Speech and language

What affects the maximum phonation time in patients with tracheoesophageal and esophageal speech?

D. Dragičević, V. Kljajić, S. Savović, M. Veselinović                                                                                   doi: 10.48095/ccorl2025S1_87

Clinic for ORL and Head and Neck Surgery, Clinical Centre of Vojvodina, Novi Sad, University of Novi Sad, Faculty of medicine, Novi Sad, Serbia

Introduction: There are three types of alaryngeal speech: tracheoesophageal speech (TES) with voice prosthesis, esophageal speech (ES) and speech with electrolarynx. Aims: To analyze the influence of different factors on the maximum phonation time (MPT) in patients with TES and ES following total laryngectomy (TL). Materials and Methods: Study included 41 patients with TES after secondary Provox® voice prosthesis insertion and 43 patients with successfully achieved ES following TL performed on Clinic for ENT and head and neck surgery, University Clinical centre of Vojvodina, Novi Sad, Serbia. MPT after six months of rehabilitation was measured in both groups and compared. The influence of different factors (age, gender, community life, level of education, hearing status, level of depression, anxiety and cognitive functions, type of surgery, intraoperative tumor and nodal status, complications following total laryngectomy, postoperative radiotherapy, urgent tracheostomy performed before total laryngectomy, number of comorbidities, cigarette smoking and alcohol consumption), on the value of MPT in both groups of patients was analyzed. Results: The mean MPT in patients with TES was statistically significantly higher than in patients with ES (8.782 s vs. 1.875 s). Mean MPT in patients with voice prosthesis was statistically significantly higher in patients < 60 years of age, with < 2 comorbidities, without complications following TL, with normal hearing or with mild and moderate hearing loss and with higher cognitive functions. Mean MPT in patients with ES was statistically significantly higher in patients with < 2 comorbidities, lower nodal status intraoperatively and in patients that did not require urgent tracheostomy before TL. Conclusion: The mean MPT in patients with secondary inserted voice prosthesis is statistically significantly higher than in patients with ES. It is differently affected by the examined factors in both groups of patients, with number of comorbidities < 2 being the common positive influencing factor.

Speech rehabilitation in tracheotomized children

M. F. Budanko                                                                                                                                                      doi: 10.48095/ccorl2025S1_88

Department of Otolaryngology, Head and Neck Surgery, University Hospital Centre Zagreb, Velika Gorica, Croatia

Tracheotomy is a surgical procedure in which an opening is made in the anterior wall of the cervical trachea, kept open by inserting a tracheal cannula to allow the patient to breathe through a new airway entry into the lower respiratory tract. The most common indications for pediatric tracheotomy include upper airway obstruction, prolonged ventilation, aspiration, secretion management, lower airway collapse, neurological impairments, and congenital heart and lung diseases. Early tracheotomy reduces or disables vocalization, diminishes auditory and oral-motor feedback, reduces oral pressure, weakens and complicates swallowing and coughing, and limits early social verbal interactions. Also, tracheotomized children often have significantly poorer, if not entirely deprived, productive and receptive language and speech skills compared to their peers. A speaking valve is a one-way valve that allows inhalation through the tracheostomy while closing upon exhalation, directing airflow through the vocal, oral, and nasal tracts. The role of the speaking valve is to push air through the dead space above the trachea into the upper airway, enhance respiratory effort, and increase sensation during secretion clearance. The aim of this paper is to raise awareness of the necessity of timely and proper implementation of a speaking valve in tracheotomized children by presenting a protocol for the selection and application of the speaking valve, conducted by an otorhinolaryngologist and a speech therapist. The protocol implementation process begins in a clinical setting and continues at home, depending on the success of the child‘s adaptation to the new respiratory conditions.

