ABSTRACT Purpose: to develop and evaluate an instructional material addressing steps and strategies in speech-language therapy for the treatment of speech disorders related to velopharyngeal dysfunction (VPD). Methods: a research taking place in three phases: 1) Planning and development of the material; 2) Evaluation of the material by speech-language therapists; and 3) Application of the material to undergraduate students of Speech-Language Therapy followed by an assessment of their understanding of the topic before and after viewing the material. Inferential statistics were presented by applying the Wilcoxon test to compare responses before and after exposure to the material, considering the level of significance less than or equal to p<0.05. Results: the content of the modules included: Velopharyngeal function during speech and VPD; Velopharyngeal sufficiency; Training of “modified breath and plosion” in speech; Training with sounds; and Tips for conducting speech-language therapy. In the second phase, five speech-language therapists evaluated the material from satisfactory to excellent, making suggestions that helped to improve it. As to the third phase, the average percentage of correct answers presented a significant increase of 23% after the students viewed the material (p=<0.001). Conclusion: the instructional material had its content and format evaluated from satisfactory to excellent by professionals; viewing by undergraduate students of Speech-Language Therapy increased their knowledge on the subject. Purpose speechlanguage language VPD. VPD . (VPD) Methods phases 1 2 3 SpeechLanguage Speech Language p005 p 0 05 p<0.05 Results included sufficiency modified plosion sounds phase it 23 p=<0.001. p0001 p=<0.001 001 (p=<0.001) Conclusion professionals subject (VPD p00 p<0.0 p000 p=<0.00 00 (p=<0.001 p0 p<0. p=<0.0 (p=<0.00 p<0 p=<0. (p=<0.0 p< p=<0 (p=<0. p=< (p=<0 p= (p=< (p= (p

RESUMO Objetivo Caracterizar e comparar a audição e o estado da orelha média na fissura labiopalatina nas condições com ou sem história de tubo de ventilação. Métodos Estudo retrospectivo de 463 prontuários de pacientes com fissura transforame unilateral não sindrômica, operados. Foram analisadas otoscopia, imitanciometria, audiometria e história de TV ao longo de dez anos. Resultados Dos 440 prontuários incluídos no estudo, 254 (58%) apresentaram história de TV, enquanto 186 (42%) não apresentaram. As alterações encontradas nos exames de otoscopia foram mais frequentes nas orelhas com história de TV, e o resultado estatístico revelou associação significativa entre presença de TV e ocorrência de fluido (p<0,001); ocorrência de opacificação (p<0,001); ocorrência de retração (p<0,001); ocorrência de perfuração na membrana timpânica (p<0,001) e ocorrência de timpanosclerose (p<0,001). A curva tipo B foi observada em 46,4% das orelhas com história de TV, comparada a 16,3% no grupo sem TV (p<0,001) e a diferença de 30,1% entre os grupos foi significativa (p<0,001), indicando associação relevante entre TV e ocorrência de curva tipo B. A perda auditiva foi mais frequente para as orelhas com TV (34,2%) do que sem TV (10,4%) e a diferença foi significativa (p<0,001) indicando associação expressiva entre TV e perda auditiva. Conclusão Foram encontrados piores resultados otoscópicos e auditivos em pacientes com fissura labiopalatina com história de tubo de ventilação presente. 46 sindrômica operados imitanciometria anos 44 estudo 25 58% 58 (58% 18 42% 42 (42% p<0,001 p0001 p 0 001 (p<0,001 p<0,001. . 464 4 46,4 163 16 3 16,3 301 30 1 30,1 p<0,001, , 34,2% 342 34 2 (34,2% 10,4% 104 10 (10,4% presente 5 (58 (42 p<0,00 p000 00 (p<0,00 46, 16, 30, 34,2 (34,2 10,4 (10,4 (5 (4 p<0,0 p00 (p<0,0 34, (34, 10, (10, ( p<0, p0 (p<0, (34 (10 p<0 (p<0 (3 (1 p< (p< (p

ABSTRACT Purpose To characterize and compare hearing and middle ear status in patients with cleft lip and palate with or without a history of ventilation tube insertion. Methods Retrospective study that involved the analysis of 463 medical records of patients with non-syndromic repaired unilateral cleft lip and palate. Otoscopy, immittance measures, audiometry and ventilation tube history over 10 years were analyzed. Results From 440 medical records included in the study, 254 (58%) had a history of VT insertion, while 186 (42%) did not. The percentage of abnormal findings in otoscopic examination was consistently higher for ears with a history of VT and statistical analysis revealed an association between history of VT and fluid in the middle ear (p<0.001); tympanic opacification (p<0.001); tympanic retraction (p<0.001) tympanic perforation (p<0.001) and tympanosclerosis (p<0.001). The type B tympanometric curve was observed in 46.4% of ears with a history of present VT, compared to 16.3% in individuals with an absent history of VT (p<0.001) and the difference of 30.1% between groups was significant (p<0.001), indicating association between VT and type B curve. Hearing loss was more frequent in ears with a history of VT (34.2%), when compared to ears without this history (10.4%), with a statistically significant difference (p<0.001), indicating positive association between VT and hearing loss. Conclusion Worse otoscopic and auditory results were found in patients with cleft lip and palate with a history of VT. insertion 46 nonsyndromic non syndromic Otoscopy measures 1 analyzed 44 25 58% 58 (58% 18 42% 42 (42% not p<0.001 p0001 p 0 001 (p<0.001 p<0.001. . 464 4 46.4 163 16 3 16.3 301 30 30.1 p<0.001, , 34.2%, 342 34.2% 34 2 (34.2%) 10.4%, 104 10.4% (10.4%) 5 (58 (42 p<0.00 p000 00 (p<0.00 46. 16. 30. 34.2 (34.2% 10.4 (10.4% (5 (4 p<0.0 p00 (p<0.0 34. (34.2 10. (10.4 ( p<0. p0 (p<0. (34. (10. p<0 (p<0 (34 (10 p< (p< (3 (1 (p

