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Dichotic tests evaluate binaural integration through simultaneous presentation of different stimuli to each ear of a listener who has normal hearing sensitivity in both ears. Dichotic listening deficits may lead to problems with language, communication, reading, or academic performance. If accurately identified, dichotic deficits may be treatable with listening training or managed with accommodation. However, it is not clear which of several commercially-available dichotic test recordings are best for audiologists to use when assessing binaural integration in children. Literature review revealed limited evidence of reliability, accuracy, usefulness, or value for dichotic tests applied to children. Of 11 dichotic tests identified, five reported some evidence of test-retest reliability. Correlation between results on repeated administration was moderate to good (r=0.59 to 0.92). Evidence of accuracy was identified for 5 tests but was not generalizable due to significant limitations in study design. No evidence was found to either support or dispute claims of usefulness or value. Since reliability is a necessary prerequisite for good test performance, we sought to directly compare test-retest reliability for three dichotic measures: SCAN-3 Competing Words (CW), Musiek's Double Dichotic Digits (DD-M), and Bergen Dichotic Listening Test with Consonant-Vowel Syllables (CV-B). Sixty English-speaking children, 7-14 years old with normal hearing, had a single study-visit during which each test was administered twice. Changes on retest were compared to binomial model predictions, summarized by within-subject standard deviation (Sw), and compared among tests. Correlates of variance were explored. All 3 tests had reliability within bounds predicted by binomial model. Forty-item scores were more reliable (Sw=5%) than those based on 20-30 items (Sw=6-8%). No associations between participant characteristics and reliability were found. CW and DD-M were evaluated for evidence of agreement and decision consistency. Although participants were rank ordered similarly by right ear (ρ = 0.58), left ear (ρ = 0.51) and total (ρ = 0.73) scores, the tests did not agree on ranking by inter-aural asymmetry (ρ =0.18). CW and DD-M did not agree on direction of ear advantage (κ = 0.01, p = 0.93) and had poor agreement on which children displayed dichotic deficits (κ = 0.22, p < 0.01). DD identified significantly more participants with deficits (n=18) than CW (n=3) (p < 0.001). Although dichotic procedures show moderate reliability, their precision is limited. Assessment of their accuracy is limited by the absence of a widely-accepted gold standard reference test, but two commonly used tests failed to agree on which children had deficits. The data do not yet support routine clinical use of dichotic tests of binaural integration with children. Additional research is needed to determine if there are any conditions under which dichotic procedures demonstrate usefulness or value.

Introdução: A literatura revela que há uma possível relação entre processamento auditivo e as disfonias no que se refere principalmente a parâmetros acústicos da voz (frequência, intensidade e duração). Desta forma, um paciente que apresenta dificuldades auditivas para analisar e discriminar um desses parâmetros, provavelmente também apresente dificuldade para reproduzi-los vocalmente, o que justificaria a não evolução do processo terapêutico. Na clínica vocal, a avaliação da reprodução tonal vocal poderia auxiliar a identificação de dificuldades do paciente disfônico que pudessem estar relacionadas com alterações do processamento auditivo, contribuindo com o diagnóstico fonoaudiológico diferencial. Objetivo: Comparar o desempenho de mulheres disfônicas e sem alterações vocais em testes de processamento auditivo e teste de reprodução tonal vocal e correlacionar os testes de processamento auditivo utilizados com o teste de reprodução tonal vocal. Metodologia: Participaram do estudo 40 mulheres, na faixa etária de 18 a 44 anos, sendo subdivididas em dois grupos: Grupo Disfônico (20 Disfônicas) e Grupo Não Disfônico (20 Não Disfônicas). Após a assinatura do Termo de Consentimento Livre e Esclarecido, as participantes do estudo passaram por entrevista, avaliação audiológica, otorrinolaringológica, vocal (registro da voz; avaliação da reprodução tonal vocal por meio da fonetografia) e avaliação do processamento auditivo - por meio dos testes de Padrão de Frequência (TPF) e Padrão de Duração (TPD) sonora, teste de Fala Comprimida-monossílabos e dissílabos (TFC-mono/TFC-di) e teste Dicótico Não Verbal (TDNV). A análise estatística foi