DYSPHONIA SEVERITY INDEX IN CHILDREN WITH VELOPHARYNGEAL DYSFUNCTION: A PRE-POST OPERATIVE COMPARISON.

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G. K, S. H.V, and P. M, “DYSPHONIA SEVERITY INDEX IN CHILDREN WITH VELOPHARYNGEAL DYSFUNCTION: A PRE-POST OPERATIVE COMPARISON”., ijmhs, vol. 3, no. 6, Dec. 2013.
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Abstract

Background & Objective: Voice is an important tool for communication through which we express our thoughts in form or sounds produced by movement of vocal folds. The voice quality is affected in children with cleft lip and palate due to velopharyngeal dysfunction (VPD) which is associated with abnormalities of velum leading to hyper adduction of vocal folds. Dysphonia Severity Index (DSI) is an objective multiparametric approach to evaluate voice quality. The present study aimed to compare the Dysphonia severity index (DSI) in children with velopharyngeal dysfunction before and after velopharyngeal surgery.

Method: Twelve children (6 males and 6 females) with Velopharyngeal dysfuction in the age range of 7-12 yrs were considered for the present study. Individuals diagnosed to have velopharyngeal dysfunction by craniofacial team using cineradiography were considered for the study. Maximum phonation time (MPT), frequency and intensity, jitter measurements were made using Lingwaves voice clinic suite pro software Version 2.5 (Wevosys, Germany).

Results and conclusion: There was significant difference between children with velopharyngeal dysfunction and age matched typically developing children on Dysphonia Severity Index values. There was a significant difference for I-low (p=0.03) and Dysphonia Severity Index (p=0.01) for pre and post-operative conditions. There was significant difference between gender on Fo high and females (3.11) had better DSI values compared to males (2.37). These results of the present study suggest the need for gender specific voice therapy goals in rehabilitation of voice problems in children with VPD. 

