The UIHC Speech and Swallowing Service staff conduct and participate in many research projects each year. These projects are frequently designed to test or clarify some aspect of the medical, surgical, or behavioral care of patients who may have difficulty with speech, language, voice, or swallowing. Some recent findings in each of these areas are described below:

Speech - Cleft Palate

Dailey SA, Karnell MP, Karnell LH, Canady JW. (2005) Comparison of Resonance Outcomes after Pharyngeal Flap and Furlow Double-Opposing Z-Plasty for Surgical Management of Velopharyngeal Inadequacy. Cleft Palate Craniofacial Journal, in press.

To our knowledge, no reports have compared the Furlow double-opposing Z-plasty and pharyngeal flap in the management of VPI. The Z-plasty may be effective in patients with marginal VPI and the pharyngeal flap may be effective in patients with more severe VPI. If using VPI status as the primary criterion for selecting type of surgery results in comparable outcomes for both procedures, then surgeons may be more confident about using Z-plasty in less severely impaired patients while avoiding the risks of nasal airway obstruction. The purpose of this research was to test the hypothesis that no significant difference exists in the speech outcomes for appropriately selected patients who receive pharyngeal flap and those that receive a Z-Plasty.

Karnell, MP, Bailey MA, Johnson, L, Dragan, A. Facilitating communication among speech pathologists treating children with cleft palate. Cleft Palate-Craniofacial Journal, In Press.

Objective: To design an interactive web based system to facilitate communications between non-specialist speech pathologists who provide therapy for individuals with speech disorders associated with cleft palate/craniofacial anomalies and specialist speech pathologists who provide physiologically based assessments of speech production.

Methods: A speech pathologist specializing in speech disorders associated with cleft palate, an instructional developer, a website/database consultant, and several outcomes researchers worked together to formulate, design, test, and implement the site.

Results: Public instructional presentations, public demonstrations of mock clinical data, and secure streaming video clips of clinical endoscopic examinations and other clinical information including recommendations by the specialist speech-language pathologist and speech therapy provided by non-specialist speech pathologists.

Conclusions: Web-based tools can be designed to improve the effectiveness of communications among clinicians to optimize the outcomes of speech therapy for children with speech disorders associated with cleft palate. Use of such on-line communication tools may also assist academic training programs involved in teaching new clinicians interested in cleft palate speech.

Swallowing Disorders

Karnell MP, Rogus NM. (2005) Comparison of clinician judgments and measurements of swallow response time: A preliminary report. Journal of Speech & Hearing Research, in press.

Practicing clinicians frequently offer judgments about aspects of swallowing physiology rather than performing actual measurements. Little is known about the accuracy of those judgments. The purpose of this preliminary study was to explore agreement of clinicians' judgments of pharyngeal swallow response time (PSRT) with temporal measurements of PSRT. In preparation for a larger study, PSRT was measured from the first 3 ml liquid bolus swallow that appeared in each of twenty videofluorographic swallowing evaluations. The same 20 swallows were then shown to three clinicians who were instructed to subjectively rate PSRT. The reliability of the PSRT measurements was strong (r > 0.95). Intra judge and inter judge agreement was better than chance in all but one inter judge comparison. Percent agreement between clinicians' judgments and the measurements, when the measurements were categorized as either not delayed or delayed, ranged from 60-95%. Chi square and Phi statistics comparing the outcomes of clinicians’ ratings with the measurement outcomes were significant supporting the agreement of the judgments with the measurements. Although the results of tests of agreement were found to be acceptable, clinician experience and training remain important issues whenever clinical judgments are involved. Larger studies are needed to establish the accuracy and importance of clinicians' judgments of pharyngeal swallow response time and observations of swallowing physiology.Simmons JR, Dornfeld K, Karnell L, Karnell M, Funk G, Yao M, Wacha J and Zimmerman B. Radiation Doses to Structures Within and Adjacent to the Larynx are Correlated with Long Term Diet and Speech Related Quality of Life

Eating and speaking are frequently impaired following radiotherapy for head and neck cancer. We hypothesized that radiation dose to key sites in the upper aerodigestive tract are associated with long term ability to eat and speak after (chemo) radiotherapy for head and neck cancers. In this study we correlated prospectively gathered data on type of diet tolerated following treatment and changes in speaking related quality of life measures with radiation doses delivered to key sites in the upper aerodigestive tract. We used a validated, health-related quality of life (QOL) instrument employing patient-reported measures of head and neck cancer specific performance status to determine the relationship between dose of radiation to various subsites and long term diet and speaking function.

Voice Disorders

Andrews BT, Karnell MP, Van Daele DJ, Mcculloch TM, Hoffman HT. Revision Thyroplasty: Open Revision vs. Injection Laryngoplasty

Introduction: Medialization thyroplasty is a well-described treatment option for unilateral vocal cord paralysis. If inadequate outcomes result, revision surgery is possible.

Methods: A retrospective chart review of all patients who underwent a revision procedure after a type I thyroplasty were included between Jan 1, 1994 and Dec. 31, 2004. Data collected included patient demographics, operative details, follow-up clinic notes, pre and post-operative subjective voice ratings; objective GRBAS grading; and maximum phonation times.

Results: Twenty-nine patients underwent revision procedures. 14 patients underwent open implant repositioning (including 4 with implant removal without replacement). Sixteen patients received injection laryngoplasty with 10 patients having multiple injections for a total of 34 injections using collagen (n=27), fat (n=5) and calcium hydroxyappatite (n=1). One patient required both an open revision and an injection laryngoplasty. Vocal outcomes were improved in the majority of patients who underwent either open revision or injection laryngoplasty, although vocal outcome were often finite in the later group.

Conclusion: Open revision thyroplasty provides improvement of long-term vocal outcomes in the majority of patients. Injection laryngoplasty is also successful at providing good vocal outcomes but results are often temporary and multiple procedures are often required.

Chang, A., Karnell, M.P. The relationship among vocal fatigue, perceived phonatory effort and phonation threshold pressure. Journal of Voice, 18, 454-466, 2004

Although the problem of vocal fatigue is not uncommon in individuals with voice disorders, research on objective quantifiable indicators of vocal fatigue is limited. It has been suggested that a speaker’s perception of increased phonatory effort associated with periods of prolonged voice use is related to increased lung pressure required to initiate and sustain phonation. The purpose of this study was to examine the relationship among perceived phonatory effort (PPE), which was used as a subjective index of vocal fatigue, and phonation threshold pressure (PTP), a quantifiable measure defined as the minimal lung pressure required to initiate and sustain vocal fold oscillation. PTP and PPE were recorded prior to, during, and after each of five adult male and five adult female speakers engaged in a prolonged oral reading task designed to induce vocal fatigue. The results supported a direct, moderately strong, relationship between PTP and PPE, particularly when PTP was measured during speech produced at comfortable and low speaking pitch levels. No gender effects were found. PTP returned to baseline levels within one hour after conclusion of the fatiguing task. PPE returned to baseline within one day. The data support the use of PTP as an objective index of vocal fatigue.

Authored Texts and Articles

Handbook of Cleft Palate Speech: A Clinician's Guide to Diagnosis and Therapy. Peterson-Falzone, S.J., Karnell, M.P., Hardin-Jones, M.A., Cardamone, J.E. Mosby, 2005.

Peterson-Falzone, S.J., Karnell, M.P., Hardin-Jones, M.A. Cleft Palate Speech. Mosby, 2001.

Sharp HM, Dailey S, Moon JB.(2003) Speech and language development disorders in infants and children with cleft lip and palate. Pediatric Annals. 32(7):476-80, 2003 Jul.