realizada por meio dos seguintes testes: Mann-Whitney, Teste exato de Fisher e Correlação de Spearman. Resultados: Houve diferença estatisticamente significante na comparação do desempenho de disfônicas e não disfônicas nos testes TPF e TFC-monossílabos e no teste de reprodução tonal vocal, no qual as não disfônicas obtiveram melhor desempenho. Houve correlação positiva entre o TPF, TPD, TFC (monossílabos e dissílabos) com o teste de reprodução tonal vocal. Conclusões: Mulheres disfônicas apresentam alterações em algumas habilidades do processamento auditivo, como: discriminação de padrões de som relacionados à frequência sonora e habilidade de fechamento auditivo, revelando relação importante entre produção vocal e comprometimento de funções auditivas centrais. Essas alterações revelam a necessidade de um diagnóstico mais abrangente frente às disfonias, considerando-se o processamento auditivo. Mulheres disfônicas apresentaram desempenho inferior às mulheres não disfônicas na primeira tentativa e no total de tentativas do Teste de Reprodução Tonal Vocal. Desta forma, o fonoaudiólogo deve considerar na terapia vocal a importância da apresentação/repetição de pistas auditivas para facilitar a execução de alguns exercícios vocais, e favorecer um bom desempenho e o avanço na terapia de mulheres disfônicas. Quanto melhor o desempenho nos testes de processamento auditivo, melhor o desempenho de reprodução tonal vocal de disfônicas e não disfônicas. O teste de reprodução tonal vocal pode auxiliar fonoaudiólogos e preparadores vocais na verificação de possíveis dificuldades de percepção auditiva em mulheres disfônicas. / Introduction: The literature reveals a possible relationship between auditory processing and dysphonia particularly with regard to acoustic voice parameters (frequency, intensity and duration). Therefore, a patient who has hearing difficulties to analyze and discriminate one of these parameters, probably also present difficulty to reproduce them vocally, which could explain the lack of progress of the therapeutic process. In vocal practice, the evaluation of vocal tonal reproduction could help to identify dysphonic patient difficulties that could be related to auditory processing disorders, contributing to the speech differential diagnosis. Aim: To compare the performance of dysphonic women without vocal alterations in auditory processing tests and vocal tonal reproduction test and correlate the auditory processing tests used with the vocal tonal reproduction test. Methodology: The study included 40 women, aged 18-44 years, divided into two groups: Group Dysphonic (20 dysphonic) and Group not Dysphonic (20 not dysphonic). After signing the Free Informed Consent Form, the study participants underwent an interview, audiological evaluation, otorhinolaryngological, Vocal (voice record, assessment of vocal tonal reproduction through phonetography) and auditory processing evaluation - through sonorous test of Pitch Pattern Sequence (PPS) and Duration Pattern Sequence (DPS), Time-Compressed Speech test- monosyllabic and disyllabic lists (TCS- mono/TCS-di) and Non-Verbal Dichotic Test (NVDT). Statistical analysis was performed using the following tests: Mann-Whitney test, Fisher exact test and Spearman correlation. Results: There were significant differences in the comparison of performance of dysphonic and not dysphonic in PPS test and TCS-monosyllables test and vocal tonal reproduction test, in which the non-dysphonic performed better. There was a positive correlation between the PPS, DPS, TCS (monosyllabic and disyllabic) with the vocal tonal reproduction test. Conclusions: Women dysphonic present alterations in some auditory processing abilities, such as: discrimination of sound patterns related to sound frequency and auditory closure skill, revealing important relationship between vocal production and commitment of central auditory function. These alterations reveal the need for a more comprehensive diagnostic front to dysphonia, considering the auditory processing. Dysphonic women presented lower performance than non-dysphonic women on the first try and the total attempts reproduction Tonal Vocal Test. Thus, the speech pathologist should consider in voice therapy the importance of presentation/repeat auditory cues to facilitate the implementation of some vocal exercises, and encourage good performance and progress in the dysphonic women therapy. The better the performance in auditory processing tests, better the performance of vocal tonal reproduction of dysphonic and not dysphonic. The vocal tonal reproduction test can aid speech and vocal trainers to check possible difficulties in auditory perception in dysphonic women.

