Evelien D’haeseleer

Neonatal and neurodevelopmental outcome of children aged 3–10 years born following assisted oocyte activation

Assisted oocyte activation (AOA) using a calcium ionophore has been used for more than a decade following intracytoplasmic sperm injection (ICSI) fertilization failure. However, since AOA does not mimic precisely the physiological fertilization process, concerns exist about its use in human assisted reproduction. This study assessed the neonatal and neurodevelopmental outcome of children aged ≥ 3 years who had been born following AOA in our centre. Twenty-one children participated in the study (81% response rate; mean age 63.6 ± 21.07 months). Neonatal data were collected via questionnaires. Neurodevelopmental outcome was tested using the Reynell Developmental Language Scales or Clinical Evaluation of Language Fundamentals, Wechsler Preschool and Primary Scale of Intelligence or Wechsler Intelligence Scale for Children, and the Movement Assessment Battery for Children III. Behaviour was scored by the Social Communication Questionnaire, the Child Behaviour Checklist and the Teachers Report Form. For all tests and questionnaires, the mean outcomes lay within the expected ranges. These are first data on the developmental outcome of AOA children. The high response rate and the robustness of the tests support the data, which are reassuring although still considered preliminary. Therefore, AOA should still be performed only in selected couples.

The menopause and the female larynx, clinical aspects and therapeutic options: a literature review.

During lifetime the female larynx is very sensitive to sex hormone fluctuations. The menopause forms a critical event in a womens life and also affects the laryngeal tissues. The present report gives an overview of the recent literature about the impact of the menopause on the female larynx and vocal quality. The article discusses the symptoms, aetiology and different treatment options for laryngeal changes during the menopause. The literature pertaining to the impact of the menopause on the voice and the larynx was reviewed to provide a critical summary about the menopausal voice, aetiology and therapeutic options. In postmenopausal women laryngeal changes like oedema and muscular and mucosal dystrophy and atrophy were found. For the voice, the most important acoustic changes in postmenopausal women are a decreased vocal frequency range, decreased fundamental frequency and a higher frequency perturbation. Potential direct and indirect causes for these changes are discussed. Hormone replacement therapy is prescribed in some women for the treatment of menopausal complaints. The first reports in the literature point out a tendency towards a positive, organ-conserving effect of hormone treatment on the larynx and probably the voice. The type and the form of application of hormone therapy seem to be important in the outcome of the studies.

A comparison of the consonant production between Dutch children using cochlear implants and children using hearing aids

OBJECTIVES The main purpose of the present study was to compare the consonant error patterns of Dutch prelingually deaf CI children with prelingually hearing-impaired hearing aid (HA) children. The authors hypothesized that subjects using conventional hearing aids would have poorer consonant production skills. Additionally, the impact of the age at implantation (CI) and the degree of hearing loss (HA) was determined. METHODOLOGY This is a comparative study of 29 prelingually deaf CI children (m.a. 9;0 y) and 32 prelingually hearing-impaired HA children (m.a. 9;11 y) who received their first hearing aid before the age of 2 years. Nineteen CI children were implanted before the age of 5 years. Nine HA children had thresholds above 90dB (range: 91-105dB), 15 between 70 and 90dB (range: 72-90dB) and 8 below 70dB (range: 58-68dB). Speech samples of all the children were elicited by means of a picture naming test and were video-recorded for further phonetic and phonological analysis. RESULTS Considerably more phonetic and phonologic errors were observed in the HA children with thresholds above 70dB (range: 72-105dB). No notable differences could be found between deaf CI children and HA children with thresholds below 70dB. Even children implanted after the age of 5 years showed significantly fewer phonetic and phonological errors than HA children. CONCLUSION The consonant production of implanted children is more adequate than the consonant production of HA children with a hearing loss of 70dB or more. In addition, the results also indicate that even after the age of 5 years, implantation can still have an advantageous effect on a childs consonant production.

Normative Nasalance Data in Ugandan English-Speaking Children

Aims: The aim of this study was to obtain normative nasalance values for typically developing Ugandan English-speaking children as a reference point for clinical practice and further research. Methods: Sixty-nine typically developing Ugandan children (35 males and 34 females, 2.7–13.5 years of age) participated in the study. Nasalance scores were obtained with the Nasometer while children repeated 4 sustained sounds, 14 repeated syllables, 15 sentences (12 oral, 3 nasal) and 2 texts (‘Rainbow Passage’ and ‘Zoo Passage’). Data were analyzed for gender and age dependence. Results: No significant effects of age or gender on nasalance values were obtained; hence, normative values for the overall group were reported. The average nasalance scores for Ugandan English-speaking children were 17 and 64% for the oral and nasal sentences and 33 and 14% for the oronasal and oral text, respectively. Conclusion: The normative values are important as a reference point to assess the impact of several surgical procedures and several surgical timing strategies on speech in Uganda.

