Mona A. Hegazi

Aspects of Assessment and Management of Velopharyngeal Dysfunction in Developing Countries

Proper assessment of patients with velopharyngeal valve incompetence is a mandatory prerequisite for optimal management. The protocol of assessment of Ain Shams University, Phoniatric Department, uses three levels of assessment of velopharyngeal valve incompetence according to the complexity of the armamentarium used. This allows application of those parts of the protocol that suit the needs of the different socioeconomic levels and geographical locations. Firstly, the elementary diagnostic procedures, which are rather simple, noninvasive, but essentially subjective. Despite the clinical feasibility of these procedures, documentation of the data is made utilizing the tools at the second level of assessment in that protocol (clinical diagnostic aids). This level comprises video-nasofiberscopy and high fidelity voice recording. An attempt to extract quasi-quantitative measures from the hitherto qualitative video-nasofiberscopy is made. The third level of assessment, namely additional instrumental measures, comprises CT scanning of the velopharyngeal port, aerodynamics, and acoustic analysis. The results of the three levels of the protocol are presented. Their significance and clinical efficacy are discussed. Some community-related problems that have faced the cleft palate team are outlined. Their sociocultural significance in a developing country is discussed.

Early Phonological Development in Arabic Egyptian Children: 12–30 Months

Phonological development is a dynamic process that operates on three levels: universal development, specific language development, and specific child development. An intricate relationship between the three factors delineates the course of acquisition of each child’s phonemic inventory. This study is designed to investigate the phonemic inventory and the phonological processes used by Arabic Egyptian children in order to evaluate cross-linguistic similarities and differences. Thirty Egyptian children with Cairene dialect, in the age period between 12 and 30 months, were included and divided into three groups, each covering a 6-month interval. A 1-hour tape recording for each child was done, followed by analysis of the phonemic inventory and phonological processes. Phonemic inventories showed universal similarities, with frequent occurrence of stops, nasals, and glides mostly in the form of bilabial and alveolar sounds. This is besides a specific tendency for early frequent production of laryngeal phonemes. Glottal replacement was found to be a common and naturally occurring phonological process, leading to frequent occurrence of glottal stop /U/ in the inventories of Egyptian children. The final position of the word showed the highest degree of correct phoneme production.

The Arabic Vowels: Features and Possible Clinical Application in Communication Disorders

Most scholars, old and modern, agree that the vowel system of the Arabic language is composed of 3 vowels only, namely /i/, /Ε/ and /u/. The spoken Cairo dialect suggests that there are 6 identifiable vowels, with a short and long variant for each. Objective: The aim of this study is to test the validity of the notion that there are 6 × 2 distinct vowels, with a more central one. Subjects and Methods: Spectral analysis was used to measure F1 and F2 for the vowels of 14 real words. Data was collected from 60 healthy adult informants, 30 males and 30 females. They were native Egyptians speaking the colloquial Cairene dialect. Results: The values of the 6 long and short vowels plus the central one are presented. A significant difference was found between each of them. The long and short vowels differed only in the duration but did not differ in their formant values. Conclusion: The study illustrates the distinctive features of the vowels of the Arabic language. Each of the 7 vowels represents a distinct entity. This will have important implications in assessment and management of language, speech and voice disorders in children and adults.

Spectrographic analysis of Egyptian Cairene /r/: Is it a trill or a tap?

Abstract The /r/ phoneme is variable in manner and place of articulation, and difficult to correct worldwide. Variability could exist within the same language. The objective of this study was to determine whether Egyptian Cairene /r/ was a trill or a tap and, if both forms were present, whether they were affected by word position or adjacent vowels/consonants. The information obtained was intended to improve correction of /r/ in faulty articulation. Spectrographic analysis was done for 50 Cairene subjects, who produced /r/ in different word positions in carrier phrases. Results have shown presence of both forms in the speech of every subject, but taps were more common than trills. Trills were more common in geminated /r/, in word-medial syllable final position, especially when preceded with /e/, /æ/ or /α/, and in word-medial syllable initial position, especially when preceded by non-back consonants.

