The influence of the design of removable dentures on patient's voice quality

Background: The protozoan parasite Giardia intestinalis and the pathogenic bacterium Helicobacter pylori are well known for their high prevalences in human hosts worldwide. The prevalence of both organisms is known to peak in densely populated, low resource settings and children are infected early in life. Different Giardia genotypes/assemblages have been associated with different symptoms and H. pylori with induction of cancer. Despite this, not much data are available from sub-Saharan Africa with regards to the prevalence of different G. intestinalis assemblages and their potential association with H. pylori infections. Methodology/Principal Findings: Fecal samples from 427 apparently healthy children, 0-12 years of age, living in urban Kampala, Uganda were analyzed for the presence of H. pylori and G. intestinalis. G. intestinalis was found in 86 (20.1%) out of the children and children age 1<5 years had the highest rates of colonization. H. pylori was found in 189 (44.3%) out of the 427 children and there was a 3-fold higher risk of concomitant G. intestinalis and H. pylori infections compared to non-concomitant G. intestinalis infection, OR = 2.9 (1.7-4.8). No significant association was found in the studied population with regard to the presence of Giardia and gender, type of toilet, source of drinking water or type of housing. A panel of 45 G. intestinalis positive samples was further analyzed using multi-locus genotyping (MLG) on three loci, combined with assemblage-specific analyses. Giardia MLG analysis yielded a total of five assemblage AII, 25 assemblage B, and four mixed assemblage infections. The assemblage B isolates were highly genetically variable but no significant association was found between Giardia assemblage type and H. pylori infection. Conclusions/Significance: This study shows that Giardia assemblage B dominates in children in Kampala, Uganda and that the presence of H. pylori is an associated risk factor for G. intestinalis infection

Speech in Sri Lankan cleft palate subjects with delayed palatoplasty.

This investigation was undertaken within the context of the Sri Lankan Cleft Up and Palate Project, probably the largest surgical and research programme to date concerned with the late operated cleft lip and/or palate subject (Mars et al., 1990). This study examines the speech results of88 patients who received palatal surgery by a visiting British surgical team. The main cohort, consisting of 67 nonsyndromic cleft lip and/or palate Sinh ala speaking patients over the age of eight years at palate repair, have been studied longitudinally. All these patients have pre-operative, post-operative, and post-therapy speech recordings. In addition, 21 similar patients below the age of eight years at surgery have been partially examined. 51 patients have further speech recordings at 4 or 5 years post-operatively. Investigations of velopharyngeal function were undertaken using lateral skull X-rays of patients phonating "ee', nasopharyngoscopy, and a perceptual assessment. Post-operative intra-oral examinations were also carried out. A unique method of speech analysis has been devised, and is used to describe the speech results. The results have shown that patients who have established their speech with an unrepaired palate usually have severely disordered speech, with the exception of some patients with less severe clefts. Post-operatively, many patients retain these poor speech patterns, even with some speech therapy support. Post-therapy, only one third of the cohort had normal or near-normal speech, none of whom were adults. The value of palatal closure is very limited if regular speech therapy is not available as a follow-up to surgery. Only 20% of the cohort achieved post-operative velopharyngeal closure, suggesting that palatoplasty is an inadequate surgical procedure for the majority of patients, in particular those who present with major clefts and are older than eight years of age at surgery. The important variables affecting outcome are palatal repair, speech therapy intervention, age, cleft type, nature of pre-operative speech, and nature of surgery. Structural factors in particular velopharyngeal function and also possibly fistulae, in the adult group, are further relevant variables. Criteria for selecting patients for surgery within this type of environment are proposed

The influence of the design of removable dentures on patient's voice quality

The main condition for speech intelligibility is the specific anatomical characteristics of the human speech apparatus and harmonious work of all organs in the human vocal apparatus. The voice quality is characterized by speech intelligibility (relationship between the voice pitch, volume, timbre and speech speed). Improper functional quality (related to retention,support, stability), inappropriate design of the prosthetic base and disposition of artificial teeth are the basic reasons for dyslalia - impairment of utterance with abnormality of external speech organs. In the case of dyslalia a patient may suffer from a defective utterance of separate phonemes. When designing removable dental prostheses, it is important to evaluate the disposition of the artifical teeth (taking into account phonetic pronunciation), make a phonetically beneficial construction of the base of the dentures and restore the lost alveolar bone with the basis of removable prostheses. The aim of this study was to review literature on voice quality and the way it can be affected after the insertion of removable dental prostheses and to research the literature describing the ways how voice quality can be improved. The literature reviewed in the paper was retrieved from Science Direct, PubMed, MD Consult, Cochrane Libary databases and dates back to the period from 1990 to 2012.publishersversionPeer reviewe

An ultrasound investigation of tongue dorsum raising in children with cleft palate +/- cleft lip

