The Experts below are selected from a list of 189 Experts worldwide ranked by ideXlab platform
Donald W. Warren - One of the best experts on this subject based on the ideXlab platform.
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European Journal of Orthodontics II (1989)52-58 © 1989 European Orthodontic Society Effects of velar resistance on speech aerodynamics
2016Co-Authors: Tellervo Laine, Rodger M. Dalston, Donald W. Warren, Kathleen E. MorrAbstract:SUMMARY The level of intelligibility attained by speakers with cleft palate reflects not only the ability to achieve adequate Velopharyngeal closure but other complex variables as well. When closure is inadequate, performance is influenced by compensatory responses of the tongue, vocal folds, respiratory muscles and nasal valve. The purpose of the present study was to determine how a loss of velar resistance associated with Velopharyngeal Inadequacy affects speech pressures and airflow. The pressure-flow technique (Warren, 1979) was used to assess mean airflow rate, mean intraoral and nasal pressures and Velopharyngeal orifice areas in 211 subjects diagnosed as having cleft palate or Velopharyngeal Inadequacy. The data revealed that resistance fell as Velopharyngeal orifice area increased. Intraoral pressures also fell as resistance dropped while nasal pressures and airflow rate increased. These findings suggest that individuals with velar Inadequacy and associated low velar resistance compensate by increasing airflow rate in an attempt to maintain adequate pressures for consonant sound production
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Controlling changes in vocal tract resistance
Journal of the Acoustical Society of America, 1992Co-Authors: Donald W. Warren, Rodger M. Dalston, Anne Putnam Rochet, Robert MayoAbstract:There is some evidence that speech aerodynamics follows the rules of a regulating system. The purpose of the present study was to assess how the speech system manages perturbations that produce ‘‘errors’’ within the system. Three experimental approaches were used to evaluate the physiological responses to an imposed change in airway resistance. The first involved subjects with varying degrees of Velopharyngeal Inadequacy. The second and third approaches involved noncleft subjects whose airway was perturbed by bleed valves and bite blocks during consonant productions. The pressure‐flow technique was used to measure aerodynamic variables associated with the production of test consonants. The results of this study provide additional evidence that the speech system actively responds to perturbations in ways that tend to minimize a change in consonant speech pressures. The degree of success in stabilizing pressures appears to reflect the capability of the system to use whatever articulatory and respiratory res...
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Controlling changes in vocal tract resistance.
The Journal of the Acoustical Society of America, 1992Co-Authors: Donald W. Warren, Rodger M. Dalston, Anne Putnam Rochet, Robert MayoAbstract:There is some evidence that speech aerodynamics follows the rules of a regulating system. The purpose of the present study was to assess how the speech system manages perturbations that produce "errors" within the system. Three experimental approaches were used to evaluate the physiological responses to an imposed change in airway resistance. The first involved subjects with varying degrees of Velopharyngeal Inadequacy. The second and third approaches involved noncleft subjects whose airway was perturbed by bleed valves and bite blocks during consonant productions. The pressure-flow technique was used to measure aerodynamic variables associated with the production of test consonants. The results of this study provide additional evidence that the speech system actively responds to perturbations in ways that tend to minimize a change in consonant speech pressures. The degree of success in stabilizing pressures appears to reflect the capability of the system to use whatever articulatory and respiratory responses are available.
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Increased nasal resistance induced by the pressure-flow technique and its effect on pressure and airflow during speech.
The Cleft Palate-Craniofacial Journal, 1991Co-Authors: Hui Liu, Donald W. Warren, Rodger M. DalstonAbstract:Abstract Although the validity of the pressure-flow technique has been verified in a number of laboratories, some questions still remain. The purpose of this study was to determine whether the procedures involved in estimating orifice size affect the pressure and airflow variables being measured. Twenty subjects with demonstrated Velopharyngeal Inadequacy on pressure-flow testing (VPO ≥ 0.10 cm2) were assessed under two contrasting conditions. Subjects were asked to produce /p/ in the word “hamper” with a) one nostril occluded by a cork as in pressure-flow testing and b) both nostrils patent. The results indicate that the increased nasal resistance resulting from occlusion of one nostril does not appreciably affect pressure and airflow associated with plosive consonant production in patients with Velopharyngeal Inadequacy.
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Maintaining speech pressures in the presence of Velopharyngeal impairment.