INTRODUÇÃO: Baseado na hipótese de que os transtornos de leitura possam ser causados por uma alteração no processamento temporal auditivo (PTA), programas de treinamento auditivo computadorizados são utilizados como método de reabilitação em crianças com dislexia. Apesar disso, há controvérsias sobre a influência deste tipo de tratamento nas habilidades de leitura. OBJETIVOS: Desenvolver um programa de treinamento auditivo computadorizado, aplicar e analisar a sua eficácia em crianças com dislexia, por meio da comparação dos desempenhos obtidos em testes de leitura, consciência fonológica e PTA, aplicados antes e após a utilização do programa. MÉTODO: o software desenvolvido apresentou dois jogos contendo estímulos não-verbais e verbais (fala expandida). O treinamento foi conduzido na casa de cada participante durante dois meses, sendo cinco vezes por semana. A eficácia foi analisada por meio de dois estudos. No primeiro, os desempenhos do grupo experimental (treinado) em testes de leitura, consciência fonológica e PTA, aplicados pré e pós-treinamento, foram comparados com o desempenho do grupo controle (não treinado), nos mesmos testes, aplicados no mesmo período. Ambos os grupos foram formados por crianças com dislexia e idades entre 7 e 14 anos, sendo 12 do grupo experimental e 28 do grupo controle. No estudo 2, o desempenho do grupo experimental (18 crianças com dislexia) nos mesmos testes citados no estudo 1, foram comparados em três momentos: dois meses antes do início do treinamento, no início e no final do treinamento. RESULTADOS: No estudo 1, houve melhora significante do grupo experimental, se comparado ao controle, em relação ao desempenho em uma das habilidades de consciência fonológica (Tarefas Silábicas; p=0,044) e em uma das habilidades de PTA (Padrão de Freqüência; 7 a 10 anos de idade p<0,001, 11 a 14 anos de idade p=0,018). No estudo 2, houve melhora significante do grupo experimental, se comparado ao controle, em relação ao desempenho em uma das habilidades de leitura (Leitura de Texto; p<0,001), em uma das habilidades de consciência fonológica (Tarefas Fonêmicas; p<0,001), e em ambas habilidades de PTA (Padrão de Freqüência p<0,001 e Duração p=0,010). CONCLUSÃO: o software mostrou-se eficaz para o treinamento temporal auditivo do grupo, o qual pôde ser comprovado por meio da melhora pós-treinamento, em relação a esta habilidade, na maioria das situações analisadas. Os desempenhos encontrados pós-treinamento, em relação às provas de leitura e consciência fonológica, questionam a hipótese que relaciona o PTA e a leitura, já que a melhora esteve presente apenas para algumas habilidades de leitura e consciência fonológica. / INTRODUCTION: Based on the hypothesis that reading disorders can be caused by an alteration of the temporal auditory processing (TAP), computadorized auditory training programs are used as a rehabilitation method in children with dyslexia. However, there are some controversies about the influence of this kind of treatment in reading abilities. AIM: to develop and administer a computadorized auditory training program as also as analyze its efficacy in children with dyslexia; through a comparison of the performances obtained in reading, in phonological awareness and in TAP tests conducted before and after the use of the program. METHODS: the software developed presented two games with non-verbal and verbal (expanded speech) stimuli. Training was conducted in each participants home during two months, five times a week. Efficacy was analyzed through two studies. In the first one the performance of the experimental group (trained) in reading, phonological awareness and TAP tests, pre and post-training, was compared with the performance of the control group (non trained) for the same tests conducted in the same period. Both groups were constituted by children with dyslexia with age range between 7 and 14 years old, being 12 of the experimental group and 28 of the control group. In study 2, the performance of the experimental group (18 children with dyslexia) in the same tests conducted in study 1 was compared in three circumstances: Two months before the beginning of treatment, at the beginning of treatment and at the end of treatment. RESULTS: In study 1 there was significant improvement of the experimental group compared to the control group in relation to the performance of one phonological awareness ability (Syllabic Tasks; p=0.044) and in one TAP ability (Frequency pattern; 7 to 10 years old: p<0.001; 11 to 14 years old: p=0.018). In study 2 there was significant improvement of the experimental group, if compared to the control group, in one reading ability (Text Reading; p<0.001), one phonological awareness ability (Phonemic Tasks; p<0.001) and in both TAP abilities (Frequency pattern; p<0.001 and Duration; p=0.010). CONCLUSION: the software showed its efficacy for the auditory temporal training of the group, which was proved by the post-training improvement in this ability for the majority of the situations analyzed. Post-training performances regarding reading and phonological awareness tests put in question the hypothesis that relates TAP and reading, as far as improvement was only showed for some reading and phonological awareness abilities.

