A series of 514 patients seen at three clinics in the United States and Spain were evaluated using clinical Judgments of hypernasality, and nasometric assessment of oral-nasal resonance balance. Data from the nasometer were obtained while patients read a passage devoid of nasal consonants. Across all subjects, the Pearson correlation coefficient between the clinical and instrumental measures was 0.78. Prediction analyses revealed that maximum efficiency was obtained using a somewhat different threshold nasalance value for each of the three patient samples. When all 514 subjects were investigated as a single group, a threshold nasalance score of 28 was found to optimize identification of patients with and without clinically significant hypernasality. In that analysis, a sensitivity of 0.87, a specificity of 0.86 and an overall efficiency of 0.87 was obtained. The clinical relevance of these findings is discussed.
Get full access to this article
View all access options for this article.
References
1.
BradfordL.J., BrooksA.R., SheltonR.L.. Clinical judgment of hypernasality in cleft palate children.Cleft Palate J1964; 1: 329–335.
2.
CounihanD.T., CullinanW.L.. Reliability and dispersion of nasality ratings.Cleft Palate J1970; 7: 261–270.
3.
DalstonR.M.. Computer-generated reports of speech and language evaluations.Cleft Palate J1983; 20: 227–237.
4.
DalstonR.M.. Using simultaneous photodetection and nasometry to monitor velopharyngeal behavior during speech.J Speech Hear Res1989; 32: 195–202.
5.
DalstonR.M., SeaverE.J.. Nasometric and phototransductive measurements of reaction times among normal adult speakers.Cleft Palate J1990; 27: 61–66.
6.
DalstonR.M., WarrenD.W., DalstonE.T.. The modified tongue-anchor technique as a screening test for velopharyngeal inadequacy: a reassessment.J Speech Hear Disord1990; 55: 510–515.
7.
DalstonR.M., WarrenD.W., DalstonE.T.. The use of nasometry as a diagnostic tool for identifying patients with velopharyngeal impairment.Cleft Palate J1991a; 28: 184–189.
8.
DalstonR.M., WarrenD.W., DalstonE.T.. A preliminary investigation concerning the use of nasometry in identifying patients with hyponasality and/or nasal airway impairment.J Speech Hear Disord1991b; 34: 11–18.
9.
DalstonR.M., WarrenD.W., DalstonE.T.. The identification of nasal obstruction using clinical judgments of hyponasality and nasometric assessment of speech acoustics.Am J Orthod Dentofacial Orthop1991c; 100: 59–65.
10.
FlegeJ.E.. Anticipatory and carry-over nasal coarticulation in the speech of children and adults.J Speech Hear Res1989; 31: 525–536.
11.
FletcherS.G., AdamsL.E., McCutcheonM.J.. Cleft palate speech assessment through oral-nasal acoustic measures. In: BzochK.R., ed. Communicative disorders related to cleft lip and palate.Boston: Little Brown, 1989: 246–257.
12.
FornerL.L.. Speech segment durations produced by five and six year old speakers with and without cleft palates.Cleft Palate J1983; 20: 185–198.
13.
Gonzalez-LandaG.. A clinical and nasometric study of children with cleft lip and palate before and after hard palate closure using the two stage approach. Unpublished doctoral dissertation, 1991.
14.
HaapanenM.L.. A simple clinical method of evaluating perceived hypernasality.Folia Phoniatr1991; 43: 122–132.
15.
HepptW., WestrichM., StrateB., MohringL.. Nasalance: a new concept for objective analysis of nasality.Laryngorhinootologie1991; 70: 208–213.
16.
KarnellM.P., FolkinsJ.W., MorrisH.L.. Relationships between the perception of nasalization and speech movements in speakers with cleft palate.J Speech Hear Res1985; 28: 63–72.
17.
KeefeM.J., DalstonR.M.. An analysis of velopharyngeal timing in normal adult speakers using a microcomputer based photodetector system.J Speech Hear Res1989; 32: 39–48.
18.
MayoR., DalstonR.M.. Nasometric assessment of velopharyngeal liming among craniofacial patients.Research in progress.
19.
NellisJ.L., NeimanG.S., LehmanJ.A.. Comparison of nasometer and listener judgments of nasality in the assessment of velopharyngeal function after pharyngeal flap surgery.Cleft Palate J1992; 29: 157–163.
20.
ParkerA.J., MawA.R., SzallasiF.. An objective method of assessing nasality: a possible aid in the selection of patients for adenoidectomy.Clin Otolaryngol1989; 14: 161–166.
21.
ParkerA.J., ClarkP.M., DawksP.J., MawA.R.. A comparison of active anterior rhinomanometry and nasometry in the objective assessment of nasal obstruction.Rhinology1990; 28: 47–53.
22.
PaynterE.T., WattersonT.L., BooseW.T.. The relationship between nasalance and listener judgments. Paper presented at the 48th annual convention of the American Cleft Palate-Craniofacial Association, Hilton Head, South Carolina. 1991.
23.
Santos-TerronM.J., Gonzalez-LandaG., Sanchez-RuizI.. Patrones normales del nasometer en ninos de habla castellana.[Nasometric patterns in the speech of normal child speakers of Castilian Spanish.] Rev Esp Foniatr1991; 4: 71–75.
24.
SeaverE.J., DalstonR.M.. Using simultaneous nasometry and acoustical signals to detect the onsets and offsets of speech.J Speech Hear Res1990; 33: 358–362.
25.
SeaverE.J., DalstonR.M., LeeperH.A., AdamsL.E.. A study of nasometric values for normal nasal resonance.J Speech Hear Res1991; 34: 715–721.
26.
TobiasJ.. Relative occurrence of phonemes in American English.J Acoust Soc Am1959: 31: 631.
27.
WilliamsR.G., EcclesR., HutchingsH.. The relationship between nasalance and nasal resistance to airflow.Acta Otolaryngol (Stockholm)1990; 110: 443–449.
28.
WarrenD.W., DalstonR.M., MayoR.. Hypernasality in the presence of “adequate” velopharyngeal closure.Cleft Palate Craniofac J1993; 30: 150–154.
29.
WarrenD.W., DalstonR.M., TrierW.C., HolderM.G.. A pressure-flow technique for quantifying temporal patterns of palatopharyngeal closure, Cleft Palate J1985; 22: 11–19.
30.
WattersonT., WrightD.S., McFarlaneS.C.. The relationship between nasalance and nasality in cleft palate children. Paper presented at the 47th annual convention of the American Cleft Palate-Craniofacial Association, St. Louis, Missouri, 1990.
