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Master's Dissertation
DOI
https://doi.org/10.11606/D.25.2014.tde-02062015-110023
Document
Author
Full name
Fabiane Rodrigues Larangeira
Institute/School/College
Knowledge Area
Date of Defense
Published
Bauru, 2014
Supervisor
Committee
Krook, Maria Ines Pegoraro (President)
Dutka, Jeniffer de Cassia Rillo
Marino, Viviane Cristina de Castro
Title in Portuguese
Nasalidade de fala e nasometria nas fissuras labiopalatinas
Keywords in Portuguese
Fala
Fissura palatina
Medida da produção da fala
Abstract in Portuguese
Introdução: A avaliação perceptivo-auditiva é considerada o primeiro método para diagnosticar a disfunção velofaríngea e, por ser subjetiva, há muitas controvérsias sobre a utilização desta forma de avaliação como o único meio para avaliar a ressonância de fala. Portanto, o uso de medidas instrumentais objetivas, como, a nasometria, por exemplo, tem sido recomendado. Porém, ainda há uma falta de padronização dos testes usados, sendo necessária a realização da confiabilidade entre os métodos para maior credibilidade clínica e científica. Objetivos: Descrever e comparar os resultados da nasalidade de fala de indivíduos com fissura labiopalatina, obtidos por meio do julgamento perceptivo-auditivo realizado ao vivo com a escala de 4-pontos, do Teste de Hipernasalidade (THIPER), do julgamento perceptivo-auditivo de gravações de áudio por juízes e da nasometria. Estabelecer sensibilidade, especificidade e eficiência geral do nasômetro. Material e Métodos: A casuística foi constituída de 331 pacientes (ambos os sexos), com fissura labiopalatina unilateral operada do palato entre 9 e 18 meses de idade, por três cirurgiões (C1, C2 e C3). Os dados do julgamento perceptivo-auditivo ao vivo com a escala de 4-pontos, do THIPER e da nasometria foram coletados do prontuário de cada paciente, e os dados do julgamento por juízes foram realizados a partir de gravações de frases contendo consoantes de baixa pressão (BP) previamente realizadas nestes pacientes. Todas as avaliações e gravações coletadas foram realizadas entre 5 e 13 anos (média = 8 anos) de idade. O limite de corte estabelecido para a sensibilidade e especificidade do nasômetro foi de 27%. Resultados: Foram observadas as mesmas porcentagens de ausência de hipernasalidade no julgamento perceptivo ao vivo e no THIPER, sendo de 83% para os pacientes operados pelo C1, de 73% pelo C2 e de 81% pelo C3. As obtidas pelo julgamento das gravações por juízes foram de 70% (C1), de 54% (C2) e de 73% (C3). As obtidas pela nasometria foram de 66% (C1) e de 52% (C2 e C3). Não houve diferenças significantes apenas entre as modalidades do julgamento ao vivo e do THIPER para os pacientes do C1, C2 e C3 e entre o julgamento por juízes e a nasometria para o C1 e C2. A concordância Kappa entre as modalidades de avaliação variou entre 70% e 95% (K = 0,24 - 0,86), sendo de regular a quase perfeita. Os valores de sensibilidade, especificidade e eficiência geral da nasometria encontrados para C1, C2, C3 foi de 0,51, 0,81 e 0,71, de 0,79, 0,85 e 0,82 e de 0,53, 0,96 e 0,76, respectivamente. Conclusões: Os resultados revelaram que os índices de sensibilidade do nasômetro foram menores para os pacientes do C1 e do C3, e de especificidade maior para os do C3. Houve maior concordância (quase perfeita) entre os resultados do julgamento ao vivo e o THIPER para os pacientes dos três cirurgiões, demonstrando que estas modalidades de avaliações têm boa validade para a avaliação clínica da hipernasalidade, porém com a desvantagem de os dados não poderem ser reproduzidos, quantificados e nem compartilhados por outros membros da equipe.
Title in English
Nasality of speech and nasometry in labiopalatine cleft
Keywords in English
Cleft palate
Speech
Speech production measurement
Abstract in English
Introduction: The perceptual evaluation is considered the first method to diagnose the velopharyngeal dysfunction (VPD) and, being subjective, there are many controversies about the use of this form of assessment as the only means to assess speech resonance. Therefore, the use of objective instrumental measurements as the nasometry, for example, has been recommended. However, there is still a lack of standardization of tests used, the realization of reliability between the methods for most clinical and scientific credibility is required. Objectives: To describe and compare the results of nasality of speech of individuals with cleft lip and palate, obtained through the perceptual auditory judgment performed live with the 4-point scale, Test Cul-de-Sac of Hypernasality (THIPER), auditory-perceptual judgment of audio recordings by judges and nasometry. To establish sensitivity, specificity and overall efficiency of nasometer. Material and Methods: The sample consisted of 331 patients (both genders), with unilateral cleft lip and palate operated between 9 and 18 months of age, by three surgeons (C1, C2 and C3). Data from the perceptual auditory judgment performed live with a 4-point scale, the THIPER and the nasometry were collected from the medical records of each patient, and data from the judgment by judges were made from recordings of sentences containing low pressure consonants performed previously in those patients. All evaluations and collected recordings were done between 5 and 13 years (mean 8 years) old. The cutoff limit for the sensitivity and specificity of nasometer was 27%. Results: The same percentage of the absence of hypernasality, 83%, was observed in the perceptual judgment performed live and in the THIPER for patients operated by C1, 73% by C2, and 81 by C3. The percentages obtained by the judgements made by the judges were 70% for those operated by C1, 54% by C2 and 73% by C3. The percentages obtained by nasometry were 66% for those operated by C1, 52% by C2, and 52% by C3. There was no significant difference between the modalities of the judgement performed live and the THIPER, and between the judgment made from tape recordings and nasometry. The Kappa agreement between the methods of assessment varied between 70% and 95% (K = 0.24 to 0.86), ranged from almost perfectly to regular. Sensitivity, specificity and overall efficiency of nasometry ranged from 0.51 to 0.79, 0.81 to 0.96, and from 0.71 to 0.82, respectively. Conclusions: The results have shown that the nasometer sensitivity indexes were lower for patients of the C1 and C3, and greater specificity for patients of C3, which demonstrated that the cut-off value of 27% maximized the specificity of nasometer. There was a higher agreement (almost perfect) between the live perceptual judgment and THIPER for patients of the three surgeons has shown that live perceptual judgment and THIPER have good validity for clinical evaluation of hypernasality, with the disadvantage that the data can not be reproduced, quantified or shared by other team members.
 
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Publishing Date
2015-06-08
 
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