RESUMO Objetivo: Comparar conhecimento de graduandos de Odontologia e Fonoaudiologia sobre tratamento protético na disfunção velofaríngea referente a casos de fissura labiopalatina antes e após uso de material multimídia educacional. Método: Aplicação de um questionário sobre tratamento protético da disfunção velofaríngea em casos de fissura labiopalatina a um grupo de estudantes de graduação de Odontologia e Fonoaudiologia, antes e após acesso a material multimídia educacional/vídeo desenvolvido sobre o tema abordado neste estudo. Estatística inferencial foi usada para investigar significância das diferenças nas respostas corretas entre as situações antes e após acesso ao material multimídia/vídeo apresentado a graduandos de Odontologia e Fonoaudiologia. Resultados: Participaram 58 discentes, 38 do curso de Odontologia e 20 de Fonoaudiologia. Antes do acesso ao material multimídia/vídeo, graduandos de Fonoaudiologia apresentaram mais acertos (Odontologia 4,89±1,31 / Fonoaudiologia 6,30±0,57). Após acesso a esse material, a diferença de acertos entre alunos dos referidos cursos diminuiu (Odontologia 6,00±0,66 / Fonoaudiologia 6,45±0,51), sendo que, neste momento, graduandos de Odontologia mostraram aumento no conhecimento sobre a temática desta pesquisa. Ao comparar a amostra total, antes e após aplicação do material multimídia/vídeo, verificou-se aumento dos acertos. Conclusão: Certificou-se maior conhecimento prévio no curso de Fonoaudiologia acerca do tema referente à prótese de palato em quadros de disfunção velofaríngea em casos de fissura labiopalatina. Todavia, o uso de material multimídia, possivelmente, viabilizou ampliação de conhecimentos relacionados a tal tema tanto aos discentes do Curso de Odontologia como de Fonoaudiologia. Objetivo educacional Método educacionalvídeo vídeo estudo multimídiavídeo Resultados 5 3 2 489131 4 89 1 31 4,89±1,3 6,30±0,57. 630057 6,30±0,57 . 6 30 0 57 6,30±0,57) 600066 00 66 6,00±0,6 6,45±0,51, 645051 6,45±0,51 , 45 51 6,45±0,51) que momento pesquisa total verificouse verificou se Conclusão Certificouse Certificou Todavia possivelmente 48913 8 4,89±1, 63005 6,30±0,5 60006 6,00±0, 64505 6,45±0,5 4891 4,89±1 6300 6,30±0, 6000 6,00±0 6450 6,45±0, 489 4,89± 630 6,30±0 600 6,00± 645 6,45±0 48 4,89 63 6,30± 60 6,00 64 6,45± 4,8 6,30 6,0 6,45 4, 6,3 6, 6,4

ABSTRACT Objective: To compare the knowledge of Dental and Speech-Language Pathology undergraduate students about prosthesis treatment of velopharyngeal dysfunction in cases of cleft lip and palate before and after using educational multimedia material. Methods: The sample comprised 58 students (38 from the Dental program, and 20 from the Speech-Language Pathology program). A questionnaire on prosthesis treatment of velopharyngeal dysfunction in cases of cleft lip and palate was administered to a group of Dental and Speech-Language Pathology undergraduate students before and after they had access to educational multimedia (video) material on the topic approached in this study. Inferential statistics were used to investigate the significance of differences in correct answers before and after the Dental and Speech-Language Pathology undergraduate students had access to the multimedia/video material. Results: Before having access to the multimedia/video material, Speech-Language Pathology students had more correct answers (Dental: 4.89±1.31; SLP: 6.30±0.57). After having access to the material, the difference in correct answers between the students of both programs decreased (Dental: 6.00±0.66; SLP: 6.45±0.51), as Dental students’ knowledge of the research topic increased. The comparison of the total sample before and after applying the multimedia/video material also demonstrated an increase in correct answers. Conclusion: Speech-Language Pathology students proved to have greater previous knowledge of palatal prostheses used for velopharyngeal dysfunction in cases of cleft lip and palate. Moreover, using the multimedia material possibly increased both Dental and Speech-Language Pathology students’ knowledge of this topic. Objective SpeechLanguage Speech Language Methods 5 38 (3 program 2 program. . program) video (video study multimediavideo Results (Dental 4.89±1.31 489131 4 89 1 31 SLP 6.30±0.57. 630057 6.30±0.57 6 30 0 57 6.30±0.57) 6.00±0.66 600066 00 66 6.45±0.51, 645051 6.45±0.51 , 45 51 6.45±0.51) Conclusion Moreover 3 ( 4.89±1.3 48913 8 63005 6.30±0.5 6.00±0.6 60006 64505 6.45±0.5 4.89±1. 4891 6300 6.30±0. 6.00±0. 6000 6450 6.45±0. 4.89±1 489 630 6.30±0 6.00±0 600 645 6.45±0 4.89± 48 63 6.30± 6.00± 60 64 6.45± 4.89 6.30 6.00 6.45 4.8 6.3 6.0 6.4 4. 6.

