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Oral Motor Function, Voice, Speech and Language in Children with Tonsillar Hypertrophy in Relation to Surgical Outcome
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Logopedi. Linköpings universitet, Hälsouniversitetet.
2010 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The aim of this thesis was two-fold: first, to evaluate four different functional aspects of the speech and language spectrum; oral-motor function, voice, /s/-articulation and phonology in preschool children with tonsillar hypertrophy before and after surgical treatment. The second aim was to investigate weather the outcome of surgery was equal for two surgical techniques; tonsillectomy or tonsillotomy combined with adenoidectomy when necessary. In all included publications (I-IV), 67 children on waiting list for tonsil surgery and randomized to either tonsillectomy (33) or tonsillotomy (34) participated. The children were assessed and audio-recorded within a month before surgery and six months postoperatively. Results were compared to age-matched control groups.

In the first study, oral motor function was assessed using the Nordic Orofacial Test-Screening, NOT-S, consisting of a structured interview and a clinical examination. Before surgery, the children in the study group differed in all domains of the structured interview in comparison to age-matched controls and in the clinical examination regarding the parameters deviant lip position and trouble nose-breathing. Postoperatively oral motor functions were normalized in both surgical groups and no differences to age matched controls were observed. In study two, recordings of three sustained vowels (/α , u, i/) and 14 words elicited by picture naming were analysed both perceptually and acoustically. Compared to the controls, significant differences were found in the study group preoperatively with higher ratings on Visual Analogue Scales (VAS) for the voice quality parameters “hyponasality” and “compressed/throaty” and also lower for pitch. Significantly higher values on all studied perturbation measures (jitter, shimmer and Noise to Harmonics Ratio) were found. Regarding center frequencies of formants, the study groups had lower F3 values for /u / and also lower F2 and F3 for / i / compared to age-matched controls. After surgery there were no significant differences between the perceptual ratings of voice quality of the two surgical groups and there were no significant differences between the children in the surgical groups and the corresponding controls. The acoustic analyses showed a decrease in all the measures of perturbation for the study group after surgery with a slight difference between the two surgical groups. The children in the tonsillotomy group had higher shimmer value for /u/ and higher NHR for /α/. In comparison to the older controls significantly higher values were found an all perturbation measures and the difference seen regarding formant frequencies for the /i/-sound in comparison to controls still remained. The significantly lower third formant (F3) of the /u/-sound also remained. When comparing pre- versus postoperative results for the surgical group as a whole, a decrease was found on all perturbation measures postoperatively, however the differences were not statistically significant. A significant increase was found in formant 3 for /α/ and /u/ was found.

The material used in the third study were speech samples containing the /s/-sound and elicited by picture naming and sentence repetition. Before surgery the study group was rated to have more indistinct /s/-sounds than agematched controls. The acoustic analyses showed that the study group had lower spectral peak values for the /s/-sound than controls. After surgery the operated children’s /s/-production did not differ perceptually from the older controls, neither as a whole group nor when divided according to surgical methods. Regarding the acoustic analyses however, the study groups differed from the age-matched control group showing that noise duration was longer and the peak location higher in the study groups.

In study four, a Swedish phonology test was performed and transcribed phonetically. The transcription of each child was analyzed in terms of phonological processes and categorized into one of six developmental stages according to the model developed by Nettelbladt (1983) and adapted by Sahlén, Reuterskiold-Wagner, Nettelbladt & Radeborg (1999). A majority of the children in the study group (62.7 %) showed a slowed phonological development preoperatively (developmental stages 0-4), compared to the age-matched control group. Postoperatively the children in both surgical groups had improved their phonological skills. However, they were still behind in comparison to age-matched controls and the difference was even larger than before surgery.

The results of this thesis project have clinical relevance for both speech and language pathologists (SLP’s) and ear-nose and throat-surgeons (ENT-surgeons). SLP’s must be aware of the potential impact of tonsillar hypertrophy on oral-motor function and the speech and language spectrum to be able to help affected children adequately and ENT- surgeons should include oral motor and speech and language problems as additional indications for tonsillar surgery.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press , 2010. , s. 63
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1199
Nationell ämneskategori
Oto-rino-laryngologi
Identifikatorer
URN: urn:nbn:se:liu:diva-61246ISBN: 978-91-7393-333-9 (tryckt)OAI: oai:DiVA.org:liu-61246DiVA, id: diva2:361171
Disputation
2010-11-12, Elsa Brändströmsalen, Campus US, Linköpings univeristet, Linköping, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2010-11-16 Skapad: 2010-11-08 Senast uppdaterad: 2018-07-03Bibliografiskt granskad
Delarbeten
1. Oral motor dysfunction in children with adenotonsillar hypertrophy-effects of surgery
Öppna denna publikation i ny flik eller fönster >>Oral motor dysfunction in children with adenotonsillar hypertrophy-effects of surgery
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2009 (Engelska)Ingår i: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 34, nr 3, s. 111-116Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Adenotonsillar hypertrophy is associated with a wide range of problems. The enlargement causes obstructive symptoms and affects different functions such as chewing, swallowing, articulation, and voice. The objective of this study was to assess oral motor function in children with adenotonsillar hypertrophy using Nordic Orofacial Test-Screening (NOT-S) before and 6 months after surgery consisting of adenoidectomy combined with total or partial tonsil removal. A total of 67 children were assigned to either tonsillectomy (n=33) or partial tonsillectomy, 'tonsillotomy' (n=34); 76 controls were assessed with NOT-S and divided into a younger and older age group to match pre- and post-operated children. Most children in the study groups had oral motor problems prior to surgery including snoring, open mouth position, drooling, masticatory, and swallowing problems. Post-surgery oral motor function was equal to controls. Improvement was independent of surgery method.