The Cleft Palate-Craniofacial Journal, 1990Co-Authors: Donald W. Warren, Rodger M. Dalston, Eileen T. DalstonAbstract:Abstract Most, but not all, individuals with Velopharyngeal Inadequacy maintain consonant pressures greater than 3 cm H2O even with decreased velar resistance. The purpose of this study was to identify variables that might differentiate those who achieve adequate pressures from those who do not. Forty-four cleft lip and/or palate subjects were assessed during production of /p/ in the word “hamper.” Twenty-three subjects achieved pressures greater than 3 cm H2O and 21 did not. The pressure-flow technique was used to assess Velopharyngeal orifice size, nasal resistance, velar resistance, and nasal airflow during speech. Nasal cross-sectional area was measured during breathing. The data were analyzed by age and gender. Results indicate that the inability to achieve adequate consonant pressures in the presence of Velopharyngeal Inadequacy is more likely to occur in adults than in children. Although children are known to produce consonants at higher pressures than adults, the age disparity between groups did n...
Rodger M. Dalston - One of the best experts on this subject based on the ideXlab platform.
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European Journal of Orthodontics II (1989)52-58 © 1989 European Orthodontic Society Effects of velar resistance on speech aerodynamics
2016Co-Authors: Tellervo Laine, Rodger M. Dalston, Donald W. Warren, Kathleen E. MorrAbstract:SUMMARY The level of intelligibility attained by speakers with cleft palate reflects not only the ability to achieve adequate Velopharyngeal closure but other complex variables as well. When closure is inadequate, performance is influenced by compensatory responses of the tongue, vocal folds, respiratory muscles and nasal valve. The purpose of the present study was to determine how a loss of velar resistance associated with Velopharyngeal Inadequacy affects speech pressures and airflow. The pressure-flow technique (Warren, 1979) was used to assess mean airflow rate, mean intraoral and nasal pressures and Velopharyngeal orifice areas in 211 subjects diagnosed as having cleft palate or Velopharyngeal Inadequacy. The data revealed that resistance fell as Velopharyngeal orifice area increased. Intraoral pressures also fell as resistance dropped while nasal pressures and airflow rate increased. These findings suggest that individuals with velar Inadequacy and associated low velar resistance compensate by increasing airflow rate in an attempt to maintain adequate pressures for consonant sound production
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Controlling changes in vocal tract resistance
Journal of the Acoustical Society of America, 1992Co-Authors: Donald W. Warren, Rodger M. Dalston, Anne Putnam Rochet, Robert MayoAbstract:There is some evidence that speech aerodynamics follows the rules of a regulating system. The purpose of the present study was to assess how the speech system manages perturbations that produce ‘‘errors’’ within the system. Three experimental approaches were used to evaluate the physiological responses to an imposed change in airway resistance. The first involved subjects with varying degrees of Velopharyngeal Inadequacy. The second and third approaches involved noncleft subjects whose airway was perturbed by bleed valves and bite blocks during consonant productions. The pressure‐flow technique was used to measure aerodynamic variables associated with the production of test consonants. The results of this study provide additional evidence that the speech system actively responds to perturbations in ways that tend to minimize a change in consonant speech pressures. The degree of success in stabilizing pressures appears to reflect the capability of the system to use whatever articulatory and respiratory res...
-
Controlling changes in vocal tract resistance.
The Journal of the Acoustical Society of America, 1992Co-Authors: Donald W. Warren, Rodger M. Dalston, Anne Putnam Rochet, Robert MayoAbstract:There is some evidence that speech aerodynamics follows the rules of a regulating system. The purpose of the present study was to assess how the speech system manages perturbations that produce "errors" within the system. Three experimental approaches were used to evaluate the physiological responses to an imposed change in airway resistance. The first involved subjects with varying degrees of Velopharyngeal Inadequacy. The second and third approaches involved noncleft subjects whose airway was perturbed by bleed valves and bite blocks during consonant productions. The pressure-flow technique was used to measure aerodynamic variables associated with the production of test consonants. The results of this study provide additional evidence that the speech system actively responds to perturbations in ways that tend to minimize a change in consonant speech pressures. The degree of success in stabilizing pressures appears to reflect the capability of the system to use whatever articulatory and respiratory responses are available.
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Increased nasal resistance induced by the pressure-flow technique and its effect on pressure and airflow during speech.
The Cleft Palate-Craniofacial Journal, 1991Co-Authors: Hui Liu, Donald W. Warren, Rodger M. DalstonAbstract:Abstract Although the validity of the pressure-flow technique has been verified in a number of laboratories, some questions still remain. The purpose of this study was to determine whether the procedures involved in estimating orifice size affect the pressure and airflow variables being measured. Twenty subjects with demonstrated Velopharyngeal Inadequacy on pressure-flow testing (VPO ≥ 0.10 cm2) were assessed under two contrasting conditions. Subjects were asked to produce /p/ in the word “hamper” with a) one nostril occluded by a cork as in pressure-flow testing and b) both nostrils patent. The results indicate that the increased nasal resistance resulting from occlusion of one nostril does not appreciably affect pressure and airflow associated with plosive consonant production in patients with Velopharyngeal Inadequacy.