RESUMO Objetivo: caracterizar o funcionamento velofaríngeo de indivíduos que apresentam disfunção velofaríngea sugestiva de velofaringe hipodinâmica. Métodos: a amostra foi constituída por exames de nasoendoscopia, de indivíduos adultos com palato operado, sem fístula, com disfunção velofaríngea e provável diagnóstico de velofaringe hipodinâmica. Todos os indivíduos utilizavam obturador faríngeo e nunca haviam realizado terapia fonoaudiológica para tratamento da disfunção velofaríngea. Três fonoaudiólogas avaliaram o movimento das estruturas velofaríngeas. Os resultados foram analisados por meio de estatística descritiva e o Teste de Kappa foi utilizado para calcular a concordândia intra-avaliador. Resultados: das 28 gravações, 23 (82%) apresentaram mobilidade mínima do véu palatino e paredes laterais, com gap velofaríngeo residual grande. Além disso, 23 (82%) não apresentaram movimento antagônico e o anel de Passavant estava presente em 7 (25%). Quanto ao tipo de gap, 16 (57%) apresentaram gap circular, 8 (28%) gap circular com anel de Passavant, 3 (10%) gap coronal e 1 (5%) gap sagital. Não houve movimentação da parede posterior da faringe em 14 (50%) gravações. A concordância foi considerada quase perfeita para todos os aspectos analisados (Kappa = 1,00). Conclusão: sujeitos com disfunção velofaríngea indicativa de uma velofaringe hipodinâmica apresentaram gap velofaríngeo igual ou acima de 50% do tamanho do espaço velofaríngeo em repouso, com movimento mínimo do véu palatino e das paredes faríngeas. Objetivo Métodos nasoendoscopia operado fístula velofaríngeas intraavaliador. intraavaliador intra avaliador. avaliador intra-avaliador Resultados 2 gravações 82% 82 (82% laterais grande disso 25%. 25 25% . (25%) 57% 57 (57% 28% (28% 10% 10 (10% 5% 5 (5% sagital 50 (50% 1,00. 100 1,00 00 1,00) Conclusão repouso faríngeas (82 (25% (57 (28 (10 (5 (50 1,0 0 (8 (25 (2 (1 ( 1,

ABSTRACT Purpose: to characterize the velopharyngeal function of individuals presented with velopharyngeal dysfunction, suggestive of a hypodynamic velopharynx. Methods: the sample comprised nasoendoscopy examinations from adult subjects with repaired cleft palate, no fistula, velopharyngeal dysfunction, and a probable diagnosis of hypodynamic velopharynx. All participants used a pharyngeal bulb prosthesis and had never undergone speech therapy for velopharyngeal dysfunction. Three speech-language pathologists assessed the movement of velopharyngeal structures. The results were analyzed using descriptive statistics, the Kappa being employed to measure intra-rater agreement. Results: out of the 28 recordings, 23 (82%) exhibited minimal mobility of the soft palate and lateral pharyngeal walls, with a large residual velopharyngeal gap. Additionally, 23 (82%) showed no antagonistic movement, and the Passavant's ridge was present in 7 (25%). Regarding the type, 16 (57%) had a circular gap, 8 (28%) had a circular gap with a Passavant´s ridge, 3 (10%) had a coronal gap, and 1 (5%) had a sagittal one. There was no movement of the posterior pharyngeal wall in 14 (50%) recordings. Agreement was considered almost perfect for all aspects analyzed (Kappa = 1.00). Conclusion: subjects presented with velopharyngeal dysfunction, indicative of a hypodynamic velopharynx, exhibited a velopharyngeal gap equal to or greater than 50% of the resting size of the velopharyngeal space, with minimal movement of the soft palate and pharyngeal walls. Purpose dysfunction velopharynx Methods fistula speechlanguage language structures statistics intrarater intra rater agreement Results 2 recordings 82% 82 (82% walls Additionally Passavants Passavant s 25%. 25 25% . (25%) type 57% 57 (57% 28% (28% 10% 10 (10% 5% 5 (5% one 50 (50% 1.00. 100 1.00 00 1.00) Conclusion space (82 (25% (57 (28 (10 (5 (50 1.0 0 (8 (25 (2 (1 ( 1.