Nyckelord
Adenotonsillar hypertrophy; children; NOT-S; oral motor function; tonsil surgery
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-51583 (URN)10.1080/14015430903066937 (DOI)19565403 (PubMedID)
Tillgänglig från: 2009-11-09 Skapad: 2009-11-09 Senast uppdaterad: 2017-12-12
2. Acoustic and perceptual aspects of vocal function in children with adenotonsillar hypertrophy —effects of surgery
Öppna denna publikation i ny flik eller fönster >>Acoustic and perceptual aspects of vocal function in children with adenotonsillar hypertrophy —effects of surgery
2012 (Engelska)Ingår i: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 26, nr 4, s. 480-487Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To evaluate outcome of two types of tonsil surgery (tonsillectomy+adenoidectomy or tonsillotomy +adenoidectomy) on vocal function perceptually and acoustically.

Study Design: Sixty-seven children, aged 50-65 months, on waiting list for tonsil surgery were randomized to tonsillectomy (n=33) or tonsillotomy (n=34). Fifty-seven age and gender matched healthy pre-school children were controls. Twenty-eight of them, aged 48-59 months, served as control group before surgery, and 29, aged 60-71 months, after surgery

Methods: Before surgery and six months postoperatively, the children were recorded producing three sustained vowels (/A, u, i/) and 14 words. The control groups were recorded only once.

Three trained speech and language pathologists performed the perceptual analysis using Visual Analogue Scales (VAS) for eight voice quality parameters. Acoustic analysis from sustained vowels included average fundamental frequency, jitter percent, shimmer percent, noise-to-harmonic ratio and the centre frequencies of formants 1-3

Results: Before surgery the children were rated to have more hyponasality and compressed/throaty voice (p<0,05) and  lower mean pitch (p<0,01) in comparison to the control group. They also had higher perturbation measures and lower frequencies of the second and third formant. After surgery there were no differences perceptually. Perturbation measures decreased but were still higher compared to the control group’s, p<0, 05. Differences in formant frequencies for /i/ and /u/ remained. No differences were found between the two surgical methods.

Conclusion: Voice quality is affected perceptually and acoustically by adenotonsillar hypertrophy. After surgery the voice is perceptually normalized but acoustic differences remain. Outcome was equal for both surgical methods.

Ort, förlag, år, upplaga, sidor
Elsevier, 2012
Nyckelord
Voice quality; children; perceptual and acoustic analyses; tonsil surgery
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-61240 (URN)10.1016/j.jvoice.2010.11.003 (DOI)000305961500018 ()978-91-7393-333-9 (ISBN)
Tillgänglig från: 2010-11-08 Skapad: 2010-11-08 Senast uppdaterad: 2018-07-03Bibliografiskt granskad
3. Influence of adenotonsillar hypertrophy on /s/-articulation in children-effects of surgery
Öppna denna publikation i ny flik eller fönster >>Influence of adenotonsillar hypertrophy on /s/-articulation in children-effects of surgery
2011 (Engelska)Ingår i: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 36, nr 3, s. 100-108Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Tonsillar hypertrophy is common in young children and affects several aspects of the speech such as distortions of the dento-alveolar consonants. The study objective was to assess s-articulation, perceptually and acoustically in children with tonsillar hypertrophy and compare effects of two types of surgery, total tonsillectomy and tonsillotomy. Sixty-seven children, 50-65 months, on waiting list for surgery, were randomized to tonsillectomy or tonsillotomy. The speech material was collected pre-operatively and six months post-operatively.  Two groups of age-matched children were controls. /S/-articulation was affected acoustically with lower spectral peak locations and perceptually with less distinct /s/-production before surgery, in comparison to controls.  After surgery /s/-articulation was normalized perceptually, but acoustic differences remained. No significant differences between surgical methods were found.

Ort, förlag, år, upplaga, sidor
Informa Healthcare, 2011
Nyckelord
child, s-articulation, adeno-tonsillar hypertrophy, perceptual and acoustic evaluations
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-61244 (URN)10.3109/14015439.2010.531047 (DOI)000295479900002 ()
Tillgänglig från: 2010-11-08 Skapad: 2010-11-08 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
4. Phonological development in children with obstructive sleep-disordered breathing
Öppna denna publikation i ny flik eller fönster >>Phonological development in children with obstructive sleep-disordered breathing
Visa övriga...
2009 (Engelska)Ingår i: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 23, nr 10, s. 751-61Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Adeno-tonsillar hypertrophy with obstructive sleep disordered breathing (OSDB) is known to affect oral-motor function, behaviour, and academic performance. Adeno-tonsillectomy is the most frequently performed operation in children, with total tonsillectomy (TE) being more common than partial resection, 'tonsillotomy' (TT). In the present study 67 children, aged 50-65 months, with OSBD were randomized to TE or TT. The children's phonology was assessed pre-operatively and 6 months post-operatively. Two groups of children served as controls. Phonology was affected in 62.7% of OSBD children before surgery, compared to 34% in the control group (p < .001). Also, OSBD children had more severe phonological deficits than the controls (p < .001). Phonology improved 6 months equally after both surgeries. Despite improvement post-operatively, the gap to the controls increased. Other functional aspects, such as oral motor function, were normalized regardless of surgical method--TE or TT. The impact of OSBD should be considered as one contributing factor in phonological impairment.

Nyckelord
Child, phonological disorders, obstructive sleep-disordered breathing, tonsil surgery
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-51582 (URN)10.3109/02699200903144770 (DOI)19883185 (PubMedID)
Tillgänglig från: 2009-11-09 Skapad: 2009-11-09 Senast uppdaterad: 2017-12-12

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