Artigo Original

Influence of speech stimuli in the auditory perceptual identification of hypernasality in individuals with cleft lip and palate

Influência de estímulos de fala na identificação perceptivo-auditiva da hipernasalidade em indivíduos com fissura labiopalatina

Viviane Cristina de Castro Marino; Jeniffer de Cássia Rillo Dutka; Flora Taube Manicardi; Giovana Gifalli; Patrick Pedreira Silva; Maria Inês Pegoraro-Krook

Downloads: 1
Views: 685


Purpose: To investigate the influence of speech stimuli in the auditory perceptual identification of hypernasality in individuals with Cleft Lip and Palate (CLP). Methods: Speech samples from 80 individuals with operated unilateral CLP, ages ranged from nine to 17 years (the mean age of: 12y7m), both genders, were edited for this study. Samples were recorded over the production of nine different speech stimuli, including counting and short sentences characterized by oral sounds, one loaded with low pressure consonants and seven loaded with high pressure consonants. Three speech-language pathologists rated the presence or absence of hypernasality while analyzing 864 recordings (80 individuals X 9 stimuli + 144 repeated recordings, for measuring the intra-rater agreement). Intra-rater and inter-rater indexes of agreement were established for all nine stimulus conditions. The indexes of inter-rater agreement were compared using the Z test (p<0.005), with samples comprising significant indexes of agreement interpreted as better stimuli for identifying the hypernasality in these individuals. Results: Intra-rater agreement for high pressure stimuli with voiced consonants were significantly lower than indexes for other stimuli. Inter-rater agreement between each pair of SLPs ranged from 0.11 (plosive voicing stimuli) to 0.57 (12 short sentences, one of each high pressure consonant). The values of mean inter-rater agreement between all SLPs was 0.47 indicating moderate agreement for identifying hypernasal speech. Conclusion: Speech recordings obtained over the production of longer speech samples including 12 short sentences, for instance one for each high pressure consonant, may favor inter-rater agreement for identifying hypernasality


Cleft Palate; Velopharyngeal Insufficiency; Speech; Speech Disorders; Speech Perception; Resonance


Objetivo: Investigar a influência de estímulos de fala distintos na identificação perceptivo-auditiva da hipernasalidade em indivíduos com fissura labiopalatina operada (FLP). Método: Foram editadas amostras de fala gravadas em áudio de 80 indivíduos com FLP unilateral operada, de ambos os sexos, com idades entre 9 e 17 anos (média=12 anos e 7 meses). As amostras foram gravadas durante a produção de 9 estímulos de fala distintos: contagem de números e conjuntos de frase orais, sendo 1 constituído por consoantes de baixa pressão e 7 constituídos por consoantes de alta pressão. Três fonoaudiólogas identificaram a presença ou ausência da hipernasalidade ao analisarem 864 gravações (80 indivíduos X 9 estímulos + 144 gravações repetidas para análise de concordância intra-avaliador). Os índices de concordância intra e interavaliadores foram estabelecidos para todos os 9 estímulos de fala e comparados entre si por meio do Teste Z, com nível de significância de 5%, com maiores índices de concordância interpretados como melhores estímulos para identificação da hipernasalidade. Resultados: Índices de concordância intra-avaliadores de estímulos de fala vozeados foram significativamente menores do que outros estímulos. Índices de concordância entre os pares de fonoaudiólogas variaram de 0,11 (concordância estímulos plosivos vozeados) a 0,57 (12 frases, uma com cada consoante de alta pressão), com média de 0,47 entre as três avaliadoras, indicando concordância moderada para identificação da hipernasalidade. Conclusão: Gravações de fala obtidas durante a produção de estímulos mais longos, incluindo 12 frases, uma com cada consoante de pressão, podem favorecer a concordância interavaliador na identificação da hipernasalidade


Fissura Palatina; Insuficiência Velofaríngea; Fala; Percepção de Fala; Distúrbios de Fala; Ressonância


1 Kuehn DP, Moller KT. Speech and language issues in the cleft palate population: the state of the art. Cleft Palate Craniofac J. 2000;37(4):1-35. [ Links ]

2 Zajac DJ, Vallino LD. Evaluation and management of cleft lip and palate: a developmental perspective. San Diego: Plural Publishing; 2017. Speech and resonance characteristics; p. 193-226. [ Links ]

3 Baylis A, Chapman K, Whitehill TL. Validity and reliability of visual analog scaling for assessment of hipernasality and audible nasal emission in children with repaired cleft palate. Cleft Palate Craniofac J. 2015;52(6):660-70. PMid:25322442. [ Links ]

4 Kummer AW. Speech evaluation for patients with cleft palate. Clin Plast Surg. 2014;41(2):241-51. PMid:24607192. [ Links ]

5 Bettens K, De Bodt M, Maryn Y, Luyten A, Wuyts FL, Van Lierde KM. The relationship between the Nasality Severity Index 2.0 and perceptual judgments of hypernasality. J Commun Disord. 2016;62:67-81. PMid:27310727. [ Links ]

6 Kreiman J, Gerratt BR, Kempster GB, Erman A, Berke GS. Perceptual evaluation of voice quality: review, tutorial, and a framework for future research. J Speech Hear Res. 1993;36(1):21-40. PMid:8450660. [ Links ]