Abstract Introduction Compensatory articulations are speech disorders due to the attempt of the individual with cleft palate/velopharyngeal dysfunction to generate intraoral pressure to produce high-pressure consonants. Speech therapy is the indicated intervention for their correction, and an intensive speech therapy meets the facilitating conditions for the correction of glottal stop articulation, which is the most common compensatory articulation. Objective To investigate the influence of an intensive speech therapy program (ISTP) to correct glottal stop articulation in the speech of individuals with cleft palate. Methods Speech recordings of 37 operated cleft palate participants of both genders (mean age = 19 years old) were rated by 3 experienced speech/language pathologists. Their task was to rate the presence and absence of glottal stops in the 6 Brazilian Portuguese occlusive consonants (p, b, t, d, k, g) distributed within several places in 6 sentences. Results Out of the 325 pretherapy target consonants rated with glottal stop, 197 (61%) remained with this error, and 128 (39%) no longer presented it. The comparison of the pre- and posttherapy results showed: a) a statical significance for the p1, p2, p3, p4, t1, k1, k2 and d6 consonants (McNemar test; p < 0.05); b) a statistical significance for the p consonant in relation to the k, b, d, g consonants and for the t consonant in relation to the b, d, and g consonants (chi-squared test; p < 0.05) in the comparison of the proportion improvement among the 6 occlusive consonants. Conclusion The ISTP influenced the correction of glottal stops in the speech of individuals with cleft palate. palatevelopharyngeal velopharyngeal highpressure high (ISTP mean 1 old speechlanguage language pathologists p, (p b d k sentences 32 61% 61 (61% error 12 39% 39 (39% it pre showed p1 p2 p3 p4 t1 k1 McNemar test 0.05 005 0 05 chisquared chi squared (61 (39 0.0 00 (6 (3 0. (

ABSTRACT Purpose: to verify the association between central auditory skills and speech disorders related to velopharyngeal dysfunction. Methods: forty-five children, with repaired non-syndromic cleft lip and palate or cleft lip only, aged 7-11 years old, were divided into three groups: G1 (n=15), children with hypernasality, nasal air emission, and compensatory articulations; G2 (n=15), children with hypernasality and nasal air emission, but without compensatory articulations; and G3 (n=15), children without hypernasality, nasal air emission, and compensatory articulations. The medical records of all participants were analyzed to verify the eligibility criteria and obtain speech assessments, and then, they were submitted to an assessment of central auditory skills. Statistical analysis comprised descriptive and chi-square test with a significance level of 5%. Results: G1 presented a higher occurrence of impairment in central auditory skills differing from the other groups, particularly in the temporal ordering and binaural integration skills. A significant difference was observed among groups in temporal ordering ability. No significant association was found between the use of specific types of compensatory articulations and impaired auditory skills. Conclusion: there was an association between changes in temporal ordering auditory skills and binaural integration in children with velopharyngeal dysfunction, regardless of the presence or type of compensatory articulation found. Purpose dysfunction Methods fortyfive forty five nonsyndromic non syndromic only 711 7 11 7-1 old G n=15, n15 n n=15 , 15 (n=15) emission assessments then chisquare chi square 5 5% Results ability Conclusion 71 1 7- n1 n=1 (n=15 n= (n=1 (n= (n

RESUMO Introdução: As técnicas de mineração de dados ampliam o acesso a informações importantes para o processo de tomada de decisão durante os cuidados com a saúde. O objetivo do estudo propõe a utilização de técnicas de mineração de dados para identificar variáveis (protocolos de tratamento cirúrgico, características do paciente, intercorrências pós-cirúrgicas) associadas à ocorrência de fístulas após palatoplastia primária em pacientes com fissura transforame incisivo unilateral (FTIU). Método: Um conjunto de dados de 222 pacientes com FTIU sem síndromes, operados por quatro cirurgiões com as técnicas de palatoplastia primária de Furlow ou von Langenbeck, foi analisado para este estudo. Dois modelos para detecção do resultado da cirurgia foram induzidos usando técnicas de mineração de dados (Árvore de Decisão e Apriori). Resultados: Cinco regras foram selecionadas de uma árvore de decisão apontando para algumas variáveis como preditivas de fístulas associadas à palatoplastia primária: infecção, tosse, hipernasalidade, cirurgião. A análise do modelo indica que ele classifica corretamente 95,9% das ocorrências entre ausência e presença de fístulas. O segundo modelo indica que a ausência de intercorrências pós-cirúrgicas (infecção e febre) e resultado de fala normal (hipernasalidade ausente, sem sugestivo de disfunção velofaríngea) estão relacionados à ausência de fístulas. Em relação aos procedimentos cirúrgicos, o uso da técnica de Furlow e retalho de Vomer foram mais frequentes nos pacientes com fístulas. Conclusão: Técnicas de mineração de dados, conforme aplicadas no presente estudo, apontaram para infecção e tosse, presença de hipernasalidade, cirurgião e técnica cirúrgica como preditores de fístulas relacionadas à palatoplastia primária. Introdução saúde protocolos cirúrgico paciente póscirúrgicas pós cirúrgicas FTIU. . (FTIU) Método 22 síndromes Langenbeck Árvore Apriori. Apriori Apriori) Resultados tosse hipernasalidade 959 95 9 95,9 febre ausente velofaríngea cirúrgicos Conclusão (FTIU 2 95,