Objetivos: Estabelecer um banco de amostras de fala constituído por gravações representativas do uso de articulação compensatória do tipo (FF), da presença de hipernasalidade e da ausência de hipernasalidade; identificar valores de nasalância (média e desvio padrão) em amostras de fala estudadas; e comparar os valores de nasalância nas diferentes amostras de fala. Método: Um total de 1680 amostras de fala foram fornecidas por 19 indivíduos com fissura labiopalatina (FLP) operada, com ou sem disfunção velofaringea (DVF) e por cinco indivíduos sem DVF e sem histórico de FLP. Os participantes repetiram um conjunto de 14 frases (13 constituídas de sons de alta pressão e uma constituída de um som de baixa pressão), enquanto os sinais de áudio e nasalância foram capturados simultaneamente. Os sinais de áudio foram editados e foram julgados por três juízas experientes por consenso. Após julgamento as amostras foram reagrupadas em quatro grupos distintos: G1 incluiu 255 amostras de fala julgadas como representativas de hipernasalidade (hiper); G2 incluiu 130 amostras de fala julgadas como representativas do uso de FF e hipernasalidade; G3 incluiu 280 amostras de fala julgadas como representativas de fala típica (sem FF e sem hiper) em falantes com histórico de FLP; G4 incluiu 175 amostras de fala julgadas como representativas de fala típicas (sem FF e sem hiper) em falantes sem histórico de FLP. Resultados: Os julgamentos aferidos por consenso pelas três juízas permitiram a identificação de amostras representativas do uso de FF e da presença e ausência de hipernasalidade. As amostras julgadas e redistribuídas nos quatro grupos de interesse permitiram o cálculo dos valores de nasalância para cada grupo e foi realizado estatística inferencial utilizando o teste Kruskal-Wallis para testar a hipótese de que a presença de FF, associada ou não à hipernasalidade, nas amostras de fala de interesse, altera os resultados de nasalância. Quando houve diferença estatisticamente significante foi aplicado o teste Dunn\'s para comparar os grupos aos pares. Após a análise estatística inferencial realizada observa-se que houve diferença estatisticamente significativa entre os grupos com alteração de fala (G1 e G2) e aqueles sem alteração (G3 e G4). A diferença entre o grupo com hipernasalidade (G1) e o grupo com FF (G2) não foi significante Conclusão: O uso de FF não influenciou significativamente os valores de nasalância para a amostra estudada, refutando a hipótese estipulada. / Objective: This study had the objectives of establishing a data bank of speech recordings representative of use of pharyngeal fricative compensatory articulation (PF); presence and absence of hypernasality; identifying nasalance values (mean and standard deviation for the samples studied; and comparing nasalance finding among the different speech samples established. Method: A total of 1680 speech samples were recorded from 19 individuals with cleft lip and palate (CLP), 11 with velopharyngeal dysfunction (VPD) and 8 without VPD, and from 5 individuals without history of CLP. The participants repeated a series of 14 phrases (13 with high pressure consonants and 1 with a low pressure consonant), while audio and nasometric data was simultaneously recorded. The audio signals captures were edited and rated by 3 experienced judges with 100% agreement. After the ratings the samples were distributed into 4 groups (G): G1 included 255 samples rated as representative of presence of hypernasality; G2 included 130 samples rated as representative of use of PF and hypernasality; G3 included 280 samples rated as representative of normal speech (without PF and without hypernasality) for speakers with history of cleft palate; G4 included 175 samples rated as representative of normal speech (without PF and without hypernasality) for speakers without history of cleft palate. Results: The ratings established with agreement by the 3 judges during auditory-perceptual analysis of the recordings responded to objectives this study which proposed to establish samples representative of use of PF and of presence and absence of hypernasality. The samples rated by the judges were distributed into the four groups of interest for calculation of the nasalance scores, The Kruskal-Wallis statistical test was used to test the hypothesis that presence of PF, with or without hypernasality significantly would affect nasalance scores. When significant difference was found Dunns test was used to compared data in group pairs. After inferential statistics we observed that a significant difference was found between nasalance scores for groups G1 and G2 (samples representative of speech errors) with groups G3 and G4 (samples representative of normal speech). The difference between the group with hypernasality (G1) and the group with PF (G2) was not significant. Conclusion: The use of PF did not significantly influence nasalance values for the studied sample, refuting the proposed hypothesis.