7 Oliveira ACASF, Scarmagnani RH, Fukushiro AP, Yamashita RP. The influence of listener training on the perceptual assessment of hypernasality. CoDAS. 2016;28(2):141-8. PMid:27191877. [ Links ]

8 Kent RD. Hearing and believing some limits to the auditory-perceptual assessment of speech and voice disorders. Am J Speech Lang Pathol. 1996;5(3):7-23. [ Links ]

9 Lee A, Whitehill TL, Ciocca V. Effect of listener training on perceptual judgement of hypernasality. Clin Linguist Phon. 2009;23(5):319-34. PMid:19399664. [ Links ]

10 Chapman KL, Baylis A, Trost-Cardamone J, Cordero KN, Dixon A, Dobbelsteyn C, et al. The Americleft Speech Project: a training and reliability study. Cleft Palate Craniofac J. 2016;53(1):93-108. PMid:25531738. [ Links ]

11 Padilha EZ, Dutka JCR, Marino VCC, Lauris JRP, Silva MJF, Pegoraro-Krook MI. Assessment of speech nasality in individuals with cleft palate. Audiol Commun Res. 2015;20(1):48-55. [ Links ]

12 Castick S, Knight RA, Sell D. Perceptual judgments of resonance, nasal airflow, understandability, and acceptability in speakers with cleft palate: ordinal versus visual analogue scaling. Cleft Palate Craniofac J. 2017;54(1):19-31. PMid:28067575. [ Links ]

13 Bettens K, Bruneel L, Maryn Y, De Bodt M, Luyten A, Van Lierde KM. Perceptual evaluation of hypernasality, audible nasal airflow and speech understandability using ordinal and visual analogue scaling and their relation with nasalance scores. J Commun Disord. 2018;76:11-20. PMid:30071470. [ Links ]

14 Yamashita RP, Borg E, Granqvist S, Lohmander A. Reliability of hypernasality rating: comparison of 3 different methods for perceptual assessment. Cleft Palate Craniofac J. 2018;55(8):1060-71. PMid:29634363. [ Links ]

15 Counihan DT, Cullinan WL. Reliability and dispersion of nasality ratings. Cleft Palate J. 1970;7(1):261-70. PMid:5266336. [ Links ]

16 Henningsson G, Kuehn DP, Sell D, Sweeney T, Trost-Cardamone JE, Whitehill TL. Universal parameters for reporting speech outcomes in individuals with cleft palate. Cleft Palate Craniofac J. 2008;45(1):1-17. PMid:18215095. [ Links ]

17 Glade RS, Deal R. Diagnosis and management of velopharyngeal dysfunction. Oral Maxillofac Surg Clin North Am. 2016;28(2):181-8. PMid:27150305. [ Links ]

18 Ferlin F, Yamashita RP, Fukushiro AP. Influence of high and low intraoral pressure consonants on the speech nasality and nasalance in patients with repaired cleft palate. Audiol Commun Res. 2017;22:e1851. [ Links ]

19 Lohmander A, Persson C, Willadsen E, Lundeborg I, Alaluusua S, Aukner R, et al. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds - velopharyngeal competency and hypernasality. J Plast Surg Hand Surg. 2017;51(1):27-37. PMid:28218551. [ Links ]

20 Lee A, Potts S, Bressmann T. Speech-language therapy students’ auditory-perceptual judgements of simulated concurrent hypernasality and articulation disorders. Clin Linguist Phon. 2020;34(5):479-92. PMid:31429313. [ Links ]

21 Medeiros MNL, Fukushiro AP, Yamashita RP. Influence of speech sample on perceptual rating of hypernasality. CoDAS. 2016;28(3):289-94. PMid:27409419. [ Links ]

22 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74. PMid:843571. [ Links ]

23 Chan KM, Yiu EM. A comparison of two perceptual voice evaluation training programs for naive listeners. J Voice. 2006;20(2):229-41. PMid:16139475. [ Links ]

24 Scarmagnani RH, Barbosa DA, Fukushiro AP, Salgado MH, Trindade IET, Yamashita RP. Relationship between velopharyngeal closure, hypernasality, nasal air emission and nasal rustle in subjects with repaires cleft palate. CoDAS. 2015;27(3):267-72. PMid:26222944. [ Links ]

25 Waknis AP, Tak HRS, Kulkarni SP. Perceptual and instrumental analysis of hypernasality in children with repaired cleft palate. J Cleft Lip Palate Craniofacial Anomalies. 2016;3(2):67-72. [ Links ]

26 Pegoraro-Krook MI, Marino VCC, Dutka JCR. Tratado de motricidade orofacial. 1. ed. São José dos Campos: Pulso; 2019. Avaliação das alterações de fala na fissura labiopalatina e disfunção velofaríngea; p. 695-706. [ Links ]

27 Prado-Oliveira R, Marques IL, Souza L, Souza-Brosco TV, Dutka JC. Assessment of speech nasality in children with Robin Sequence. CoDAS. 2015;27(1):51-7. PMid:25885197. [ Links ]

28 Lewis KE, Watterson T, Quint T. The effect of vowels on nasalance scores. Cleft Palate Craniofac J. 2000;37(6):584-9. PMid:11108528. [ Links ]

6018591f0e88255b4850abd9 codas Articles


Share this page
Page Sections