ABSTRACT Introduction: Data mining techniques expand access to important information for the decision-making process during health care. The objective the study proposes using data mining techniques to identify variables (surgical treatment protocols, patient characteristics, post-surgical complications) associated with fistulas after primary palatoplasty in patients with unilateral transforamen incisor cleft (UTIC). Method: A data set of 222 patients with UTIC without syndromes, operated by four surgeons with Furlow’s or von Langenbeck’s primary palatoplasty techniques, was analyzed for this study. Two models for detecting the outcome of surgery were induced using data mining techniques (Decision Tree and Apriori). Results: Five rules were selected from a decision tree pointing to some variables as predictors of fistulas associated with primary palatoplasty: infection, cough, hypernasality, and surgeon. Analysis of the model indicates that it correctly classifies 95.9% of occurrences between the absence and presence of fistulas. The second model indicates that the absence of post-surgical complications (infection and fever) and normal speech results (absent hypernasality, without suggestive of velopharyngeal dysfunction) are related to the absence of fistulas. Regarding surgical procedures, the Furlow technique and the Vomer flap were more frequent in patients with fistulas. Conclusion: Data mining techniques, as applied in the present study, pointed to infection and cough, hypernasality, and surgeon and surgical techniques as predictors of fistulas related to primary palatoplasty. Introduction decisionmaking making care protocols characteristics postsurgical post UTIC. . (UTIC) Method 22 syndromes Furlows s Langenbecks Langenbeck Decision Apriori. Apriori Apriori) Results cough hypernasality 959 95 9 95.9 fever absent dysfunction procedures Conclusion (UTIC 2 95.

RESUMO Objetivo Analisar o efeito de um treinamento perceptivo-auditivo de fonoaudiólogas sem experiência na classificação da hipernasalidade de fala de indivíduos com fissura labiopalatina e comparar a classificação da presença e grau de hipernasalidade realizadas dessas fonoaudiólogas (com a avaliação padrão-ouro), antes e depois do treinamento perceptivo-auditivo. Método Três fonoaudiólogas sem experiência analisaram 24 amostras de fala de alta pressão de indivíduos com fissura labiopalatina, antes e depois de treinamento perceptivo-auditivo, usando escala de quatro pontos. As amostras de fala correspondiam a seis amostras de cada grau de hipernasalidade. Entre as análises, as fonoaudiólogas receberam treinamento perceptivo-auditivo. Houve acesso às amostras de referência e feedback de respostas corretas quanto ao grau de hipernasalidade no treinamento. Resultados Não houve diferença significativa na porcentagem geral de acertos entre os momentos antes e depois do treinamento perceptivo-auditivo. Houve associação e concordância significativa das três avaliadoras com avaliação padrão ouro após treinamento, com aumento da concordância para uma avaliadora (aumento de respostas corretas para os graus ausente e leve). A análise dicotômica dos dados mostrou aumento do índice de concordância Kappa dessa avaliadora. Houve aumento do índice concordância inter-avaliadores para hipernasalidade ausente, leve, e grave, porém sem significância estatística. Conclusão O treinamento perceptivo-auditivo não resultou em melhora significativa da classificação da hipernasalidade de fala pelas fonoaudiólogas sem experiência, embora a análise individual dos dados tenha mostrado que o treinamento favoreceu uma dessas avaliadoras. Novos estudos envolvendo treinamento perceptivo-auditivo gradual e mais extenso poderão favorecer a classificação da hipernasalidade de fala por fonoaudiólogos sem experiência. perceptivoauditivo perceptivo auditivo padrãoouro, padrãoouro , padrão-ouro) perceptivoauditivo. auditivo. 2 perceptivoauditivo, auditivo, pontos análises leve. leve . leve) interavaliadores inter avaliadores grave estatística padrão-ouro

ABSTRACT Purpose To analyze the effect of auditory-perceptual training by inexperienced speech-language pathologists in the classification of hypernasality in individuals with cleft lip and palate and compare their classification of hypernasality individually, with the gold standard evaluation, before and after this training. Methods Three inexperienced speech-language pathologists used a four-point scale to assess 24 high-pressure speech samples from individuals with cleft lip and palate, before and after auditory-perceptual training. The speech samples corresponded to six samples of each degree of hypernasality. The speech-language pathologists received auditory-perceptual training during the assessments. They had access to anchor samples and immediate feedback of correct answers regarding the degree of hypernasality in training. Results There was no significant difference in the overall percentage of correct answers when comparing before and after the auditory-perceptual training. There was a significant association and agreement of the three evaluators with a gold standard evaluation after training, with an increase in agreement for a single evaluator for absent and mild degrees of hypernasality. The dichotomous analysis of the data showed an increase in the Kappa Index of Agreement of this evaluator. Although there was an increase in the Index of Agreement between evaluators for absent, mild, and severe hypernasality, this increase did not reach statistical significance. Conclusion The auditory-perceptual training provided did not result in a significant improvement in the hypernasality classification for the inexperienced speech-language pathologists, even though the individual data analysis showed that the training favored one of the evaluators. Further studies involving gradual and more extensive auditory-perceptual training may favor the classification of hypernasality by inexperienced SLPs. auditoryperceptual auditory perceptual speechlanguage language individually fourpoint four point 2 highpressure high pressure assessments significance SLPs