The impact of palatal repair before and after 6 months of age on speech characteristics

OBJECTIVE Optimal timing of palatal repair is still subject of discussion. Although literature provides some evidence that palatal closure prior to 6 months positively influence speech outcome in children with clefts, only few studies verified this hypothesis. The purpose of this study was to describe and compare articulation and resonance characteristics following early (≤6 months) and later (>6 months) palatal repair, performed using the Sommerlad technique. METHODS Comparison was made between 12 Ugandan children with isolated cleft (lip and) palate following early palatal repair (mean age: 3.3 m) and 12 Belgian patients with later palatal repair (mean age: 11.1 m), matched for cleft type, age and gender. A Ugandan and Belgian age- and gender-matched control group without clefts was included to control for language, culture and other environmental factors. Articulation assessments consisted of consonant inventories and phonetic and phonological analyses that were based on consensus transcriptions. In addition, resonance was evaluated by perceptual consensus ratings and objective mean nasalance values. RESULTS The Belgian and Ugandan control groups were comparable for the majority of the variables. Comparison of cleft palate groups revealed no clinically relevant significant group differences for consonant inventory or phonological processes. Phonetic analysis showed significantly more distortions in the Belgian cleft palate group due to higher occurrence frequencies for (inter)dental productions of apico-alveolar consonants. Neither perceptual consensus ratings of hypernasality, hyponasality, cul-de-sac resonance and nasal emission/turbulence, nor objective mean nasalance values for oral speech samples revealed significant group differences (p>0.05). CONCLUSION Articulation and resonance characteristics of young children following palatal repair before and after 6 months of age seem to be at least comparable.

Parental satisfaction in Ugandan children with cleft lip and palate following synchronous lip and palatal repair.

UNLABELLED The purpose of the present case control study was to assess parental satisfaction with speech and facial appearance in Ugandan children with complete unilateral or bilateral cleft lip and palate (CLP), who underwent a synchronous lip and palatal closure. The results are compared with an age- and gender-matched control group. The experimental group consisted of the parents or guardians of 44 Ugandan patients (21 males, 23 females) with complete unilateral or bilateral CLP (mean age: 3;1 years). The control group included the foster mothers of 44 orphan children matched by age and gender (mean age: 3;7 years). A survey based on the Cleft Evaluation Profile was used to assess the perceived satisfaction for individual features related to cleft care. Overall high levels of satisfaction were observed in the experimental group for all features (range: 56-100%). No significant differences could be established regarding age, gender, age of lip and palatal closure, cleft type or maternal vs. paternal judgments. In participants who were dissatisfied with the appearance of the lip, the time period between the cleft closure and the survey was significantly larger compared with satisfied participants. Furthermore, significantly lower levels of satisfaction were observed in the cleft group for speech and the appearance of the teeth and the nose compared with the control group. Satisfaction with speech and facial appearance in Ugandan children with cleft lip and/or palate is important since normal esthetics and speech predominantly determine the childrens social acceptance in the Ugandan society. LEARNING OUTCOMES As a result of reading this manuscript, the reader will be able to explain the attitudes of parents toward the surgical repair of their childrens cleft lip and palate. As a result of reading this manuscript, the reader will be able to identify differences in parental attitudes toward synchronous lip and palate repair.

Nasalance and nasality in children with cochlear implants and children with hearing aids

OBJECTIVES In prelingually deaf children, many speech production aspects including resonance, are known to be problematic. This study aimed to investigate nasality and nasalance in two groups of prelingually hearing impaired children, namely deaf children with a cochlear implant (CI) and moderate-to-severely hearing impaired hearing aid (HA) users. The results of both groups are compared with the results of normal hearing children. Besides, the impact of the degree of hearing loss was determined. METHODOLOGY 36 CI children (mean age: 9;0y), 25 HA children (mean age: 9;1y) and 26 NH children (mean age: 9;3y) were assessed using objective assessment techniques and perceptual evaluations in order to investigate the nasal resonance of the three groups. Ten HA children had thresholds above 70dB (range: 91dB-105dB) and fifteen below 70dB (range: 58dB-68dB). The Nasometer was used for registration of the nasalance values and nasality was perceptually evaluated by two experienced speech therapists using a nominal rating scale (consensus evaluation). RESULTS For nasal stimuli, both CI children and HA children showed lower nasalance values in comparison with NH children. The opposite was observed for the oral stimuli. In both hearing impaired groups, cul-de-sac-resonance was observed on a significantly larger scale than in the NH group, and the HA children were judged to be significantly more hypernasal in comparison with NH children. CONCLUSIONS Despite the fact that a substantial number of the CI and HA children demonstrate normal (nasal) resonance quality, this aspect of speech production is still at risk for hearing impaired children.