Introdução: A literatura revela que há uma possível relação entre processamento auditivo e as disfonias no que se refere principalmente a parâmetros acústicos da voz (frequência, intensidade e duração). Desta forma, um paciente que apresenta dificuldades auditivas para analisar e discriminar um desses parâmetros, provavelmente também apresente dificuldade para reproduzi-los vocalmente, o que justificaria a não evolução do processo terapêutico. Na clínica vocal, a avaliação da reprodução tonal vocal poderia auxiliar a identificação de dificuldades do paciente disfônico que pudessem estar relacionadas com alterações do processamento auditivo, contribuindo com o diagnóstico fonoaudiológico diferencial. Objetivo: Comparar o desempenho de mulheres disfônicas e sem alterações vocais em testes de processamento auditivo e teste de reprodução tonal vocal e correlacionar os testes de processamento auditivo utilizados com o teste de reprodução tonal vocal. Metodologia: Participaram do estudo 40 mulheres, na faixa etária de 18 a 44 anos, sendo subdivididas em dois grupos: Grupo Disfônico (20 Disfônicas) e Grupo Não Disfônico (20 Não Disfônicas). Após a assinatura do Termo de Consentimento Livre e Esclarecido, as participantes do estudo passaram por entrevista, avaliação audiológica, otorrinolaringológica, vocal (registro da voz; avaliação da reprodução tonal vocal por meio da fonetografia) e avaliação do processamento auditivo - por meio dos testes de Padrão de Frequência (TPF) e Padrão de Duração (TPD) sonora, teste de Fala Comprimida-monossílabos e dissílabos (TFC-mono/TFC-di) e teste Dicótico Não Verbal (TDNV). A análise estatística foi realizada por meio dos seguintes testes: Mann-Whitney, Teste exato de Fisher e Correlação de Spearman. Resultados: Houve diferença estatisticamente significante na comparação do desempenho de disfônicas e não disfônicas nos testes TPF e TFC-monossílabos e no teste de reprodução tonal vocal, no qual as não disfônicas obtiveram melhor desempenho. Houve correlação positiva entre o TPF, TPD, TFC (monossílabos e dissílabos) com o teste de reprodução tonal vocal. Conclusões: Mulheres disfônicas apresentam alterações em algumas habilidades do processamento auditivo, como: discriminação de padrões de som relacionados à frequência sonora e habilidade de fechamento auditivo, revelando relação importante entre produção vocal e comprometimento de funções auditivas centrais. Essas alterações revelam a necessidade de um diagnóstico mais abrangente frente às disfonias, considerando-se o processamento auditivo. Mulheres disfônicas apresentaram desempenho inferior às mulheres não disfônicas na primeira tentativa e no total de tentativas do Teste de Reprodução Tonal Vocal. Desta forma, o fonoaudiólogo deve considerar na terapia vocal a importância da apresentação/repetição de pistas auditivas para facilitar a execução de alguns exercícios vocais, e favorecer um bom desempenho e o avanço na terapia de mulheres disfônicas. Quanto melhor o desempenho nos testes de processamento auditivo, melhor o desempenho de reprodução tonal vocal de disfônicas e não disfônicas. O teste de reprodução tonal vocal pode auxiliar fonoaudiólogos e preparadores vocais na verificação de possíveis dificuldades de percepção auditiva em mulheres disfônicas. / Introduction: The literature reveals a possible relationship between auditory processing and dysphonia particularly with regard to acoustic voice parameters (frequency, intensity and duration). Therefore, a patient who has hearing difficulties to analyze and discriminate one of these parameters, probably also present difficulty to reproduce them vocally, which could explain the lack of progress of the therapeutic process. In vocal practice, the evaluation of vocal tonal reproduction could help to identify dysphonic patient difficulties that could be related to auditory processing disorders, contributing to the speech differential diagnosis. Aim: To compare the performance of dysphonic women without vocal alterations in auditory processing tests and vocal tonal reproduction test and correlate the auditory processing tests used with the vocal tonal reproduction test. Methodology: The study included 40 women, aged 18-44 years, divided into two groups: Group Dysphonic (20 dysphonic) and Group not Dysphonic (20 not dysphonic). After signing the Free Informed Consent Form, the study participants underwent an interview, audiological evaluation, otorhinolaryngological, Vocal (voice record, assessment of vocal tonal reproduction through phonetography) and auditory processing evaluation - through sonorous test of Pitch Pattern Sequence (PPS) and Duration Pattern Sequence (DPS), Time-Compressed Speech test- monosyllabic and disyllabic lists (TCS- mono/TCS-di) and Non-Verbal Dichotic Test (NVDT). Statistical analysis was performed using the following tests: Mann-Whitney test, Fisher exact test and Spearman correlation. Results: There were significant differences in the comparison of performance of dysphonic and not dysphonic in PPS test and TCS-monosyllables test and vocal tonal reproduction test, in which the non-dysphonic performed better. There was a positive correlation between the PPS, DPS, TCS (monosyllabic and disyllabic) with the vocal tonal reproduction test. Conclusions: Women dysphonic present alterations in some auditory processing abilities, such as: discrimination of sound patterns related to sound frequency and auditory closure skill, revealing important relationship between vocal production and commitment of central auditory function. These alterations reveal the need for a more comprehensive diagnostic front to dysphonia, considering the auditory processing. Dysphonic women presented lower performance than non-dysphonic women on the first try and the total attempts reproduction Tonal Vocal Test. Thus, the speech pathologist should consider in voice therapy the importance of presentation/repeat auditory cues to facilitate the implementation of some vocal exercises, and encourage good performance and progress in the dysphonic women therapy. The better the performance in auditory processing tests, better the performance of vocal tonal reproduction of dysphonic and not dysphonic. The vocal tonal reproduction test can aid speech and vocal trainers to check possible difficulties in auditory perception in dysphonic women.