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Maintaining speech pressures in the presence of Velopharyngeal impairment.
The Cleft Palate-Craniofacial Journal, 1990Co-Authors: Donald W. Warren, Rodger M. Dalston, Eileen T. DalstonAbstract:Abstract Most, but not all, individuals with Velopharyngeal Inadequacy maintain consonant pressures greater than 3 cm H2O even with decreased velar resistance. The purpose of this study was to identify variables that might differentiate those who achieve adequate pressures from those who do not. Forty-four cleft lip and/or palate subjects were assessed during production of /p/ in the word “hamper.” Twenty-three subjects achieved pressures greater than 3 cm H2O and 21 did not. The pressure-flow technique was used to assess Velopharyngeal orifice size, nasal resistance, velar resistance, and nasal airflow during speech. Nasal cross-sectional area was measured during breathing. The data were analyzed by age and gender. Results indicate that the inability to achieve adequate consonant pressures in the presence of Velopharyngeal Inadequacy is more likely to occur in adults than in children. Although children are known to produce consonants at higher pressures than adults, the age disparity between groups did n...
Ian M Zlotolow - One of the best experts on this subject based on the ideXlab platform.
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efficacy of speech aid prostheses for acquired defects of the soft palate and Velopharyngeal Inadequacy clinical assessments and cephalometric analysis a memorial sloan kettering study
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2005Co-Authors: George C Bohle, Jana Rieger, Joseph M Huryn, David Verbel, Freeman Hwang, Ian M ZlotolowAbstract:Background. Restoration of speech after surgical resection for oropharyngeal cancer traditionally includes max- illofacial prosthetic intervention. Relatively few publications with objective speech outcomes exist. The purpose of this study was to evaluate speech outcome relative to the size of the surgical defect, the type of speech prosthesis, and the height and position of the speech bulb in relation to the posterior pharyngeal wall in the nasopharynx. Methods. Fifty-five patients treated at the Memorial Sloan-
David L. Larson - One of the best experts on this subject based on the ideXlab platform.
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Identification and assessment of Velopharyngeal Inadequacy
American Journal of Otolaryngology, 1997Co-Authors: Stephen F Conley, Arun K. Gosain, Susan M. Marks, David L. LarsonAbstract:Abstract Purpose: To review current literature with respect to the diagnosis and assessment of Velopharyngeal Inadequacy (VPI), including present knowledge about the most common causes of VPI. Methods: Data sources include published reports over the past 20 years derived from computerized databases and bibliographies of pertinent articles and books. Indexing terms used were “Velopharyngeal incompetence,” “Velopharyngeal Inadequacy,” “Velopharyngeal insufficiency.” Conclusion: VPI is most commonly associated with cleft palate, submucous cleft palate, and following adenoidectomy. The otolaryngologist can prevent the latter by preoperative identification of physical stigmata associated with VPI. Perceptual assessment is the criterion standard for diagnosis of VPI. Multiview videofluorography and flexible nasal endoscopy provide the best direct assessments to help plan and direct the optimal treatment of VPI.
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Submucous cleft palate: diagnostic methods and outcomes of surgical treatment.