Resumo Introdução: Indivíduos com fissura palatina podem apresentar disfunção velofaríngea após a palatoplastia primária e necessitam de um secundário devido à insuficiência velofaríngea. Nesses casos, o obturador faríngeo pode ser usado temporariamente enquanto se aguarda uma cirurgia secundária. Objetivo: Investigar o resultado do tratamento da hipernasalidade com o uso de obturador faríngeo em pacientes com histórico de fissura palatina que apresentam insuficiência velofaríngea após a palatoplastia primária. Nossa hipótese é que o uso do obturador faríngeo seja uma abordagem eficaz para eliminar a hipernasalidade relacionada à insuficiência velofaríngea em pacientes com fissura palatina Método: Participaram do estudo 30 indivíduos falantes do Português Brasileiro (15 homens e 15 mulheres) com fissura palatina operada, de 6 a 14 anos de idade (média: 9 anos; DP = 1,87 anos). Todos os pacientes receberam obturador faríngeo para o tratamento da insuficiência velofaríngea, enquanto aguardavam vaga para a cirurgia secundária. A análise perceptivo-auditiva da fala, realizada nas condições com e sem obturador faríngeo, foi realizada por três ouvintes, quanto à presença e ausência da hipernasalidade. Resultados: 70% dos pacientes eliminaram a hipernasalidade de fala com o uso do obturador faríngeo, enquanto 30% não eliminaram. A comparação foi estatisticamente significante (p < 0,001). Conclusão: O uso temporário do obturador faríngeo é uma abordagem efetiva para eliminar a hipernasalidade decorrente da insuficiência velofaríngea.

Abstract Introduction: Individuals with cleft palate can present with velopharyngeal dysfunction after primary palatoplasty and require a secondary treatment due to insufficiency. In these cases, the pharyngeal bulb prosthesis can be used temporarily while awaiting secondary surgery. Objective: This study aimed to investigate the outcome of treatment of hypernasality with pharyngeal bulb prosthesis in patients with history of cleft palate presenting with velopharyngeal insufficiency after primary palatal surgery. We hypothesized that the use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency in patients with cleft palate. Methods: Thirty speakers of Brazilian Portuguese (15 males and 15 females) with operated cleft palate, ages ranging from 6 to 14 years (mean: 9 years; SD = 1.87 years), participated in the study. All patients were fitted with a pharyngeal bulb prosthesis to manage velopharyngeal insufficiency while they were awaiting corrective surgery to be scheduled. Auditory-perceptual analysis of speech recorded in the conditions with and without pharyngeal bulb prosthesis were obtained from three listeners who rated the presence or absence of hypernasality for this study. Results: Seventy percent of the patients eliminated hypernasality while employing the pharyngeal bulb prosthesis, while 30% still presented with hypernasality. The comparison was statistically significant (p < 0.001). Conclusion: The use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency.

ABSTRACT Purpose: to investigate the effectiveness of a pharyngeal bulb prosthesis to eliminate hypernasality in patients with operated cleft palate presenting with diagnosis of hypodynamic velopharynx. Methods: twenty patients with cleft palate, ages 11-40 years, presenting hypodynamic velopharynx participated in the study. Patients had their speech audio recorded twice, with and without prosthesis, simultaneously with nasometry. Three speech-pathologists rated the presence and absence of hypernasality. Perceptual and nasometric data without and with prosthesis were compared, using the McNemar Test (p<0.05). Results: three (15%) patients presented hypernasality without prosthesis and normal resonance with prosthesis, 3 (15%), normal resonance without prosthesis and hypernasality with prosthesis, 9 (45%), hypernasality without and with prosthesis, and 5 (25%), normal resonance in both conditions. Nasometry (≤27% cut off): 1 (5%), presented scores >27% without prosthesis and <27% with prosthesis, 2 (10%), scores <27% without prosthesis and >27% with prosthesis, 17 (85%), scores >27% in both conditions, and 1(5%), scores <27% in both conditions. The comparisons between the results were not significant (p=1.000). Conclusion: the pharyngeal bulb prosthesis alone is insufficient to eliminate hypernasality of patients presented with hypodynamic velopharynx. To this purpose, the combination between the prosthesis and speech therapy is required.

Abstract During times of increasingly recognized importance of interprofessional practices, professionals in Medicine, Dentistry, and Speech Pathology areas cooperate to optimize treatment of velopharyngeal dysfunction (VPD), after primary palatoplasty for correction of cleft palate. Objective Our study aims to compare velar length, velar thickness, and depth of the nasopharynx of patients with unilateral cleft lip and palate (UCLP) with the presence, or absence, of hypernasality and nasal air emission; and to verify if the depth:length ratio, between nasopharynx and velum, would be predictive of consistent hypernasality and nasal air emission (speech signs of VPD). Methodology Cephalometric radiographs and outcome of speech assessment were obtained from 429 individuals, between 6 and 9 years of age, with repaired unilateral cleft lip and palate. Velar length, velar thickness, depth of the nasopharynx, depth:length ratio, scores of hypernasality, and scores of nasal air emission were studied and compared; grouping the radiographs according to presence or absence of hypernasality and nasal air emission. Results For the group with speech signs of velopharyngeal dysfunction (those with consistent hypernasality and nasal air emission), the velums were shorter and thinner; the nasopharynx was deeper and the depth:length ratio was larger than the group without hypernasality and nasal air emission. Velar length was significantly shorter in individuals with consistent hypernasality and nasal air emission (p<0.001) and with history of palatal fistula (p=0.032). Depth of nasopharynx was significantly greater in individuals with consistent hypernasality and nasal air emission (p<0.001). Depthlength ratio was significantly larger in individuals with consistent hypernasality and nasal air emission (p<0.001). A depth:length ratio larger than 0.93 was always associated with speech signs of VPD. Conclusion Estimated with cephalometric radiographs, a depth:length ratio greater than 0.93, between the nasopharyngeal space and the velum, was 100% accurate in predicting hypernasality and nasal air emission after primary repair of unilateral cleft lip and palate.

