Roopa Nagarajan

Communication disorders in individuals with cleft lip and palate: An overview.

The need for an interdisciplinary approach in the comprehensive management of individuals with cleft lip and palate is well recognized. This article provides an introduction to communication disorders in individuals with cleft lip and palate for members of cleft care teams. The speech pathologist is involved in identifying those infants who are at risk for communication disorders and also for initiating early intervention to prevent or mitigate communication disorders caused by the cleft. Even with early cleft repair, some children exhibit ‘cleft palate speech’ characterized by atypical consonant productions, abnormal nasal resonance, abnormal nasal airflow, altered laryngeal voice quality, and nasal or facial grimaces. These manifestations are evaluated to identify those that (a) are developmental, (b) can be corrected through speech therapy alone, and, (c) those that may require both surgery and speech therapy. Speech is evaluated perceptually using several types of stimuli. It is important to identify compensatory and obligatory errors in articulation. When velopharyngeal dysfunction is suspected, the assessment should include at least one direct measure such as nasoendoscopy or videofluoroscopy. This provides information about the adequacy of the velopharyngeal valve for speech production, and is useful for planning further management of velopharyngeal dysfunction. The basic principle of speech therapy in cleft lip and palate is to establish the correct placement of the articulators and appropriate air flow. Appropriate feedback is important during therapy for establishing the correct patterns of speech.

Use of a Consensus Building Approach to Plan Speech Services for Children with Cleft Palate in India

Cleft lip and palate (CLP) is a common birth defect worldwide. While surgical repair can normalize appearance, debilitating speech disorders frequently persist. Speech-language pathology (SLP) services are needed to address these disorders. However in many regions of the world, there is no discipline of SLP or inadequate numbers of trained clinicians. New models for service delivery must be explored to address the needs of children with CLP. Community-based rehabilitation (CBR) programs represent one model that has been successful in the delivery of other rehabilitation services. This paper presents the outcome of a consensus workshop held in India that explored the application of the CBR model to address the need for SLP services for children with CLP when traditional SLP services are limited or not available.

Vocal Abuse and Vocal Hygiene Practices Among Different Level Professional Voice Users in India: A Survey

Abstract Vocal hygiene is a primary aspect of concern for professional voice users. This study aimed to describe vocal abuse and vocal hygiene practices among different levels of professional voice users in India. A questionnaire regarding vocal abuse and vocal hygiene practices was administered to 400 voice professionals (singers, teachers, politicians, and vendors). The results revealed politicians and vendors had the highest point prevalence and frequency of voice problems. Politicians had highest prevalence of abusive non-vocal habits. About 84.3% of voice professionals considered that abusive (nonvocal) habits had a negative influence on voice. All subjects indulged in throat clearing, loud speaking/singing for long durations (abusive vocal habits). An equal number of subjects reported that they would resort to home remedies or not seek any help. Both ancient traditional practices (consuming milk with pepper or turmeric) and empirically proven methods are practiced among these different voice professionals in India to prevent voice problems. Lack of awareness to treat the voice problems earlier was high among vendors and politicians. The findings from the study would enable speech and voice pathologists to plan strategically to prevent voice problems and reach these voice professionals.

Tele-ABR using a satellite connection in a mobile van for newborn hearing testing

Summary We assessed the feasibility of conducting Auditory Brainstem Response (ABR) testing in a mobile van with satellite connectivity, with the help of trained health workers. ABR recordings in newborn babies made by telemedicine were compared with recordings made face to face. The auditory evoked response equipment was controlled by an audiologist at a nearby hospital. Videoconferencing was used during the testing process to monitor patient preparation by the village health worker. A total of 24 newborns (13 male and 11 female) aged 8–30 days underwent ABR in face-to-face and tele-mode. There was no significant difference between peak V latency measured at three intensity levels in the two modes. Agreement between the two methods of measurement was examined with a Bland-Altman plot. Almost all points were within the limits of agreement, suggesting no bias in the telemedicine measurements. Real-time tele-ABR testing as a component of newborn hearing screening is feasible in a mobile van using satellite link with the assistance of village health workers.

Multi parametric voice assessment: sri ramachandra university protocol.