Plastic and Reconstructive Surgery, 1996Co-Authors: Arun K. Gosain, Stephen F Conley, Susan M. Marks, David L. LarsonAbstract:The following statements summarize our interpretation of the literature regarding submucous cleft palate: Incidence and Diagnosis of Submucous Cleft Palate 1. In surveys of classic stigmata of submucous cleft palate among the general population, the incidence has been reported to be 0.02 to 0.08 percent. In the larger of these series, the incidence of Velopharyngeal Inadequacy among patients identified to have submucous cleft palate was 1 to 9. The incidence of occult submucous cleft palate is not known, since these patients will only be detected during the evaluation of patients who present with Velopharyngeal Inadequacy. 2. The diagnosis of submucous cleft palate is made by identification of the classic stigmata on physical examination. The diagnosis of occult submucous cleft palate is only pursued if the patient has Velopharyngeal Inadequacy. 3. For consistency in evaluating and reporting data, patients with an overt cleft of the secondary palate that extends beyond the uvula should be reported as having a cleft palate, and not a submucous cleft palate, even if a submucous cleft exists in a portion of the palate anterior to the overt cleft. 4. The true incidence of otitis media with effusion in the presence of submucous cleft palate has yet to be determined using a prospective study. Surgical Treatment of Velopharyngeal Inadequacy in Patients with Submucous Cleft Palate 1. The technique that has most consistently been documented to result in a significant correction of Velopharyngeal Inadequacy is the pharyngeal flap. There is recent evidence from one large center supporting the efficacy of the Furlow Z-plasty in selected patients with submucous cleft palate. Both these procedures appear to be most effective in patients with good lateral pharyngeal wall motion. 2. If a pharyngeal flap is performed as the primary procedure to act as an obturator against which the lateral pharyngeal walls appose for closure, we do not see the need for adjunctive palatal procedures. The dynamic component of Velopharyngeal competence following such a pharyngeal flap consists of lateral wall motion, which is not enhanced by further surgical manipulation of the palate. However, a pharyngeal flap may be performed as an adjunctive procedure to a palatal pushback in order to provide lining for the resultant defect in the nasal mucosa. 3. The present literature does not support "prophylactic" operations on patients who present with the physical stigmata of submucous cleft palate prior to reaching an age at which it can be demonstrated by perceptual speech assessment that Velopharyngeal Inadequacy remained refractory to speech therapy. A significant number of patients will never develop Velopharyngeal Inadequacy; therefore, surgery would be unnecessary. In addition, objective data regarding the outcomes of different surgical techniques cannot be gathered if patients with submucous cleft palate are operated on without having had Velopharyngeal Inadequacy documented prior to those operations. 4. In order to objectively compare the outcomes of different surgical techniques, any future studies should be prospective and utilize uniform means of assessment. As minimum criteria, these would include preoperative and postoperative perceptual speech assessments performed by a trained speech pathologist and preoperative nasopharyngoscopy and multiview videofluoroscopy. The latter two studies should be repeated postoperatively only in those patients who have persistent Velopharyngeal Inadequacy.
Stephen F Conley - One of the best experts on this subject based on the ideXlab platform.
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Pediatric myasthenia gravis and Velopharyngeal incompetence.
International Journal of Pediatric Otorhinolaryngology, 2004Co-Authors: Anthony A. Rieder, Stephen F Conley, Laura A. RoweAbstract:Abstract Objective: To determine the clinical course of Velopharyngeal incompetence in children with myasthenia gravis (MG). Methods: A 30-year retrospective study was performed using the medical records of 538 children who presented with Velopharyngeal Inadequacy (VPI) to a tertiary care academic pediatric center. Children with Velopharyngeal incompetence due to myasthenia gravis were identified and their clinical courses were reviewed. Results: Four children were identified with Velopharyngeal incompetence associated with myasthenia gravis. All four children required intervention for improvement of speech intelligibility. A speech prosthesis was the uniform intervention. Conclusion: Neonatal myasthenia gravis patients should be followed long-term as symptoms may recur as speech impairment. In addition, a high index of suspicion for this entity is required for early diagnosis due to the highly variable presentation and clinical course.
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A prospective evaluation of the prevalence of submucous cleft palate in patients with isolated cleft lip versus controls.
Plastic and Reconstructive Surgery, 1999Co-Authors: Arun K. Gosain, Timothy D. Santoro, Stephen F Conley, Arlen D. DennyAbstract:Although there is an established relationship between cleft lip and overt cleft palate, the relationship between isolated cleft lip and submucous cleft palate has not been investigated. To test the hypothesis that patients with isolated cleft lip have a greater association with submucous cleft palate, a double-armed prospective trial was designed. A study group of 25 consecutive children presenting with an isolated cleft lip, with or without extension through the alveolus but not involving the secondary palate, was compared with a control group of 25 children with no known facial clefts. Eligible patients were examined for the presence of physical criteria associated with classic submucous cleft palate, namely, (1) bifid uvula, (2) absence of the posterior nasal spine, and (3) zona pellucida. Nasoendoscopy was subsequently performed just after induction of general anesthesia, and the findings were correlated with digital palpation of the palatal muscles. Patients who did not satisfy all three physical criteria and in whom nasoendoscopy was distinctly abnormal relative to the control group were classified as having occult submucous cleft palate. Classic submucous cleft palate was found in three study group patients (12 percent), all of whom had flattening or a midline depression of the posterior palate and musculus uvulae on nasoendoscopy and palpable diastasis of the palatal muscles under general anesthesia. An additional six study group patients (24 percent) had similar nasoendoscopic criteria and palpable diastasis of the palatal muscles; they were classified as having occult submucous cleft palate. No submucous cleft palate was identified in the control group. Seventeen patients in the study group had an alveolar cleft with a 53 percent (9 of 17) prevalence of submucous cleft palate. In the present study, classic submucous cleft palate in association with isolated cleft lip was 150 to 600 times the reported prevalence in the general population. All children with an isolated cleft lip should undergo peroral examination and speech/resonance assessment no later than the age of 3 years. Any child with an isolated cleft lip with Velopharyngeal Inadequacy or before an adenoidectomy should be assessed by flexible nasal endoscopy to avoid missing an occult submucous cleft palate.