Objective: This study aimed to determine whether overuse of the tongue dorsum, or back, is evident in children with repaired cleft palate with or without cleft lip (CP+/-CL). We hypothesized that children with CP+/-CL would show overuse of the tongue dorsum, a compensatory pattern. Method: Secondary data analysis of mid-sagittal ultrasound tongue imaging data from 31 children with CP+/-CL and 29 typically developing children were used. We annotated the consonants /ʃ, t, s, k/ at the point of maximum constriction in an /aCa/ environment. Children with CP+/-CL said the tokens 10 times, typically developing children said them once. We automatically fitted splines to the tongue contour and extracted the Dorsum Excursion Index (DEI) for each consonant. This metric measures the relative use of the tongue dorsum, with more posterior consonants having higher values. We compared DEI values across groups and consonants using a linear mixed effects model. DEI was predicted by the interaction of consonant (baseline: /ʃ/) and speaker type (baseline: TD), including by-speaker random slopes for consonant and random intercepts for speaker. Results: Overall DEI was not higher in children with CP+/-CL compared to typically developing children. Between groups the only significant difference was the position of /k/ relative to /ʃ/, where the difference between these two consonants was smaller in the children with CP+/-CL. Conclusions: There was no support for the hypothesis that overuse of the tongue dorsum is a common characteristic in children with repaired CP+/-CL. However, individual children may present with this pattern

Reliability and Validity of a Computer-Mediated, Single-Word Intelligibility Test: Preliminary Findings for Children With Repaired Cleft Lip and Palate

To determine the reliability and validity of a computer-mediated, 50 word intelligibility test designed to be a global measure of severity of speech disability in children with repaired cleft lip and palate (CLP)

AN INVESTIGATION OF VELOPHARYNGEAL CLOSURE WITH LINEAR REGRESSION

Cleft lip and palate is a common birth defect in the United States. Children diagnosed with this abnormality face difficulties during feeding, hearing and speech. Surgical methods exist to repair the cleft lip and palate but often require subsequent surgeries as children are unable to gain full speech capabilities as they tend to develop hypernasal speech due to velopharyngeal inadequacy. Investigating velopharyngeal closure can help speech pathologists, surgeons and related professionals understand the effect of velopharyngeal anatomy on velopharyngeal function. In order to accomplish this, several studies have used two dimensional and three dimensional modeling to visualize the velum. Very few attempts have been made to track the velum and plot its movement against time. Image segmentation has been used widely for various purposes. However, its proficiency in tracking the velum is questionable at the moment. Two image segmentation methods, EdgeTrak and the Hidden Markov Model, are reviewed in this report. EdgeTrak, a software developed at the Video/Image Modeling and Synthesis Laboratory, has been proven to track the surface of a human tongue during speech production. An attempt was made to similarly track the velum during speech production using EdgeTrak but the results were disappointing. Also, synchronized audio mapping using the Hidden Markov Model was only partially successful. This report describes the challenges image segmentation faces with regards to tracking the velum.M.S

A feasibility study of visual feedback speech therapy for nasal speech associated with velopharyngeal dysfunction

Nasal speech associated with velopharyngeal dysfunction (VPD) is seen in children and adults with cleft palate and other conditions that affect soft palate function, with negative effects on quality of life. Treatment options include surgery and prosthetics depending on the nature of the problem. Speech therapy is rarely offered as an alternative treatment as evidence from previous studies is weak. However there is evidence that visual biofeedback approaches are beneficial in other speech disorders and that this approach could benefit individuals with nasal speech who demonstrate potential for improved speech. Theories of learning and feedback also lend support to the view that a combined feedback approach would be most suitable. This feasibility study therefore aimed to develop and evaluate Visual Feedback Therapy (VFTh), a new behavioural speech therapy intervention, incorporating speech activities supported by visual biofeedback and performance feedback, for individuals with mild to moderate nasal speech. Evaluation included perceptual, instrumental and quality of life measures. Eighteen individuals with nasal speech were recruited from a regional cleft palate centre and twelve completed the study, six female and six male, eleven children (7 to 13 years) and one adult, (43 years). Six participants had repaired cleft palate and six had VPD but no cleft. Participants received 8 sessions of VFTh from one therapist. The findings suggest that that the intervention is feasible but some changes are required, including participant screening for adverse response and minimising disruptions to intervention scheduling. In blinded evaluation there was considerable variation in individual results but positive changes occurred in at least one speech symptom between pre and post-intervention assessment for eight participants. Seven participants also showed improved nasalance scores and seven had improved quality of life scores. This small study has provided important information about the feasibility of delivering and evaluating VFTh. It suggests that VFTh shows promise as an alternative treatment option for nasal speech but that further preliminary development and evaluation is required before larger scale research is indicated