Swapna Sebastian

Acoustic measurements of geriatric voice

Background: Aging larynx can cause changes in the voice. Knowledge about the normal changes in voice parameters is important in differentiating it from pathological voices. This study is a preliminary investigation on the age related changes in the parameters of voice in geriatric normal subjects, which has been scarcely reported in the Indian literature. Materials and Methods: Our study focused on the changing acoustic parameters of voice due to aging in normal geriatric subjects. The acoustic parameters of males and females with normal voice between the age groups of 60 to 80 were studied. 20 subjects in each category (male and female) were included in the study. All the subjects were taken after clearance from ENT to rule out any vocal pathology. The parameters taken were fundamental frequency, formants (f1, f2), jitter and shimmer. Results and Discussion: Our study shows that there are not any significant changes in the acoustic parameters either in males or in females across the age of 60 years to 80 years. However when compared to adult norms (18-25 yrs) the acoustic values are showing a difference both in males as well as in females in fundamental frequency. Comparison was also done between males and females between the age group of 60 to 80 years. Males differed from females significantly for the parameters of fundamental frequency and formant frequencies (f1 and f2 ) only and not for the parameters of jitter and shimmer.

The impact of hearing loss in the life of adults: A comparison between congenital versus late onset hearing loss

Aim of the Study: The aim of our study was to compare the impact of hearing loss in the life of adults who had congenital hearing loss with that of adults with acquired adult onset hearing loss (auditory neuropathy). Methodology: The quality of life scale questionnaire was administered on two groups. One group consisted of 10 adults with prelingual bilateral severe to profound hearing loss identified before the age of 3 years and who were using hearing aids and had received regular intervention for speech and language development by a qualified speech language pathologist. Second group consisted of 10 adults with auditory neuropathy. Results and Discussion: Wilcoxon rank sum test was used to compare the domains across the groups and the gender distributions between two groups were analyzed using Fisher′s exact test. The results revealed that differences between the adults with early-onset hearing loss and late onset hearing loss was statistically significant for most of the domains. The results indicated the fact that accepting a hearing loss during adulthood leads to more psychological trauma than adjusting and living with the hearing loss from the early years of life. Loss of hearing is quite traumatic to adults. Psychological trauma that they undergo is as important as their physiological problem and psychological referral to a clinical psychologist may be beneficial to many of them.

Laryngeal movements in stutterers

Background: The etiology of stuttering is a puzzle. Abnormal laryngeal movements have been assumed to be a cause of stuttering by many researchers. We aimed at comparing the laryngeal functions of stutterers using electroglottogram (EGG) and vocal tract functioning using formant frequency analysis. Materials and Methods: We compared the acoustic and electroglottographic parameters in the phonation of stutterers between the age range of 15-25 years and normal subjects matched for age and sex. Results and Discussion: All the electroglottographic parameters of stutterers differed from that of normal speaking subjects which is indicative of difficulty in adjustment of the laryngeal gestures for speech in stutterers. There was no significant difference between the stutterers and non-stutterers in terms of formant frequencies. Similar formant frequencies in stutterers and normal speakers and abnormal electroglottographic parameters are suggestive of abnormal laryngeal movements and normal vocal tract functioning in stutterers.

A Case–Control Study on the Association Between Endoscopic ACE Grade of Adenoid Hypertrophy and Hearing Loss in Children and Its Impact on Speech and Language Development

To establish an association between adenoid hypertrophy and hearing loss and its impact on speech and language in pediatric age group. A prospective case control study done in a tertiary hospital in South India. Twenty children with hearing loss were recruited in the study group and twenty-four children as controls. These groups underwent at detailed otorhinolaryngologic examination, hearing and speech evaluation. The size of the adenoids was graded endoscopically. Findings between the two groups were compared and analysed. Our study found statistically significant association between adenoid hypertrophy with choanal obstruction and abutment of eustachian tube opening seen on endoscopy with hearing loss (p = 0.025). The children with hearing loss also had speech and language delay (p = 0.004). Children with enlarged adenoids obstructing the > 50% of the choanae or abutting the eustachian tube opening are more likely to have hearing loss and may develop speech and language delay. The ACE endoscopic adenoid grading system is consistent and reliable in evaluation of adenoids.

Assessment of Communication in Children With Autism Spectrum Disorder in South India: Influence of Environment

Assessment of communication skills in children with autism spectrum disorder (ASD) is challenging in an unfamiliar clinical environment due to their limited verbal output and inadequate motivation to communicate. To analyze whether the communication sample recorded at clinic represents the child’s competence and performance, this study compared caregiver–child interaction in 24 to 48 months old children with ASD (n = 10, M = 38.2 months) at clinic and home. The 30-minute caregiver–child interaction at clinic and home was video recorded and analyzed for frequency of pragmatic acts (initiations and responses) and duration of joint engagement. Results indicated that children initiated and responded more at home than at clinic, whereas caregivers initiated and responded more at clinic. The study provides evidence that communication profile of children with ASD in multiple environments needs to be considered for obtaining representative and reliable communication sample for child-centered assessment and intervention.

Oropharyngeal Dysphagia: Neurogenic Etiology and Manifestation

To determine the type, severity and manifestation of dysphagia in patients with neurogenic etiology. Clinical documentation was done on the different etiologies, its manifestation, assessment findings and management strategies taken for patients with neurogenic oropharyngeal dysphagia who were referred for assessment and management of dysphagia over a period of three months in a tertiary care teaching hospital. Flexible endoscopic examination was done in all the patients. The severity of dysphagia in these patients were graded based on Gugging Swallowing Screen (GUSS). A total of 53 patients with neurogenic oropharyngeal dysphagia were evaluated by an otolaryngologist and a speech language pathologist over a period of three months. The grading of severity based on GUSS for these patients were done. There were 30 patients with recurrent laryngeal nerve injury due to various etiologies, one patient with Neurofibroma-vestibular schwanoma who underwent surgical excision, 16 patients with stroke, two patients with traumatic brain injury, two patients with Parkinsonism and two patients with myasthenia gravis. The manifestation of dysphagia was mainly in the form of prolonged masticatory time, oral transit time, and increased number of swallows required for each bolus, cricopharyngeal spasms and aspiration. Among the dysphagia patients with neurogenic etiology, dysphagia is manifested with a gradual onset and is found to have a progressive course in degenerative disorders. Morbidity and mortality may be reduced with early identification and management of neurogenic dysphagia.