RESUMO Objetivo Investigar a influência de estímulos de fala distintos na identificação perceptivo-auditiva da hipernasalidade em indivíduos com fissura labiopalatina operada (FLP). Método Foram editadas amostras de fala gravadas em áudio de 80 indivíduos com FLP unilateral operada, de ambos os sexos, com idades entre 9 e 17 anos (média=12 anos e 7 meses). As amostras foram gravadas durante a produção de 9 estímulos de fala distintos: contagem de números e conjuntos de frase orais, sendo 1 constituído por consoantes de baixa pressão e 7 constituídos por consoantes de alta pressão. Três fonoaudiólogas identificaram a presença ou ausência da hipernasalidade ao analisarem 864 gravações (80 indivíduos X 9 estímulos + 144 gravações repetidas para análise de concordância intra-avaliador). Os índices de concordância intra e interavaliadores foram estabelecidos para todos os 9 estímulos de fala e comparados entre si por meio do Teste Z, com nível de significância de 5%, com maiores índices de concordância interpretados como melhores estímulos para identificação da hipernasalidade. Resultados Índices de concordância intra-avaliadores de estímulos de fala vozeados foram significativamente menores do que outros estímulos. Índices de concordância entre os pares de fonoaudiólogas variaram de 0,11 (concordância estímulos plosivos vozeados) a 0,57 (12 frases, uma com cada consoante de alta pressão), com média de 0,47 entre as três avaliadoras, indicando concordância moderada para identificação da hipernasalidade. Conclusão Gravações de fala obtidas durante a produção de estímulos mais longos, incluindo 12 frases, uma com cada consoante de pressão, podem favorecer a concordância interavaliador na identificação da hipernasalidade.

ABSTRACT Purpose To investigate the influence of speech stimuli in the auditory perceptual identification of hypernasality in individuals with Cleft Lip and Palate (CLP). Methods Speech samples from 80 individuals with operated unilateral CLP, ages ranged from nine to 17 years (the mean age of: 12y7m), both genders, were edited for this study. Samples were recorded over the production of nine different speech stimuli, including counting and short sentences characterized by oral sounds, one loaded with low pressure consonants and seven loaded with high pressure consonants. Three speech-language pathologists rated the presence or absence of hypernasality while analyzing 864 recordings (80 individuals X 9 stimuli + 144 repeated recordings, for measuring the intra-rater agreement). Intra-rater and inter-rater indexes of agreement were established for all nine stimulus conditions. The indexes of inter-rater agreement were compared using the Z test (p<0.005), with samples comprising significant indexes of agreement interpreted as better stimuli for identifying the hypernasality in these individuals. Results Intra-rater agreement for high pressure stimuli with voiced consonants were significantly lower than indexes for other stimuli. Inter-rater agreement between each pair of SLPs ranged from 0.11 (plosive voicing stimuli) to 0.57 (12 short sentences, one of each high pressure consonant). The values of mean inter-rater agreement between all SLPs was 0.47 indicating moderate agreement for identifying hypernasal speech. Conclusion Speech recordings obtained over the production of longer speech samples including 12 short sentences, for instance one for each high pressure consonant, may favor inter-rater agreement for identifying hypernasality.

ABSTRACT Purpose To describe the speech of a patient with Pierre Robin Sequence (PRS) and severe speech disorders before and after participating in an Intensive Speech Therapy Program (ISTP). Methods The ISTP consisted of two daily sessions of therapy over a 36-week period, resulting in a total of 360 therapy sessions. The sessions included the phases of establishment, generalization, and maintenance. A combination of strategies, such as modified contrast therapy and speech sound perception training, were used to elicit adequate place of articulation. The ISTP addressed correction of place of production of oral consonants and maximization of movement of the pharyngeal walls with a speech bulb reduction program. Therapy targets were addressed at the phonetic level with a gradual increase in the complexity of the productions hierarchically (e.g., syllables, words, phrases, conversation) while simultaneously addressing the velopharyngeal hypodynamism with speech bulb reductions. Results Re-evaluation after the ISTP revealed normal speech resonance and articulation with the speech bulb. Nasoendoscopic assessment indicated consistent velopharyngeal closure for all oral sounds with the speech bulb in place. Conclusion Intensive speech therapy, combined with the use of the speech bulb, yielded positive outcomes in the rehabilitation of a clinical case with severe speech disorders associated with velopharyngeal dysfunction in Pierre Robin Sequence.