Emergence of “Voice specialty clinics” in ENT and Speech Language Pathologist (SLP) practice in India necessitates development of standard protocols for assessment and management of voice disorders. Based on recommendations from European Laryngological Society in Dejonckere (Eur Arch Otorhinolaryngol 258:77–82, 2001), a comprehensive voice assessment protocol was adapted for Indian population. This study aimed at verifying the face validity and feasibility of using the developed voice assessment protocol in a multi specialty tertiary care hospital. It included: history, clinical examination, visual analysis, perceptual analysis, aerodynamic measures, acoustic analysis and patients’ self assessment of voice. The developed protocol was administered on 200 patients with voice concerns and problems. Correlation of self assessment with the assessment by the professionals was done using Kendaul tau_b correlation test. The scores of self assessment did not correlate significantly with acoustic measures. Differences in lab findings and self percept of voice indicated that these two were complementary measures in the protocol. Further, diagnosis and management decisions were arrived through a consensus discussion involving the ENT surgeon, SLP and the patient. Vocal hygiene and voice conservation were advised to all patients. Recommendations for voice therapy and/or surgery were provided based on findings from the protocol. The study demonstrated feasibility of using a comprehensive protocol for effective documentation, comparisons, review, training and treatment planning.

Vocal Hygiene Awareness Program for Professional Voice Users (Teachers): An Evaluative Study from Chennai

Abstract Vocal hygiene awareness programs aim at educating vocal professionals regarding prevalent voice use, abuse, and misuse and address ways to prevent voice problems. This study investigated the efficacy of one such program on vocal hygiene education (lecture demonstration) designed for school teachers in Chennai. A questionnaire addressing various issues/aspects of vocal hygiene was developed. The teachers (65) had to complete the same twice (pre- and posteducation). These were compared for differences in scores, which indicated awareness of vocal hygiene related issues after the program. The post-test scores were found to be 9% higher than pretest scores which suggested that the teachers had better awareness after the program.

Association of family history and consanguinity with permanent hearing impairment

Background: Risk factors for hearing impairment can offer important information for both the family and health-care providers regarding etiology, other associated health problems, and risk of recurrence in sub-sequent pregnancy. Family history and consanguinity indicates the possible involvement of genetic factors. Objective: The aim of the study is to find the strength of association of family history and consanguinity with permanent hearing impairment in infants. Materials and Methods: A case-control study was designed on 420 infants with permanent hearing impairment and normal hearing from the year 2008 to 2012. The case control ratio was 1:1. Alternate sampling method was used in a hospital for selecting the control group. Parent interview was carried out to collect the information of family history of hearing impairment and consanguineous marriage. Results: Family history and consanguinity was seen in 18.6% and 39.5% of the hearing-impaired group. These factors were associated with hearing impairment with a high significance (odds ratio (OR) 6.5; 95% Confidence interval (CI) 2.8, 15.1; P = 0.000 and OR: 2.7; 95% CI 1.9-3.9; P = 0.000). The combination of risk-factors is seen in 10% of the hearing-impaired group, whereas only 0.5% had it in the control group. Conclusion: Family history and consanguinity seems to be an important risk factor of hearing impairment both in isolation and in combination.

Cost and outcome of a community-based paediatric hearing screening programme in rural India with application of tele-audiology for follow-up diagnostic hearing assessment

Abstract Objective: This study evaluated the cost and outcome of a community-based hearing screening programme in which village health workers (VHWs) screened children in their homes using a two-step DPOAE screening protocol. Children referred in a second screening underwent tele diagnostic ABR testing in a mobile tele-van using satellite connectivity or at local centre using broadband internet at the rural location. Design: Economic analysis was carried out to estimate cost incurred and outcome achieved for hearing screening, follow-up diagnostic assessment and identification of hearing loss. Two-way sensitivity analysis determined the most beneficial cost-outcome. Study sample: 1335 children under 5 years of age underwent screening by VHWs. Results: Nineteen of the 22 children referred completed the tele diagnostic evaluation. Five children were identified with hearing loss. The cost-outcomes were better when using broadband internet for tele-diagnostics. The use of least expensive human resources and equipment yielded the lowest cost per child screened (Rs.1526;

School-based language screening among primary school children using telepractice: A feasibility study from India

23; €21). When follow-up expenses were thus maximised, the cost per child was reduced considerably for diagnostic hearing assessment (Rs.102,065;

Validation of DPOAE screening conducted by village health workers in a rural community with real-time click evoked tele-auditory brainstem response

1532; €1368) and for the cost per child identified (Rs.388,237;