Tim Bressmann

Quantitative three‐dimensional ultrasound analysis of tongue protrusion, grooving and symmetry: Data from 12 normal speakers and a partial glossectomee

The functional determinants for a good speech outcome after a partial tongue resection and reconstruction are not well established. The purpose of the present study was to assess the protrusion, grooving and symmetry of the tongue during sustained speech sound production using three‐dimensional ultrasound. The participants were twelve normal speakers and one partial glossectomee. The three‐dimensional ultrasound volumes of nine sustained speech sounds were measured in three sagittal planes. The data were re‐plotted as three‐dimensional surfaces. We calculated an anteriority index, a concavity index and an asymmetry index. The glossectomees postoperative surface plots were characterized by asymmetry and convexity of the tongue surface. The anteriority index illustrated that the glossectomees ability to protrude her tongue was not affected by the operation. The concavity index captured a decrease in midsagittal grooving in the glossectomees tongue. The asymmetry index demonstrated height differences in the elevation of the right and left side of the tongue. We conclude that three‐dimensional ultrasound offers us a practical tool for the detailed and concise assessment of the lingual shape and deformation in patients undergoing glossectomy surgery.

INCREASED MIDSAGITTAL TONGUE VELOCITY AS INDICATION OF ARTICULATORY COMPENSATION IN PATIENTS WITH LATERAL PARTIAL GLOSSECTOMIES

The purpose of this study was to describe the impact of partial lateral glossectomy on midsagittal tongue movement during speech.

Nasalance distance and ratio: two new measures.

OBJECTIVES Mean nasalance in speakers with perceptually normal nasal resonance can differ in magnitude considerably. In addition, categorizations of speech based on nasalance scores may not agree with perceptual judgments. To overcome this limitation, we evaluated two new simple measures derived from mean nasalance data: the nasalance distance (range between maximum and minimum nasalance) and the nasalance ratio (minimum nasalance divided by maximum nasalance). SETTING Department of Oral and Maxillofacial Surgery, University of Technology, Munich, Germany. SUBJECTS The sample consisted of 133 cleft lip and palate patients with normal nasal resonance or varying degrees of hypernasality. PROCEDURES Oral and nasal acoustic measurements were made using the NasalView system. Nasalance distance and nasalance ratio were calculated for five non-nasal and three nasal sentences from the modified Heidelberg Rhinophonia Assessment Form. RESULTS Optimum cutoffs were derived from receiver-operating characteristics. Results for the sentence stimuli ranged from 64.4% to 89.6% sensitivity and from 91.2% to 94.1% specificity. When the analysis was limited to only one nonnasal and one nasal sentence, results ranged from 79.7% to 87.5% sensitivity and from 88.2% to 97.1% specificity. CONCLUSIONS We conclude that the two new measurements are valuable in routine clinical examinations. Nasalance distance and ratio derived from sentence stimuli are two useful and easily applicable measures that can be used to supplement the nasalance mean value.

Quantitative three-dimensional ultrasound imaging of partially resected tongues

OBJECTIVE: We sought to assess the impact of partial lateral glossectomies on tongue function and speech. STUDY DESIGN AND SETTING: Tongue shapes of 12 patients with lateral tumors of the tongue were recorded with three-dimensional ultrasound before their surgery and two months after. Twelve normal participants served as controls. Speech acceptability was also assessed. RESULTS: Principal component analyses demonstrated that the flap reconstructions led to a stiffening of the operated side of the tongue. A concavity index and an asymmetry index demonstrated that the glossectomy patients exhibited decreased midsagittal grooving and increased lingual asymmetry. The change in midsagittal grooving correlated moderately with the decrease in speech acceptability. CONCLUSION: A lateral partial glossectomy affects the tongues intrinsic deformation, in particular midsagittal grooving and symmetry. This can have a detrimental effect for speech. SIGNIFICANCE: A lateral resection affects the tongues symmetry and midsagittal groove. The change in midsagittal grooving correlates with a decrease in speech acceptability.