With reductions in the age criterion for cochlear implantation, the need for age-appropriate measures of speech perception skills has increased. One recently developed tool that shows great promise for the clinical assessment of auditory speech perception capacity in young children with cochlear implants is the On-Line Imitative Test of Speech-Pattern Contrast Perception (OlimSpac). The OlimSpac requires a child to imitate nonword utterances by providing a verbal response. The child's perceptual abilities are inferred from the child's productions through having a listener, who is masked to the stimulus select the utterance produced by the child in an eight-alternative force-choice task. Although the OlimSpac has the potential for use in children with cochlear implants, the specific role of measured speech production abilities on performance has yet to be systematically examined. Thus, the main objective of the present study was to examine the influence of speech production abilities on OlimSpac performance in an auditory-visual (A-V) and auditory-only (A-O) condition in young children with cochlear implants relative to an articulation-matched sample of normal hearing peers. A secondary objective was to determine whether the presentation modality affected a child's OlimSpac performance. A matched pair design was used to compare the OlimSpac performance of ten children with cochlear implants (ages 29 to 76 months) to normal hearing peers (ages 27 to 73 months). Each child with cochlear implants was matched to a child with normal hearing from a sampled population of 22 normal hearing participants based on word-level articulation skills, as measured by the GFTA-2, accounting for hearing age and gender. The OlimSpac software generated a score for a single contrast and a single presentation modality (A-V or A-O). The score was based on eight binary trials. Due to the small trial size, individual contrast scores were interpreted as pass/fail, given that only a score of seven or eight is significantly better than chance. Therefore, OlimSpac performance was determined by a composite score reflecting the average across all six contrasts, based on 48 binary trials. Average composite scores for both the A-V and A-O conditions were lower, albeit not significant, for young children with cochlear implants compared to their articulation-matched controls. Examination of individual phonemic contrast scores revealed that the articulation-matched sample of normal hearing participants most often failed the post-alveolar consonant place contrast, whereas children with cochlear implants most often failed the consonant voicing contrast. There were also no significant within group difference in speech perception performance between the A-V and A-O conditions of the OlimSpac. The results of this study demonstrated that children with cochlear implants achieved similar speech perception performance to their articulation-matched normal hearing peers. Although children's speech production abilities partially influenced their OlimSpac performance, knowledge of word-level articulation skills allows clinicians to make appropriate judgments when interpreting composite scores, thus validating the OlimSpac as an indirect measure of a child's speech perception capacity and a direct measure of speech perception skills. Objective scores obtained from a child's OlimSpac performance may be used to assess outcomes of cochlear implant use, guide cochlear implant mapping, and plan habilitative intervention. A greater understanding of the potential effect of speech production performance on estimates of speech perception ability may also assist in highlighting other developmental, linguistic and/or cognitive delays masked by a child's hearing loss.

Excessive nasal resonance in speech (hypernasality) is a disorder which may have negative communicative and social consequences for the speaker. Excessive nasal resonance is often associated with cleft lip and palate, velopharyngeal impairment, dysarthria or hearing impairment. Evaluation of hypernasality has proved to be a challenge in the clinic and in research. There are questions regarding the accuracy and reliability of auditory perceptual evaluations of nasal speech, and whether instrumental measures can be used to improve the reliability of clinical evaluation. There is also the question of whether clinical evaluation reflects the impact of hypernasality in a speaker’s everyday life. The purpose of this thesis was to evaluate the extent of reliability problems connected with auditory perceptual assessment of nasality in speech, to explore whether they might interfere with treatment decisions or have an impact in the everyday life of patients, and whether they can be effectively diminished by the use of nasometry. Speakers with cleft lip and palate or velopharyngeal impairment formed the basis of the clinical population used in this study. Speech samples from 52 of these speakers, along with samples from a reference population of 21 speakers who did not have cleft palate, velopharyngeal impairment or speech disorders were used in perceptual evaluation tasks. Fourteen speakers from the clinical population and 11 from the reference population also underwent nasometric evaluation. A further reference population of 220 children from three Swedish cities, whose ages were consistent with those used for clinical checks of children born with cleft palate were assessed with nasometry to establish normative data for the Nasometer™. Perceptual speech assessments were conducted on hyper- and hyponasality, as well as audible nasal air emission and/or nasal turbulence, using 5-point ordinal scales. Listeners were SLPs experienced in the evaluation of cleft palate speech, non-expert SLPs and untrained listeners. Listening assessments were performed from audio recorded speech samples assembled in random order. Nasometry measures were made on three speech passages each with specific phonetic content, using the Nasometer™, model II. Perceptual evaluation Results showed that for hypernasality assessment, 15% of hypernasality assessments had disagreements between expert SLPs that were potentially important for clinical decisions, as did 6% of assessments for audible nasal air emission and/or nasal turbulence. For nasality problems, a comparison of expert and untrained listeners showed that they generally agreed on which speakers were hypernasal and on the ranking of nasal speakers. All speakers that had been rated with moderate to severe hypernasality by expert listeners were considered by the untrained listeners as having a serious enough speech disorder to call for intervention. However, in the case of audible nasal air emission and/or nasal turbulence the expert listeners were more prone to notice this feature than the untrained listeners. Instrumental evaluation The development of normative values for the three Swedish passages for the NasometerTM (comparable to normative values in other languages) has provided a basis for use of instrumental measures in Swedish clinics, oral sentences mixed sentences nasal sentences. The measures showed no significant differences due to city, gender or age within an age range of 4-10 years. When nasometry measures were compared with perceptual evaluation of speech samples from the same speakers, all correlations were moderate to good for expert SLPs and non-expert SLPs. The difference between correlations was significantly higher for expert SLPs than for untrained listeners. Reliability figures for perceptual assessments for expert SLP listeners indicated that there were some cases where lack of reliability could affect clinical decision making. However, in the main, judgements of nasality problems made by clinicians had everyday validity. They reflected the impressions of the everyday listener, especially in regard to the need for intervention. The study also indicates that now that Swedish norms are available, the Nasometer™ might be useful as a complement to auditory perceptual clinical speech assessments in Swedish cleft palate clinics in order to improve reliability of clinical assessment.