Key words: Dysphonia severity Index; Velopharyngeal Dysfunction; Voice Quality

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References

[1] Boone DR & McFarlane SC. The Voice and Voice Therapy. Englewood Cliffs, NJ: Prentice Hall; 1971. [2] Brooks AR, Alta V, Shelton RL. Incidence of voice disorders other than nasality in cleft palate children. Cleft Palate Bull. 1963; 13:63–64. [3] D’Antonio LL, Muntz HR, Province MA, Marsh JL. Laryngeal/voice findings in patients with velopharyngeal dysfunction. Laryngoscope. 1988; 98:432–438. [4] Flint R. Fundamental vocal frequency and severity of nasality in cleft palate speakers. Master’s Thesis, University of Oklahoma, 1964. [5] Grunwell P, Brondsted K, Henningsson G, et al. A six-centre international study of the outcome of treatment in patients with clefts of the lip and palate: the results of a cross-linguistic investigation of cleft palate speech. Scand J Plast Reconstr Surg Hand Surg 2000; 34:219–229. [6] Hamming K, Finkelstein M, & Sidman J. Hoarseness in Children with Cleft Palate. Otolaryng Head Neck 2009; 140 (6): 902-06. [7] Heman-Ackah YD, Heuer RJ, Michael DD, et al: Cepstral peak prominence: a more reliable measure of dysphonia. Ann Otol Rhinol Laryngol. 2003; 112: 324–333. [8] Heman-Ackah YD, Michael DD, Goding GS Jr: The relationship between cepstral peak prominence and selected parameters of dysphonia. J Voice 2002; 16: 20–27 [9] Heylen L, Wuyts FL, Mertens F, De Bodt M, Pattyn J, Croux C, et al. (1998). Evaluation of the vocal performance of children using a voice range profile index. J Speech Lang Hear Res.1998; 41(2) : 232–238. [10] Hocevar-Boltezar I, Jarc A, Kozelj V. Ear, nose and voice problems in children with orofacial clefts. J Laryngol Otol. 2006; 120:276 – 81. [11] Krieman J, Gerratt BR, & Precoda K. Listener experience and perception of voice quality. J Speech Lang Hear Res.1990; 33:103-115. [12] Lewis JR, Andreassen ML, Leeper HA, Macrae DL, Thomas J. Vocal characteristics of children with cleft lip/palate and associated velopharyngeal incompetence. J Otolaryngol.1993; 22:113–117. [13] Timmons M, Wyatt R, & Murphy T. Speech after repair of isolated cleft palate and cleft lip and palate. British Journal of Plastic Surgery 2001; 54: 377-384. [14] McWilliams BJ, Bluestone CD, Musgrave RH. Diagnostic implications of vocal cord nodules in children with cleft palate. Laryngoscope. 1969; 79:2072. [15] Mc Williams BJ, Morris HL & Shelton RL. Cleft palate speech (2nd Ed.). Philadelphia: B.C. Decker Inc; 1990. [16] Munoz J, Mendoza E, Fresneda MD, Carballo G, Lopez P. Acoustic and perceptual indicators of normal and pathological voice. Folia Phoniatr Logop 2003; 55: 102–114. [17] Peterson-Falzone SJ, Hardin-Jones MA, Karnell MP: Cleft Palate Speech. Missouri, Mosby, 2001. [18] Rampp DL, Counihan DT. Vocal pitch-intensity relationships in cleft palate speakers. Cleft Palate J. 1970; 3:846-857. [19] Van Lierde KM, Claeys S, De Bodt M, Van Cauwenberge P. Vocal quality characteristics in children with cleft palate: A multiparameter approach. J Voice 2004; 18(3):354-62. [20] Van Lierde KM, De Bodt M, Baetens I, Schrauwen V, Van Cauwenberge P. Outcome of treatment regarding articulation, resonance and voice in Flemish adults with unilateral and bilateral cleft palate. Folia Phoniatr Logop 2003; 55:80–90. [21] Van Lierde KM, De Bodt M, Van Borsel J, Wuyts FL, Van Cauwenberge P: Effect of cleft type on overall speech intelligibility and resonance. Folia Phoniatr Logop 2002; 54:158–168. [22] Van Lierde, KM, Bonte, K, Baudonck N, Van Cauwenberge, P & De Leenheer, EM. Speech outcome regarding overall intelligibility, articulation, resonance and voice in Flemish children a year after pharyngeal flap surgery. A pilot study. Folia Phoniatr Logop 2008; 60(5): 223–232. [23] Wuyts FL, De Bodt MS, Molenberghs G, Remacle M, Heylen L, Millet B, et al. The Dysphonia Severity Index: An objective measure of vocal quality based on a multiparameter approach. J Speech Lang Hear Res 2000; 43:796–809. [24] Zajac DJ, Linville RN. Voice perturbations of children with perceived nasality and hoarseness. Cleft Palate J 1989; 26:226–232.

