Response to “Nasalance-Based Preclassification of Oral–Nasal Balance Disorders Results in Higher Agreement of Expert Listeners: Methodological Issue”

Abstract

We thank Drs Siamak Sabour and Mehdi Naderi for their interest in our paper "Nasalance-Based Preclassification of Oral-Nasal Balance Disorders Results in Higher Agreement of Expert Listeners' Auditory-Perceptual Assessments: Results of a Retrospective Listening Study" (de Boer et al., 2020). In this paper, we investigated whether nasalance-based preclassification of oral-nasal balance disorders improves listener agreement. Three expert listeners took part in 2 listening studies. The speakers with cleft palate were preclassified as normal, hypernasal, hyponasal, or mixed based on their nasalance scores. In a first round of the experiment, the listeners independently categorized the speakers' oral-nasal balance. The agreement between the listeners' diagnostic category and the nasalance-based category was 45.1% and the interlistener agreement was 36.7%, which were rather low level of agreements. In a second experiment 6 months later, the listeners relistened to the samples but this time, they had a spreadsheet indicating the nasalance-based categories for the oral-nasal balance. Some of the samples were deliberately misclassified to ensure listener attentiveness to the task. The listeners confirmed, or rejected and corrected, the nasalance-based preclassifications. In this second experiment, the listeners' agreement was 75% for the correct nasalance-based categories, and interlistener agreement was 85.4%. We concluded from these results that a preclassification of oral-nasal balance disorders based on nasalance scores could help listeners achieve higher diagnostic accuracy and agreement. This could have implications for clinical practice: Currently, speech-language pathologists tend to do their auditoryperceptual assessments of oral-nasal balance disorders first and then use nasalance scores to corroborate their findings. However, if nasalance-based preclassification of oral-nasal balance disorders results in better listener agreement, as our research suggested, then it may make sense for clinicians to flip the