Use of local mitomycin C in enhancing laryngeal healing after laser cordotomy: A prospective controlled study

The purpose of this study was to investigate the role of intraoperative application of mitomycin C in prevention of glottic restenosis after posterior transverse CO2 laser cordotomy (PTLC) for patients with post‐thyroidectomy bilateral vocal fold paralysis.

Development and Standardization of a Test for Pragmatic Language Skills in Egyptian Arabic: The Egyptian Arabic Pragmatic Language Test (EAPLT)

Objective: The aim of this study was to standardize an Egyptian Arabic Pragmatic Language Test (EAPLT) using linguistically and socially suitable questions and pictures in order to be able to address specific deficits in this language domain. Participants and Methods: Questions and pictures were designed for the EAPLT to assess 3 pragmatic language subsets: pragmatic skills, functions, and factors. Ten expert phoniatricians were asked to review the EAPLT and complete a questionnaire to assess the validity of the test items. The EAPLT was applied in 120 typically developing Arabic-speaking Egyptian children (64 females and 56 males) randomly selected by inclusion and exclusion criteria in the age range between 2 years, 1 month, 1 day and 9 years, 12 months, 31 days. Children’s scores were used to calculate the means and standard deviations and the 5th and 95th percentiles to determine the age of the pragmatic skills acquisition. Results: All experts have mostly agreed that the EAPLT gives a general idea about children’s pragmatic language development. Test-retest reliability analysis proved the high reliability and internal consistency of the EAPLT subsets. A statistically significant correlation was found between the test subsets and age. Conclusion: The EAPLT is a valid and reliable Egyptian Arabic test that can be applied in order to detect a pragmatic language delay.

Videokymographic Visualization of Phonasthenia: A Nonorganic Voice Disorder

Background: Phonasthenia is a voice disorder where the larynx looks essentially normal and dysphonia is not heard but felt by the patient. This study aims to use videokymography (VKG) to detect any abnormalities in the vibratory pattern in phonasthenia and to find out whether or not these abnormalities change after vocal loading. Methods: Thirty-seven phonasthenic patients and 31 normal subjects participated in a detailed protocol, including analysis of subjective complaints and videokymographic quasi-objective parameters (baseline) followed by loading their voices through prolonged loud reading for 45 min. A second evaluation (experimental) was done after loading. Results: Before vocal loading, patients had significantly more symptoms in all questionnaire questions and higher maximum width difference in VKG than controls. When pre- and postloading values were compared, both groups experienced more symptoms after loading (significant in most of the questions), while the pre- and post-VKG parameters did not show significant differences neither in patients nor controls. On comparing their percent change, the only statistically significant difference between the 2 groups was a greater change in the total score of the questionnaire in the control group. Conclusion: Patients had more vocal fatigue symptoms and more amplitude asymmetry between left and right vocal folds than normal subjects.

R041: Videofluroscopic Assessment of Velo-Pharyngeal Port

reflexes were recorded in 15 patients undergoing ESS and 15 patients undergoing ENT surgeries other than nose under general anesthesia. In animal study, various conditions causing orbit complications in ESS were simulated while doing ESS in rabbit nose. RESULTS: Miosis occurred in all 30 patients after induction of general anaesthesia. The light reflex was negative in all 30 patients after one hour of surgery. In ESS group, the recovery of pupillary reaction was faster than the control group. In animal study, direct application of high concentrated epinephrine to rabbit conjunctiva caused a mydriasis. Intraorbital injection of a large amount of rabbit blood caused mydriasis. CONCLUSION: Pupillary size and reflexes during ESS under general anesthesia to assess orbital injury is not feasible because of miosis induced by the anaesthetic agents. The best test to ensure an intact visual pathway is to assess the patient’s visual acuity separately after recovery from the general anesthesia. SIGNIFICANCE: The best test to ensure an intact visual pathway is to assess the patient’s visual acuity separately after recovery from the general anesthesia.