INTRODUÇÃO: Baseado na hipótese de que os transtornos de leitura possam ser causados por uma alteração no processamento temporal auditivo (PTA), programas de treinamento auditivo computadorizados são utilizados como método de reabilitação em crianças com dislexia. Apesar disso, há controvérsias sobre a influência deste tipo de tratamento nas habilidades de leitura. OBJETIVOS: Desenvolver um programa de treinamento auditivo computadorizado, aplicar e analisar a sua eficácia em crianças com dislexia, por meio da comparação dos desempenhos obtidos em testes de leitura, consciência fonológica e PTA, aplicados antes e após a utilização do programa. MÉTODO: o software desenvolvido apresentou dois jogos contendo estímulos não-verbais e verbais (fala expandida). O treinamento foi conduzido na casa de cada participante durante dois meses, sendo cinco vezes por semana. A eficácia foi analisada por meio de dois estudos. No primeiro, os desempenhos do grupo experimental (treinado) em testes de leitura, consciência fonológica e PTA, aplicados pré e pós-treinamento, foram comparados com o desempenho do grupo controle (não treinado), nos mesmos testes, aplicados no mesmo período. Ambos os grupos foram formados por crianças com dislexia e idades entre 7 e 14 anos, sendo 12 do grupo experimental e 28 do grupo controle. No estudo 2, o desempenho do grupo experimental (18 crianças com dislexia) nos mesmos testes citados no estudo 1, foram comparados em três momentos: dois meses antes do início do treinamento, no início e no final do treinamento. RESULTADOS: No estudo 1, houve melhora significante do grupo experimental, se comparado ao controle, em relação ao desempenho em uma das habilidades de consciência fonológica (Tarefas Silábicas; p=0,044) e em uma das habilidades de PTA (Padrão de Freqüência; 7 a 10 anos de idade p<0,001, 11 a 14 anos de idade p=0,018). No estudo 2, houve melhora significante do grupo experimental, se comparado ao controle, em relação ao desempenho em uma das habilidades de leitura (Leitura de Texto; p<0,001), em uma das habilidades de consciência fonológica (Tarefas Fonêmicas; p<0,001), e em ambas habilidades de PTA (Padrão de Freqüência p<0,001 e Duração p=0,010). CONCLUSÃO: o software mostrou-se eficaz para o treinamento temporal auditivo do grupo, o qual pôde ser comprovado por meio da melhora pós-treinamento, em relação a esta habilidade, na maioria das situações analisadas. Os desempenhos encontrados pós-treinamento, em relação às provas de leitura e consciência fonológica, questionam a hipótese que relaciona o PTA e a leitura, já que a melhora esteve presente apenas para algumas habilidades de leitura e consciência fonológica. / INTRODUCTION: Based on the hypothesis that reading disorders can be caused by an alteration of the temporal auditory processing (TAP), computadorized auditory training programs are used as a rehabilitation method in children with dyslexia. However, there are some controversies about the influence of this kind of treatment in reading abilities. AIM: to develop and administer a computadorized auditory training program as also as analyze its efficacy in children with dyslexia; through a comparison of the performances obtained in reading, in phonological awareness and in TAP tests conducted before and after the use of the program. METHODS: the software developed presented two games with non-verbal and verbal (expanded speech) stimuli. Training was conducted in each participants home during two months, five times a week. Efficacy was analyzed through two studies. In the first one the performance of the experimental group (trained) in reading, phonological awareness and TAP tests, pre and post-training, was compared with the performance of the control group (non trained) for the same tests conducted in the same period. Both groups were constituted by children with dyslexia with age range between 7 and 14 years old, being 12 of the experimental group and 28 of the control group. In study 2, the performance of the experimental group (18 children with dyslexia) in the same tests conducted in study 1 was compared in three circumstances: Two months before the beginning of treatment, at the beginning of treatment and at the end of treatment. RESULTS: In study 1 there was significant improvement of the experimental group compared to the control group in relation to the performance of one phonological awareness ability (Syllabic Tasks; p=0.044) and in one TAP ability (Frequency pattern; 7 to 10 years old: p<0.001; 11 to 14 years old: p=0.018). In study 2 there was significant improvement of the experimental group, if compared to the control group, in one reading ability (Text Reading; p<0.001), one phonological awareness ability (Phonemic Tasks; p<0.001) and in both TAP abilities (Frequency pattern; p<0.001 and Duration; p=0.010). CONCLUSION: the software showed its efficacy for the auditory temporal training of the group, which was proved by the post-training improvement in this ability for the majority of the situations analyzed. Post-training performances regarding reading and phonological awareness tests put in question the hypothesis that relates TAP and reading, as far as improvement was only showed for some reading and phonological awareness abilities.