Comparison of Nasalance Scores Obtained With the Nasometer, the NasalView, and the OroNasal System

Objective To compare nasalance scores obtained with the Nasometer, the NasalView, and the OroNasal System; evaluate test-retest reliability of the three systems; and explore whether three common text passages used for nasalance analysis could be shortened to a sentence each. Subjects Seventy-six adults with normal speech and hearing (mean age 26.5 years). Procedures Subjects read the complete Zoo Passage, Rainbow Passage, and Nasal Sentences. Main Outcome Measures Mean nasalance magnitudes and mean nasalance distances were obtained with the three devices. Results The Nasometer had the lowest nasalance scores for the nonnasal Zoo Passage. The NasalView had the highest nasalance scores for the phonetically balanced Rainbow Passage. The OroNasal System had the lowest nasalance scores for the Nasal Sentences. The nasalance distance was largest for the Nasometer and smallest for the OroNasal System. Over 90% of the recordings were within 4% to 6% nasalance for most materials recorded with the Nasometer and the NasalView and within 7% to 9% for materials recorded with the OroNasal System. There were significant differences between the complete Zoo Passage and the Nasal Sentences and the individual sentences from these passages for the Nasometer and the OroNasal System. Conclusions The three systems measure nasalance in different ways and provide nasalance scores that are not interchangeable. Test-retest variability for the Nasometer and the NasalView may be higher than previously reported. Individual sentences from the Zoo Passage and the Nasal Sentences do not provide nasalance scores that are equivalent to the complete passages.

Lebensqualitätsforschung bei Patienten mit Lippen-Kiefer-Gaumen-Spalten

Auch wenn die funktionellen und ästhetischen Ergebnisse der Behandlung von Patienten mit Lippen-Kiefer-Gaumen-(LKG)-Spalte sich in den letzten Jahrzehnten erheblich verbessert haben, bleibt die LKG-Spalte für Patienten und Angehörige ein ernstes Problem. Während sich die psychologische Forschung bisher mit Themen wie Intelligenz, Selbstkonzept oder Behandlungszufriedenheit auseinandergesetzt hat, sind langfristige Auswirkungen von LKG-spezifischen Problemen auf psychologische Konstrukte wie Lebensqualität bisher nicht erforscht worden. Aus einem Pool von 156 LKG-Patienten nach Abschluß der primären Operationen wurden verschieden große Subgruppen mit einem Satz standardisierter Fragebögen (KINDL, SF-36, Social Support Survey) untersucht. Mit der Impact on Family Scale wurden gleichzeitig 112 Elternteile oder Elternpaare in Hinblick auf die langfristigen Auswirkungen für die Familie befragt. Weiterhin kam ein Satz von interdisziplinär entwickelten LKG-spezifischen Fragenkatalogen zum Einsatz. Die vorgestellten Ergebnisse zeigen, daß die subjektiv empfundene Lebensqualität vom LKG-Patienten, die an einem interdisziplinären Spaltzentrum über den gesamten Zeitraum der Wachstumsperiode betreut und behandelt werden, gut ist und dem Kollektiv der Normalbevölkerung entspricht. Der Grad der sozialen Integration von LKG-Patienten erscheint ebenfalls im Normbereich. Die Eltern berichten nur geringfügige langfristige Probleme für die Familiengemeinschaft und weitere Familienplanung. Die Zufriedenheit der Patienten mit ihrer Behandlung ist hoch. Die selbstentwickelten Fragensammlungen weisen auf spezifischere Probleme hin, bei denen die LKG-Spalte als Beeinträchtigung empfunden wird und die v. a. im Bereich der sozialen Akzeptanz liegen. Diese Probleme werden durch die bisher verwendeten standardisierten Fragebögen nicht erfaßt. Die Kombination beider Arten von Fragebögen stellt eine ausreichend sensitive Untersuchungsprozedur dar. While esthetic and functional outcomes of treatment have improved for patients with cleft lip and palate (CLP), a CLP remains a severe problem for patients and relatives. To date, psychological research has dealt with issues such as intelligence, self-consciousness or treatment satisfaction but the long-term impact of a CLP on a psychological construct such as quality of life has yet to be explored. From a pool of 156 patients with CLP, subgroups of varying sizes were examined with a set of standardized questionnaires (KINDL, SF-36, Social Support Survey). In all patients, primary operative treatment had been accomplished. Long-term impact of the CLP on family life was assessed by 112 of the patients’ parents by filling in the Impact on Family Scale. A set of questionnaires, especially developed for patients with CLP, was administered as well. For all patients who have been being treated in an interdisciplinary cleft center for their entire life, the results presented indicate that quality of life is good and within a normal range. Social support appears to be within a normal range. Parents report only minor long-term impact of the CLP on family life and family planning. Treatment satisfaction is high in the CLP patients. The questionnaires especially aimed at CLP patients indicate more specific problems mainly concerning social acceptance, where patients think the CLP had a negative impact. The standardized questionnaires employed so far failed to capture these problems. The combination of the two types of questionnaires is a sufficiently sensitive assessment procedure.

