participants were divided into three groups according to their age (ages 4-7; 8-12; and 13-18). Data for this descriptive study was collected in the school settings and in a center of speech and language therapy. RESULTS: This study showed a slight increase in nasalance with age, but no difference in nasalance based on gender. Furthermore, the nasalance score is determined by vowel content of the passage and that high vowels have higher nasalance than the low vowels. CONCLUSION: This paper offers a new test for nasometric evaluation in the Turkish language, which has relatively high specificity and sensitivity in the evaluation of hypernasality.

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This study was designed to develop language-specific stimuli for the assessment of resonance and to obtain nasalance scores using the newly developed speech stimuli in Mandarin. Gender and age influences on nasalance scores for each of the stimulus were also examined. Participants recruited were typically developing Mandarin-speaking ethnic Chinese children aged 6;00-7;11 growing up in Malaysia. Perceptual ratings of nasality were made based on the GOS.SP.ASS.'98 (revised) for children while nasalance scores were recorded for each stimulus using the Nasometer II (Model 6400). Fifty Mandarin-speaking children (24 males and 26 females) were recruited. None of the participants were perceived with abnormal nasality on the three stimuli. The mean nasalance scores for the Mandarin stimuli were 16.08% (SD = 2.57, 95% CI = 15.35-16.81) for the Oral passage, 25.20% (SD = 3.63, 95% CI = 24.17-26.23) for the Oral-Nasal passage and 55.44% (SD = 4.17, 95% CI = 54.25-56.63) for the Nasal passage. No significant age- and gender-related differences were observed for all the three stimuli. This is the first set of Mandarin stimuli and nasalance norms for Mandarin-speaking children in Malaysia. The influence of phonetic content on nasalance is supported. Findings call for language-specific normative nasalance data and careful selection of stimuli for the assessment of resonance.

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OBJECTIVE: The Nasometer is increasingly being used to complement auditory perceptual assessment of nasality. Nasalance scores which are obtained from the Nasometer vary across languages. Normative nasalance scores have been established for many languages but not for the Vietnamese language. The objective of this study was to obtain the normative nasalance scores for Vietnamese-speaking children. PARTICIPANTS: In this study, 102 healthy Vietnamese children speaking in the central regional dialect aged from 7 to 9 years (45 boys, 57 girls; mean age = 7.5 years) at a primary school in Hue, Vietnam participated. PROCEDURES: Three speech stimuli, which were specific for the Vietnamese language, were designed: oral stimuli (19 words and 18 sentences), oro-nasal stimuli (eight sentences) and nasal stimuli (seven sentences). The children were asked to repeat these stimuli after the examiner. The Nasometer II (model 6450) was used to obtain the nasalance scores. The procedure took about 10 minutes for each child. RESULTS: The mean nasalance scores and the standard deviation of each stimulus were: 13.1 ± 5.8 (oral stimuli), 30.7 ± 6.6 (oro-nasal stimuli) and 56.9 ± 9.2 (nasal stimuli). No significant differences between the genders were found. CONCLUSIONS: The normative nasalance scores provide essential reference information for clinicians who deal with nasalance disorders, especially patients with cleft palate. The nasalance scores in this study were established for Vietnamese children speaking in the central regional dialect and can be applied to both genders.

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OBJECTIVE: The goals of this research are (1) to establish normative nasalance values for bilingual Mandarin-English speakers and compare values to those of previously reported monolingual Mandarin speakers, and (2) to examine whether sex, age, dialect, and language proficiency affect levels of nasalance among Mandarin-English speakers in both English and Mandarin. DESIGN: All participants recorded the speech stimuli, constructed to include oral sentences, nasal sentences, oronasal sentences, and vowels /ɑ, i, u/ in Mandarin and English. Nasalance measurements were recorded using the Nasometer II 6450. PARTICIPANTS AND SETTING: A total of 45 (20 males and 25 females) native Mandarin speakers between 20 and 54 years of age from mainland China participated in the study. RESULTS: Mean nasalance scores of the Mandarin oral sentence (Mean [M] = 17.64, standard deviation [SD] = 7.33), oronasal sentence (M = 54.62, SD = 7.81), and nasal sentence (M = 68.73, SD = 8.09) are reported. Mean nasalance scores of the English oral sentence (M = 20.02, SD = 7.83), oronasal sentence (M = 58.71, SD = 7.59), and nasal sentence (M = 65.27, SD = 7.45) are reported. A repeated measures analysis of variance showed significant sex difference in nasalance scores for English stimuli ( P = .031) and Mandarin stimuli ( P = .040). There was no significant effects of age, dialect, and language proficiency on Mandarin or English stimuli. CONCLUSIONS: This is the first study to report normative values for Mandarin-English speakers using the Nasometer II. Values reported can be used for objective assessment of bilingual speakers.