Resumo Introdução: A avaliação perceptiva é considerada padrão-ouro para avaliar a nasalidade de fala. Vários procedimentos são utilizados para coletar e analisar os dados percebidos, o que a torna suscetível a erros. Por isso, há uma preocupação crescente na procura de métodos que possam aperfeiçoá-la. Objetivo: Descrever e comparar os resultados da nasalidade de fala obtidos por meio de julgamento ao vivo, Teste de Hipernasalidade (THIPER), julgamento de gravações por juízes e nasometria. Método: Estudo retrospectivo de 331 pacientes com fissura labiopalatina unilateral operada. Foi realizada a análise dos resultados do julgamento da nasalidade ao vivo e por meio de gravações por juízes, do THIPER e da nasometria. Os dados foram coletados do prontuário dos pacientes, com exceção do julgamento das gravações das amostras de fala, que foi realizado por juízes múltiplos. Resultados: Foram obtidas porcentagens mais altas de ausência de hipernasalidade no julgamento ao vivo e no THIPER, com resultados iguais entre ambas (79%). Porcentagens menores de ausência de hipernasalidade foram obtidas no julgamento das gravações por juízes (66%) e para a nasometria (57%). Conclusão: Os melhores resultados entre as quatro modalidades de avaliação da nasalidade de fala foram obtidos para as realizadas ao vivo (julgamento por um fonoaudiólogo e THIPER).

ABSTRACT INTRODUCTION: Perceptual evaluation is considered the gold standard to evaluate speech nasality. Several procedures are used to collect and analyze perceptual data, which makes it susceptible to errors. Therefore, there has been an increasing desire to find methods that can improve the assessment. OBJECTIVE: To describe and compare the results of speech nasality obtained by assessments of live speech, the Test of Hypernasality (THYPER), assessments of audio recorded speech, and nasometry. METHODS: A retrospective study consisting of 331 patients with operated unilateral cleft lip and palate. Speech nasality was assessed by four methods of assessment: live perceptual judgement, THYPER, audio-recorded speech sample judgement by multiple judges, and nasometry. All data were collected from medical records of patients, with the exception of the speech sample recording assessment, which was carried out by multiple judges. RESULTS: The results showed that the highest percentages of absence of hypernasality were obtained from judgements performed live and from the THYPER, with equal results between them (79%). Lower percentages were obtained from the recordings by judges (66%) and from nasometry (57%). CONCLUSION: The best results among the four speech nasality evaluation methods were obtained for the ones performed live (live nasality judgement by a speech pathologist and THYPER).

RESUMO Objetivo: comparar os valores de nasalância em amostras de fala com e sem o uso de fricativa faríngea e, também, com e sem hipernasalidade. Métodos: um total de 840 amostras de fala foi analisado neste estudo. As amostras foram julgadas por três juízas experientes por consenso quanto aos aspectos hipernasalidade e fricativa faríngea. Os julgamentos foram distribuídos em quatro grupos: G1: 255 amostras de fala julgadas como representativas de hipernasalidade; G2: 130 amostras julgadas como representativas do uso de fricativa faríngea e hipernasalidade; G3: 280 amostras julgadas como representativas de fala normal em falantes com história de fissura labiopalatina; G4: 175 amostras julgadas como representativas de fala normal em falantes sem história de fissura labiopalatina. Para análise dos dados foi utilizando o teste Kruskal-Wallis e quando houve diferença estatisticamente significante foi aplicado o teste Dunn's para comparar os grupos aos pares. Resultados: os julgamentos aferidos por consenso pelas três juízas permitiram a identificação de amostras representativas do uso de fricativa faríngea e da presença e ausência de hipernasalidade. Foram estabelecidos valores de nasalância (média e desvio padrão) para cada grupo e observou-se que houve diferença estatisticamente significante entre os grupos com alteração de fala (G1 e G2) e aqueles sem alteração (G3 e G4). A diferença entre o grupo com hipernasalidade (G1) e o grupo com FF (G2) não foi significante. Conclusão: o uso de FF não influenciou significantemente os valores de nasalância para a amostra estudada.

ABSTRACT Purpose: to compare nasalance scores between speech samples with and without pharyngeal fricative and with and without hypernasality. Methods: a total of 840 speech samples was analyzed in this study. The samples were rated by three experienced judges with consensus regarding the aspects of hypernasality and pharyngeal fricative. The ratings were distributed into 4 groups: G1: 255 samples rated as representative of presence of hypernasality; G2: 130 samples rated as representative of use of pharyngeal fricative and hypernasality; G3: 280 samples rated as representative of normal speech for speakers with history of cleft palate; G4: 175 samples rated as representative of normal speech for speakers without history of cleft palate. Statistical analysis involved the Kruskal-Wallis test and when significant the Dunn's test was used to compared pairs of data. Results: the ratings established with agreement between the 3 experienced judges allowed for the identification of the samples representative of use of pharyngeal fricative and hypernasal speech. Nasalance scores were establish for each group revealing a significant difference between groups G1+G2 (representative of speech errors) and groups G3+G4 (representative of normal speech). The difference between the group with hypernasality (G1) and the group with pharyngeal fricative (G2) was not significant. Conclusion: the use of pharyngeal fricative did not influence significantly the nasalance values obtained for the studied sample.