Consequences of developmental language disorder in adulthood – a questionnaire study

S. Maléřová1, Z. Zemanová2, M. Hrbková2, O. Dlouhá2                                                                                                                      doi: 10.48095/ccorl2025S1_89

1 Department of Phoniatrics, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic

2 General University Hospital in Prague, Prague, Czech Republic

Introduction: Developmental language disorder (DLD) is one of the most prevalent developmental disorders. This diagnosis is characterized by persistently low language abilities with significant functional impact. Awareness of DLD is insufficient not only among the general public but also among healthcare professionals. The prevalence of DLD is estimated to be around 3.5–7.6%. Aims: This study aims to investigate the significant long-term consequences of DLD in adulthood. Materials and Methods: We selected a cohort of young adults born in 2003. These patients were monitored at the Department of Phoniatrics, 1st Faculty of Medicine, Charles University and General Faculty Hospital in Prague with a diagnosis of DLD, without other severe diseases or cognitive deficits. We contacted the patients to conduct an anonymized telephone questionnaire. The questionnaire focused on demographic data, comorbidities, educational history, challenges in learning foreign languages, workforce integration, persistent difficulties in reading and writing, duration of speech therapy interventions, independence, financial literacy, and social interactions, including relationship-building and experiences with bullying. Results: In the cohort of patients with DLD included in the study (N = 65), 75% were male and 25% female. The most common comorbidities were attention disorders (with or without hyperactivity) and depression. Regular follow-up with a clinical speech therapist lasted, on average, until the age of 12. A total of 30% of patients achieved a high school diploma. The most frequent challenges faced by patients with DLD included learning foreign languages, obtaining a driver‘s license, communication with strangers, and establishing new social relationships. Up to 80% of patients reported experiencing bullying in elementary school, either from peers or teachers. Conclusion: Our study demonstrates that DLD has long-term health implications that can persist into adulthood. The outcomes in various aspects of life are heterogeneous. However, like young children, adults with DLD continue to face numerous challenges.

Effective strategies for vocal endurance in professional singers

I. Mãndoiu1, I. I. Denizoglu2                                                                                                                                                                                             doi: 10.48095/ccorl2025S1_90

1 Voice Therapy, Audifon Medical Center, Bucuresti, Romania

2 Vocologi Merkezi, Izmir, Türkiye

In addition to artistic quality and talent, vocal stamina is important for the vocal professional. Whether we are talking about the voice during musical tours, workshops, theatre performances, media activities, voice over, vocal endurance is an important underlying factor in these activities. Hoarseness, vocal asthenia or hypertensions are some of the symptoms commonly experienced by professional singers. How quickly and efficiently you deal with these problems will help you to perform and avoid developing unhealthy vocal habits, techniques and compulsive vocal behaviours. How you prepare, maintain and rehabilitate your voice for such a profession depends on how you understand the needs of your vocal instrument. Breathing, vocal hygiene, vocal training and the basics of laryngeal function can help you increase your vocal endurance by using the right technique for the current state of your voice. Specific vocal exercises will be presented that focus on working specific muscles for vocal endurance. Vocal “accidents” are normal in the life of the vocal professional and it is also normal to know how and who to turn to in these situations. We will therefore combine the information provided by speech therapists with the musical and vocal concepts of singing teachers in order to implement various strategies that are the cornerstones of the vocal endurance of the professional singer. The plan of methods and techniques of vocal replenishment is in full development. It is important to know how to personalise your vocal technique, when to use it and what treatment to apply in order to have a resilient and quality voice. The optimal use of the voice motivates the voice professional in his work.