Objetivos: Estabelecer um banco de amostras de fala constituído por gravações representativas do uso de articulação compensatória do tipo (FF), da presença de hipernasalidade e da ausência de hipernasalidade; identificar valores de nasalância (média e desvio padrão) em amostras de fala estudadas; e comparar os valores de nasalância nas diferentes amostras de fala. Método: Um total de 1680 amostras de fala foram fornecidas por 19 indivíduos com fissura labiopalatina (FLP) operada, com ou sem disfunção velofaringea (DVF) e por cinco indivíduos sem DVF e sem histórico de FLP. Os participantes repetiram um conjunto de 14 frases (13 constituídas de sons de alta pressão e uma constituída de um som de baixa pressão), enquanto os sinais de áudio e nasalância foram capturados simultaneamente. Os sinais de áudio foram editados e foram julgados por três juízas experientes por consenso. Após julgamento as amostras foram reagrupadas em quatro grupos distintos: G1 incluiu 255 amostras de fala julgadas como representativas de hipernasalidade (hiper); G2 incluiu 130 amostras de fala julgadas como representativas do uso de FF e hipernasalidade; G3 incluiu 280 amostras de fala julgadas como representativas de fala típica (sem FF e sem hiper) em falantes com histórico de FLP; G4 incluiu 175 amostras de fala julgadas como representativas de fala típicas (sem FF e sem hiper) em falantes sem histórico de FLP. Resultados: Os julgamentos aferidos por consenso pelas três juízas permitiram a identificação de amostras representativas do uso de FF e da presença e ausência de hipernasalidade. As amostras julgadas e redistribuídas nos quatro grupos de interesse permitiram o cálculo dos valores de nasalância para cada grupo e foi realizado estatística inferencial utilizando o teste Kruskal-Wallis para testar a hipótese de que a presença de FF, associada ou não à hipernasalidade, nas amostras de fala de interesse, altera os resultados de nasalância. Quando houve diferença estatisticamente significante foi aplicado o teste Dunn\'s para comparar os grupos aos pares. Após a análise estatística inferencial realizada observa-se que houve diferença estatisticamente significativa entre os grupos com alteração de fala (G1 e G2) e aqueles sem alteração (G3 e G4). A diferença entre o grupo com hipernasalidade (G1) e o grupo com FF (G2) não foi significante Conclusão: O uso de FF não influenciou significativamente os valores de nasalância para a amostra estudada, refutando a hipótese estipulada. / Objective: This study had the objectives of establishing a data bank of speech recordings representative of use of pharyngeal fricative compensatory articulation (PF); presence and absence of hypernasality; identifying nasalance values (mean and standard deviation for the samples studied; and comparing nasalance finding among the different speech samples established. Method: A total of 1680 speech samples were recorded from 19 individuals with cleft lip and palate (CLP), 11 with velopharyngeal dysfunction (VPD) and 8 without VPD, and from 5 individuals without history of CLP. The participants repeated a series of 14 phrases (13 with high pressure consonants and 1 with a low pressure consonant), while audio and nasometric data was simultaneously recorded. The audio signals captures were edited and rated by 3 experienced judges with 100% agreement. After the ratings the samples were distributed into 4 groups (G): G1 included 255 samples rated as representative of presence of hypernasality; G2 included 130 samples rated as representative of use of PF and hypernasality; G3 included 280 samples rated as representative of normal speech (without PF and without hypernasality) for speakers with history of cleft palate; G4 included 175 samples rated as representative of normal speech (without PF and without hypernasality) for speakers without history of cleft palate. Results: The ratings established with agreement by the 3 judges during auditory-perceptual analysis of the recordings responded to objectives this study which proposed to establish samples representative of use of PF and of presence and absence of hypernasality. The samples rated by the judges were distributed into the four groups of interest for calculation of the nasalance scores, The Kruskal-Wallis statistical test was used to test the hypothesis that presence of PF, with or without hypernasality significantly would affect nasalance scores. When significant difference was found Dunns test was used to compared data in group pairs. After inferential statistics we observed that a significant difference was found between nasalance scores for groups G1 and G2 (samples representative of speech errors) with groups G3 and G4 (samples representative of normal speech). The difference between the group with hypernasality (G1) and the group with PF (G2) was not significant. Conclusion: The use of PF did not significantly influence nasalance values for the studied sample, refuting the proposed hypothesis.