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BACKGROUND: Velopharyngeal insufficiency that accompanies speech resonance and articulation disorders can be managed through several intervention methods such as speech-language therapy, prosthetic aids, and surgery. However, for patients with severe hypernasality, surgical interventions are highly recommended. Among available surgical techniques, the posterior pharyngeal flap is most common. CASE PRESENTATION: Two adult males with high nasalance scores underwent superiorly based posterior pharyngeal flap surgery, followed by speech testing by an expert speech-language therapist. Nasalance scores and articulation accuracy were assessed up until 1 year after the surgery. Nasalance scores were measured five times using a nasometer, after which the average value was calculated. CONCLUSIONS: Consistent declines in hypernasality over time are not easy to explain since the pedicled pharyngeal flap narrowed over time, secondary to cicatrization. However, scar tethering of the soft palate in a posterior direction could reduce the velopharyngeal port size over time. Therefore, long-term follow-up with intensive speech therapy is suggested for patients with severe hypernasality.

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Normative nasalance scores are essential for the treatment and assessment purposes for clinicians. Till date, no studies have been done on nasalance in Estonia. This research was conducted to develop Estonia-specific optimized speech stimuli for Nasometer II and establish the normative nasalance scores. Ninety-two randomly selected healthy and 14 cleft palate Estonian monolingual children, aged four to seven years, were included as participants. Estonian language-specific test material was developed. The Estonian test material consisted of 24 speech stimuli. Based on the phoneme content, the stimuli were divided into three groups: (1) sentences that included oral and nasal phonemes and targeted the same phoneme distribution as in spontaneous speech, (2) sentences that included only oral phonemes and (3) sentences that were loaded with nasal phonemes. Nasometer II software was used to calculate the nasalance scores for each child and each sentence. Results indicated that there were significant differences in nasalance scores for oronasal and oral stimuli scores, and no significant differences were found in nasal stimuli scores between the study and control group. The threshold for oronasal stimuli was 42.1-18.9, oral stimuli was 27.9-3.9 and nasal stimuli was 69.4-46.2. In conclusion, Estonia-specific optimized speech stimuli were developed and normative nasalance scores were established. These normative scores can be used for the diagnosis and follow-up treatment of patients with resonance disorders, especially for patients with cleft palate.

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OBJECTIVES: This study establishes normative nasalance values for middle-aged and elderly Brazilian Portuguese-speakers and investigates age and gender effects across the life span. METHODS: Nasalance scores were obtained from 62 middle-aged (45-59 years) and 60 elderly (60-79 years) participants with normal speech for 3 nonnasal, 1 phonetically balanced, and 2 nasal-loaded test sentences using the Nasometer II 6400. The data were combined with a published data set of 237 speakers in 4 groups: children (5-9 years), adolescents (10-19 years), young adults (20-24 years), and mature adults (25-35 years). A repeated-measures analysis of variance was used to investigate differences between the stimuli by gender and age groups. RESULTS: There were statistically significant effects of stimulus, gender, and age group, as well as a stimulus-age group interaction effect and a gender-age group interaction effect. The females' mean nasalance scores were higher than those of the males. The mean nasalance scores for the child, adolescent, and young and mature adult speakers were significantly lower than those for the elderly speakers, and the children's scores were significantly lower than those of the middle-aged speakers. CONCLUSION: Higher nasalance scores among middle-aged and elderly speakers may indicate physiological changes affecting oral-nasal balance in speech across the life span.

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