The impact of a voice counseling procedure to select students with normal vocal characteristics for starting a master program in speech language pathology : a pilot study

OBJECTIVE The purpose of this study is to determine objective vocal quality, vocal characteristics, and vocal habits in future speech language pathology (SLP) students and to evaluate the possible impact of a provided vocal counseling procedure. A comparison of vocal data was done in SLP students who had and who had not undergone vocal counseling procedure. It is hypothesized that counseling results in good vocal quality, adequate vocal performance, and appropriate vocal hygiene. STUDY DESIGN Randomized controlled study design. METHODS To determine the vocal quality, questionnaires (Voice Handicap Index [VHI]), subjective (videostroboscopic and perceptual evaluations), and instrumental assessment techniques (aerodynamic, vocal range, acoustic measurements, Dysphonia Severity Index [DSI]) were used. Identical voice assessments were made in 71 students who followed and have not (n=83) followed the vocal counseling procedure. RESULTS The VHI showed the absence of a psychosocial impact of the vocal quality. Thirty percentage of the subjects mentioned hoarseness as the most common vocal complain. Videostroboscopic evaluations revealed normal vocal anatomy and physiology. A significant difference regarding the DSI value was found between the students with (+3.3, 83%) and without (+1.8, 68%) a followed voice counseling procedure. CONCLUSION This vocal counseling procedure is added as a standard procedure when future students gain information about the SLP master program. To what extent the presence and content of the vocal education strategy can influence the choice of the profession as an SLP is subject for further research.

The impact of the menopause on the voice

Abstract During lifetime the female larynx is very sensitive to sex hormone fluctuations. In the menopause the serum levels of estrogens and progesterone decrease dramatically so that the ratio of estrogens-progesterone to androgens changes in aid of the last hormone. This article gives an overview of the recent literature about the impact of the menopause on the larynx and the vocal quality. Secondly the effect of hormone replacement therapy in the menopause on the larynx and the vocal performance is discussed. Most research in postmenopausal women show that the larynx is an estrogen-target. In the larynx of postmenopausal women mucosal changes are observed. These laryngeal changes can result in altered acoustic characteristics of the voice. The most important acoustic characteristics of the voice are changes in the fundamental frequency and the frequency range of the voice. The first reports in the literature about the role of hormone replacement therapy in the larynx point out a tendency of a positive, organ-conserving effect of hormone treatment on the larynx and probably the voice. However, more research is necessary to confirm these findings. A better understanding of the relation between sex hormones and the female larynx will make it possible to develop strategies to improve the vocal quality of postmenopausal women.

Short-term and long-term test-retest reliability of the Nasality Severity Index 2.0

PURPOSE The Nasality Severity Index 2.0 (NSI 2.0) forms a new, multiparametric approach in the assessment of hypernasality. To enable clinical implementation of this index, the short- and long-term test-retest reliability of this index was explored. METHODS In 40 normal-speaking adults (mean age 32y, SD 11, 18-56y) and 29 normal-speaking children (mean age 8y, SD 2, 4-12y), the acoustic parameters included in the NSI 2.0 (i.e. nasalance of the vowel /u/ and an oral text, and the voice low tone to high tone ratio (VLHR) of the vowel /i/) were obtained twice at the same test moment and during a second assessment two weeks later. After determination of the NSI 2.0, a comprehensive set of statistical measures was applied to determine its reliability. RESULTS Long-term variability of the NSI 2.0 and its parameters was slightly higher compared to the short-term variability, both in adults and in children. Overall, a difference of 2.82 for adults and 2.68 for children between the results of two consecutive measurements can be interpreted as a genuine change. With an ICC of 0.84 in adults and 0.77 in children, the NSI 2.0 additionally shows an excellent relative consistency. No statistically significant difference was withheld in the reliability of test-retest measurements between adults and children. CONCLUSION Reliable test-retest measurements of the NSI 2.0 can be performed. Consequently, the NSI 2.0 can be applied in clinical practice, in which successive NSI 2.0 scores can be reliably compared and interpreted. LEARNING OUTCOMES The reader will be able to describe and discuss both the short-term and long-term test-retest reliability of the Nasality Severity Index 2.0, a new multiparametric approach to hypernasality, and its parameters. Based on this information, the NSI 2.0 can be applied in clinical practice, in which successive NSI 2.0 scores, e.g. before and after surgery or speech therapy, can be compared and interpreted.