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References

[1] Boone DR & McFarlane SC. The Voice and Voice Therapy. Englewood Cliffs, NJ: Prentice Hall; 1971.
[2] Brooks AR, Alta V, Shelton RL. Incidence of voice disorders other than nasality in cleft palate children. Cleft Palate Bull. 1963; 13:63–64.
[3] D’Antonio LL, Muntz HR, Province MA, Marsh JL. Laryngeal/voice findings in patients with velopharyngeal dysfunction. Laryngoscope. 1988; 98:432–438.
[4] Flint R. Fundamental vocal frequency and severity of nasality in cleft palate speakers. Master’s Thesis, University of Oklahoma, 1964.
[5] Grunwell P, Brondsted K, Henningsson G, et al. A six-centre international study of the outcome of treatment in patients with clefts of the lip and palate: the results of a cross-linguistic investigation of cleft palate speech. Scand J Plast Reconstr Surg Hand Surg 2000; 34:219–229.
[6] Hamming K, Finkelstein M, & Sidman J. Hoarseness in Children with Cleft Palate. Otolaryng Head Neck 2009; 140 (6): 902-06.
[7] Heman-Ackah YD, Heuer RJ, Michael DD, et al: Cepstral peak prominence: a more reliable measure of dysphonia. Ann Otol Rhinol Laryngol. 2003; 112: 324–333.
[8] Heman-Ackah YD, Michael DD, Goding GS Jr: The relationship between cepstral peak prominence and selected parameters of dysphonia. J Voice 2002; 16: 20–27
[9] Heylen L, Wuyts FL, Mertens F, De Bodt M, Pattyn J, Croux C, et al. (1998). Evaluation of the vocal performance of children using a voice range profile index. J Speech Lang Hear Res.1998; 41(2) : 232–238.
[10] Hocevar-Boltezar I, Jarc A, Kozelj V. Ear, nose and voice problems in children with orofacial clefts. J Laryngol Otol. 2006; 120:276 – 81.
[11] Krieman J, Gerratt BR, & Precoda K. Listener experience and perception of voice quality. J Speech Lang Hear Res.1990; 33:103-115.
[12] Lewis JR, Andreassen ML, Leeper HA, Macrae DL, Thomas J. Vocal characteristics of children with cleft lip/palate and associated velopharyngeal incompetence. J Otolaryngol.1993; 22:113–117.
[13] Timmons M, Wyatt R, & Murphy T. Speech after repair of isolated cleft palate and cleft lip and palate. British Journal of Plastic Surgery 2001; 54: 377-384.
[14] McWilliams BJ, Bluestone CD, Musgrave RH. Diagnostic implications of vocal cord nodules in children with cleft palate. Laryngoscope. 1969; 79:2072.
[15] Mc Williams BJ, Morris HL & Shelton RL. Cleft palate speech (2nd Ed.). Philadelphia: B.C. Decker Inc; 1990.
[16] Munoz J, Mendoza E, Fresneda MD, Carballo G, Lopez P. Acoustic and perceptual indicators of normal and pathological voice. Folia Phoniatr Logop 2003; 55: 102–114.
[17] Peterson-Falzone SJ, Hardin-Jones MA, Karnell MP: Cleft Palate Speech. Missouri, Mosby, 2001.
[18] Rampp DL, Counihan DT. Vocal pitch-intensity relationships in cleft palate speakers. Cleft Palate J. 1970; 3:846-857.
[19] Van Lierde KM, Claeys S, De Bodt M, Van Cauwenberge P. Vocal quality characteristics in children with cleft palate: A multiparameter approach. J Voice 2004; 18(3):354-62.
[20] Van Lierde KM, De Bodt M, Baetens I, Schrauwen V, Van Cauwenberge P. Outcome of treatment regarding articulation, resonance and voice in Flemish adults with unilateral and bilateral cleft palate. Folia Phoniatr Logop 2003; 55:80–90.
[21] Van Lierde KM, De Bodt M, Van Borsel J, Wuyts FL, Van Cauwenberge P: Effect of cleft type on overall speech intelligibility and resonance. Folia Phoniatr Logop 2002; 54:158–168.
[22] Van Lierde, KM, Bonte, K, Baudonck N, Van Cauwenberge, P & De Leenheer, EM. Speech outcome regarding overall intelligibility, articulation, resonance and voice in Flemish children a year after pharyngeal flap surgery. A pilot study. Folia Phoniatr Logop 2008; 60(5): 223–232.
[23] Wuyts FL, De Bodt MS, Molenberghs G, Remacle M, Heylen L, Millet B, et al. The Dysphonia Severity Index: An objective measure of vocal quality based on a multiparameter approach. J Speech Lang Hear Res 2000; 43:796–809.
[24] Zajac DJ, Linville RN. Voice perturbations of children with perceived nasality and hoarseness. Cleft Palate J 1989; 26:226–232.

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