Analysis of oral-nasal balance after intensive speech therapy combined with speech bulb in speakers with cleft palate and hypernasality

Gabriela Zuin Ferreira; Tim Bressmann; Jennifer de Cássia Rillo Dutka; Melina Evangelista Whitaker; Gillian de Boer; Viviane Cristina de Castro Marino; Maria Inês Pegoraro-Krook

doi:10.1016/j.jcomdis.2019.105945

Analysis of oral-nasal balance after intensive speech therapy combined with speech bulb in speakers with cleft palate and hypernasality

J Commun Disord. 2020 May-Jun:85:105945. doi: 10.1016/j.jcomdis.2019.105945. Epub 2019 Sep 25.

Authors

Gabriela Zuin Ferreira¹, Tim Bressmann², Jennifer de Cássia Rillo Dutka³, Melina Evangelista Whitaker⁴, Gillian de Boer⁵, Viviane Cristina de Castro Marino⁶, Maria Inês Pegoraro-Krook⁷

Affiliations

¹ Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil. Electronic address: gabizuin@hotmail.com.
² Department of Speech-Language Pathology, University of Toronto (UofT), University Ave, 500, Toronto, ON, M5G 1V7, Canada. Electronic address: tim.Bressmann@utoronto.ca.
³ Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil; Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil. Electronic address: jdutka@usp.br.
⁴ Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil. Electronic address: melwhi@usp.br.
⁵ Department of Speech-Language Pathology, University of Toronto (UofT), University Ave, 500, Toronto, ON, M5G 1V7, Canada. Electronic address: gillian.deboer@mail.utoronto.ca.
⁶ Department of Speech-Language Pathology and Audiology, São Paulo State University (UNESP), Faculdade de Filosofia e Ciências, Campus de Marília, Av. Higino Muzzi Filho, 737, Marília, SP, CEP 17525-900, Brazil. Electronic address: vivianemarino2@yahoo.com.br.
⁷ Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil; Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil. Electronic address: mikrook@usp.br.

PMID: 31607437
DOI: 10.1016/j.jcomdis.2019.105945

Abstract

Objective: To evaluate the efficacy of the combination of a speech bulb with an intensive speech therapy program in hypernasal participants with cleft palate.

Methods: Twenty hypernasal speakers with cleft palate (12 females and 8 males, median age 28.45 years), who were wearing speech bulbs underwent an intensive speech therapy program of 45 sessions over 3 weeks. Three experienced speech-language pathologists rated the participants' speech recordings before and after intensive speech therapy, with and without the speech bulb. Nasometric recordings and long-term averaged spectra were also analyzed using repeated-measures ANOVAs.

Results: The ANOVA of the hypernasality ratings showed significant effects of therapy [F (1,19) = 15.97; p < .001], speech bulb [F(1,190 = 28.54, p < .001] and a therapy -speech bulb interaction effect [F(1.19) = 22.30, p < 0.001]. The most favorable listener ratings of hypernasality were obtained post-therapy when participants were wearing their speech bulbs. Without the speech bulb, intensive speech therapy by itself did not result in a significant improvement. With speech bulb, nasalance scores for high [F (1,19) = 14.07, p < .001] and low pressure [F (1,19) = 14.84, p < .001] sentences were significantly lower post-therapy, providing preliminary evidence that an intensive speech therapy program may enhance the effect of a speech bulb. Before and after comparisons of individual nasalance profiles demonstrated variable improvement in 15 participants, no progress in 2 participants and more severe hypernasality after therapy in 3 participants. Long-term averaged spectra corroborated the findings of the perceptual analysis. Based on a frequency bin from 201 to 300 Hz, there was a significant within-subject effect for with and without speech bulb [F(1, 18) = 4.54, p = .047] as well as for before vs. after session [F (1,18) = 7.14, p = .015].

Conclusion: The speech bulb in combination with intensive speech therapy resulted in improved oral-nasal balance for the majority of participants. More research is needed to investigate long-term outcomes as well as individual factors contributing to therapy success.

Keywords: Nasometry; Resonance; Spectrography; Speech outcomes; Speech therapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cleft Palate*
Female
Humans
Male
Speech
Speech Production Measurement
Speech Therapy*
Velopharyngeal Insufficiency*
Voice Quality