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Identification and assessment of Velopharyngeal Inadequacy
American Journal of Otolaryngology, 1997Co-Authors: Stephen F Conley, Arun K. Gosain, Susan M. Marks, David L. LarsonAbstract:Abstract Purpose: To review current literature with respect to the diagnosis and assessment of Velopharyngeal Inadequacy (VPI), including present knowledge about the most common causes of VPI. Methods: Data sources include published reports over the past 20 years derived from computerized databases and bibliographies of pertinent articles and books. Indexing terms used were “Velopharyngeal incompetence,” “Velopharyngeal Inadequacy,” “Velopharyngeal insufficiency.” Conclusion: VPI is most commonly associated with cleft palate, submucous cleft palate, and following adenoidectomy. The otolaryngologist can prevent the latter by preoperative identification of physical stigmata associated with VPI. Perceptual assessment is the criterion standard for diagnosis of VPI. Multiview videofluorography and flexible nasal endoscopy provide the best direct assessments to help plan and direct the optimal treatment of VPI.
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Submucous cleft palate: diagnostic methods and outcomes of surgical treatment.
Plastic and Reconstructive Surgery, 1996Co-Authors: Arun K. Gosain, Stephen F Conley, Susan M. Marks, David L. LarsonAbstract:The following statements summarize our interpretation of the literature regarding submucous cleft palate: Incidence and Diagnosis of Submucous Cleft Palate 1. In surveys of classic stigmata of submucous cleft palate among the general population, the incidence has been reported to be 0.02 to 0.08 percent. In the larger of these series, the incidence of Velopharyngeal Inadequacy among patients identified to have submucous cleft palate was 1 to 9. The incidence of occult submucous cleft palate is not known, since these patients will only be detected during the evaluation of patients who present with Velopharyngeal Inadequacy. 2. The diagnosis of submucous cleft palate is made by identification of the classic stigmata on physical examination. The diagnosis of occult submucous cleft palate is only pursued if the patient has Velopharyngeal Inadequacy. 3. For consistency in evaluating and reporting data, patients with an overt cleft of the secondary palate that extends beyond the uvula should be reported as having a cleft palate, and not a submucous cleft palate, even if a submucous cleft exists in a portion of the palate anterior to the overt cleft. 4. The true incidence of otitis media with effusion in the presence of submucous cleft palate has yet to be determined using a prospective study. Surgical Treatment of Velopharyngeal Inadequacy in Patients with Submucous Cleft Palate 1. The technique that has most consistently been documented to result in a significant correction of Velopharyngeal Inadequacy is the pharyngeal flap. There is recent evidence from one large center supporting the efficacy of the Furlow Z-plasty in selected patients with submucous cleft palate. Both these procedures appear to be most effective in patients with good lateral pharyngeal wall motion. 2. If a pharyngeal flap is performed as the primary procedure to act as an obturator against which the lateral pharyngeal walls appose for closure, we do not see the need for adjunctive palatal procedures. The dynamic component of Velopharyngeal competence following such a pharyngeal flap consists of lateral wall motion, which is not enhanced by further surgical manipulation of the palate. However, a pharyngeal flap may be performed as an adjunctive procedure to a palatal pushback in order to provide lining for the resultant defect in the nasal mucosa. 3. The present literature does not support "prophylactic" operations on patients who present with the physical stigmata of submucous cleft palate prior to reaching an age at which it can be demonstrated by perceptual speech assessment that Velopharyngeal Inadequacy remained refractory to speech therapy. A significant number of patients will never develop Velopharyngeal Inadequacy; therefore, surgery would be unnecessary. In addition, objective data regarding the outcomes of different surgical techniques cannot be gathered if patients with submucous cleft palate are operated on without having had Velopharyngeal Inadequacy documented prior to those operations. 4. In order to objectively compare the outcomes of different surgical techniques, any future studies should be prospective and utilize uniform means of assessment. As minimum criteria, these would include preoperative and postoperative perceptual speech assessments performed by a trained speech pathologist and preoperative nasopharyngoscopy and multiview videofluoroscopy. The latter two studies should be repeated postoperatively only in those patients who have persistent Velopharyngeal Inadequacy.
