Objective The purpose of the study was to determine differences in articulation and nasality with obturation over time in children with a palatal fistula. Design Articulation and nasality were measured with the fistula open, immediately after obturation, and 4 to 7 weeks postobturation. Setting, Patients, Participants Subjects were 15 patients with a palatal fistula secondary to a repaired cleft palate who were seen through the Orofacial Program, Utah Department of Health, ranging in age from 4 years 6 months to 13 years 1 month. Interventions Acrylic palatal obturators were designed to provide coverage specific to the unique shape and location of each child's fistula. Obturators were cemented to molar teeth using wire clasps for control of usage. Main outcome Measures Measurements consisted of listener judgments of hypernasality, hyponasality, and nasal emissions; instrumental ratings of nasalance using the Nasometer 6200-2; and performance on a standardized articulation test. Results Significant improvement occurred only on nasal emission measures from the preobturation condition to immediate postobturation. However, significant improvement was found in articulation, listener judgments of hypernasality, nasal emissions, and Nasometric Nasal Sentence mean scores from the preobturation condition to 4 to 7 weeks postobturation and from the immediate postobturation condition to 4 to 7 weeks postobturation. No significant differences were found between conditions for listener judgments of hyponasality and Nasometric Zoo and Rainbow Passage scores. Obturation of the palatal fistula over a 4- to 7-week period resulted in no adverse effect on articulation ability, perceptual ratings of nasality, or instrumental ratings of nasalance. Conclusions Clinical management of patients with a palatal fistula can be enhanced with treatment using obturation over time. For subjects who continue to exhibit hypernasality immediately postobturation, sustained obturation is advocated prior to consideration of surgical intervention for treatment of a palatal fistula and/or velopharyngeal dysfunction.
Clinical management of patients with a palatal fistula can be enhanced with treatment using obturation over time. For subjects who continue to exhibit hypernasality immediately postobturation, sustained obturation is advocated prior to consideration of surgical intervention for treatment of a palatal fistula and/or velopharyngeal dysfunction.
The views of children toward literacy can provide insight into the relationship between areas of reading and communication abilities and suggest possibilities for classroom language intervention and the use of written materials. This investigation examined differences in the opinions of fourth-grade readers with good and poor reading skills. Interviews were conducted with 270 fourth-grade students, 142 above average (AAR) readers and 128 below average (BAR) readers. Data analysis revealed significant differences between the two groups of readers on nine of 22 questions. The subjects accurately identified themselves as good or poor readers. The AAR group reported understanding more of what they read, whereas the BAR group reported problems in comprehending written information. As oral communicators, the AARs reported talking more and being understood more often when they talked than the BARs. Significant differences were found between the AAR and BAR groups regarding how often they read at home by themselves and how often they read for fun. However, no differences existed between the groups in their opinions of the value and importance of reading.
The effectiveness of using a skin barrier product in the application of tracheostoma valves to the peristomal skin of laryngectomized patients was investigated. Three patients who expressed a desire to use the tracheostoma valve but had experienced limited or unsuccessful use due to seal failure resulting from stoma irregularities and/or recessed stomas served as case study subjects. Each subject received six applications, three using the manufacturer's prescribed method and three with the procedure modified by use of a skin barrier product. The modified application method included an additional layer of a skin barrier product with an airway hole applied to the peristomal skin under the housing. Results of the study indicated that the addition of a skin barrier product in the application of the tracheostoma valve housing in subjects with recessed or irregular stomas dramatically increased mean seal duration. Subject A showed an increase from 1 hour 8 minutes to 9 hours 26 minutes, subject B's mean seal duration increased from 21 minutes to 3 hours 45 minutes, and subject C was able to change from 11 minutes to 8 hours 22 minutes with the modified technique.
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