An ultrasonographic investigation of cleft-type compensatory articulations of voiceless velar stops

Ultrasound imaging was used to investigate the articulation of the voiceless velar stop [k] in five speakers with compensatory articulation related to cleft palate. The perceptual evaluation of the acoustic realization and the visual assessment of the tongue movement for the target sound were made by three examiners. The analysis revealed a variety of different compensatory strategies that included glottal stops, pharyngeal stops, midpalatal stops and glottal and velar co-productions. One patient produced palatal click sounds together with a midpalatal stop. The ultrasound imaging also revealed covert articulatory movements that would have been missed in a purely perceptual analysis. The analysis of the ultrasound images points to subphonemic aspects of cleft-type compensatory articulation that are important to understand for speech therapy.

Same noses, different nasalance scores: data from normal subjects and cleft palate speakers for three systems for nasalance analysis.

Nasalance scores from the Nasometer, the NasalView and the OroNasal System were compared. The data was collected from 50 normal participants and 19 hypernasal patients with cleft palate. The Nasometer had the lowest nasalance scores for the non‐nasal Zoo Passage and that the OroNasal System had the lowest nasalance scores for the Nasal Sentences. The nasalance distance was largest for the Nasometer and smallest for the OroNasal System. When the calculation was based on nasalance magnitudes, results for sensitivity ranged from 57.9% to 81.8% and results for specificity ranged from 62.0% to 76.0%. When the calculation was based on nasalance distances, results for sensitivity ranged from 84.2% to 100.0% and results for specificity ranged from 82.0% to 100.0%. Results suggest that nasalance scores from the three systems are not interchangeable. Diagnostic efficacy improved when the calculations were based on nasalance distances rather than magnitudes, but further research is warranted to corroborate these findings.

Analysing normal and partial glossectomee tongues using ultrasound

The present study aimed at identifying underlying parameters that govern the shape of the tongue. A functional topography of the tongue surface was developed based on three‐dimensional ultrasound scans of sustained speech sounds in ten normal subjects. A principal component analysis extracted three components that explained 89.2% of the variance at 33 measurement points on the tongue surface. The results from the principal component analysis supported a physiologically plausible three‐component model of tongue movement. This model breaks tongue movement down into a protrusion and retraction component that is represented by the measurement points on the posterior tongue, a tongue tip control component that is represented by the measurement points on the tongue blade, and a dorsal height and position control component that is represented by the measurement points on the tongue dorsum. A case series of three patients with partial glossectomies illustrates how this measurement system can be applied to surgically altered tongues to allow a detailed analysis of post‐surgical function.

Tongue contour tracking in dynamic ultrasound via higher-order MRFs and efficient fusion moves

Analyses of the human tongue motion as captured from 2D dynamic ultrasound data often requires segmentation of the mid-sagittal tongue contours. However, semi-automatic extraction of the tongue shape presents practical challenges. We approach this segmentation problem by proposing a novel higher-order Markov random field energy minimization framework. For efficient energy minimization, we propose two novel schemes to sample the solution space efficiently. To cope with the unpredictable tongue motion dynamics, we also propose to temporally adapt regularization based on contextual information. Unlike previous methods, we employ the latest optimization techniques to solve the tracking problem under one unified framework. Our method was validated on a set of 63 clinical data sequences, which allowed for comparative analyses with three other competing methods. Experimental results demonstrate that our method can segment sequences containing over 500 frames with mean accuracy of 3mm, approaching the accuracy of manual segmentations created by trained clinical observers.