Acquired speech dyspraxia – coexisting and dominant motor speech disorder

K. Neubauer, S. Reichel, Z, Konůpková                                                                                                         doi: 10.48095/ccorl2025S1_91

Department of Phoniatrics, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic

Introduction: Acquired Apraxia of speech (AOS), etiologically related to lesions of the secondary motor cortex, the premotor association areas, is manifested by disorders of oral speech segmentation that culminate in spontaneous. The coexistence of AOS with another neurogenic communication disorder is a diagnostic problem and the dominance of AOS after the retreat of aphasia or dysarthria symptomatology is uncommon. The case studies of persons after stroke under the care of the Phoniatric Clinic of the 1st Medical Faculty and General University Hospital in Prague, bring this specific situation and its longitudinal evolution closer. Methodology and Material: A comparative qualitative procedure is used to compare the development of two persons over a span of two years, during 2023 and 2024. The first person – male (born 1957), status after stroke 09/2021 – after a significant decline in aphasia and dysphagia symptoms, AOS manifestations predominate. The second person – female (born 1955), status after repeated strokes 04/2018 and 04/2021 after a decline in aphasia and dysarthria symptoms, AOS manifestations predominate. Results: A qualitative analysis of the frequency of strategies used in the beginning of the verbal form of spontaneous speech points to the key role of focusing the therapy of people with AOS on the area of compensatory strategies and stimulation in this area. Compensatory and therapeutic strategies of tactile, visual and phonetic focus are used most often in combination. Conclusion: AOS requires the development of specific diagnostic and therapeutic approaches and in the Speech Dyspraxia Centre of the Phoniatric Clinic, we are now modifying the diagnostic focus, inspired by the concepts of the latest version of the ABA-2 test (Apraxia Battery for Adults, B Dabul 2000). The aim is to further refine the differential diagnosis and subsequent development of a targeted rehabilitation programme for people with AOS.

Linking the auditory and visual forms of the speech segment in the process of influencing articulation and speech intelligibility in children with specific language impairment

K. Neubauer, J. Mrkvičková, T. Hladilová                                                                                                     doi: 10.48095/ccorl2025S1_92

Department of Phoniatrics, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, Prague,

Czech Republic

Introduction: The intensive form of rehabilitation program in the day hospital of the Phoniatric Clinic of the 1st Medical Faculty of Charles University and the General University Hospital in Prague is aimed at comprehensive educational, diagnostic and therapeutic multidisciplinary care for these children. In our research study, the program was enriched with a targeted set of procedures aimed at developing the compensation of children’s labile and deficient phonological and articulatory abilities by visual means, with intensive involvement of the development of partial lexical elements and phoneme to grapheme conversion. Material and Methods: The presented study includes the processing of a cohort of 30 children (average age 6.5 years) and includes diagnostic and educational procedures focused on the presence of neurodevelopmental disorders, motor speech stimulation and perceptual phonological education and their evaluation. The investigation took place between 09/2024 and 12/2024 with the participation of a qualified early childhood teacher and a qualified clinical speech and language therapist. Results: The development of articulatory abilities of children with neurodevelopmental speech communication disorders is demonstrably influenced by the processes of linking the auditory and visual forms of the speech segment, the phonemegrapheme link. It is possible to support the extension of the program of these procedures to other phonemes that are important in the development of speech intelligibility in the Czech language. The parameter of good quality audiovisual recordings is essential for this extension and should be included in the follow-up part of the research investigation. Conclusion: The involvement of early developmental education in the basics of reading and writing with appropriate visual stimuli, compensates for the labile auditory phonological development of these children. Its integration with a program of articulation development and speech intelligibility is promising and requires further follow-up in research and clinical and educational practice.

Symptomatology of developmental speech dyspraxia in children with specific language impairment

K. Neubauer, J. Mercelová, L. Neubauerová                                                                                               doi: 10.48095/ccorl2025S1_93

Department of Phoniatrics, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic

Introduction: Developmental (childhood) speech apraxia (CAS) is a severe neurodevelopmental disorder that often complicates preschool and school education for children with developmental deficits. More severe manifestations of CAS, which often coexist with other neurodevelopmental deficits (e. g., SLI – Specific language impairment). The pre-school preparatory year programme, which is implemented by the primary and special school in Prague together with the Phoniatric Clinic of the 1st Medical Faculty of Charles University and the General University Hospital in Prague is designed for children with neurodevelopmental disorders. Material and Methods: The presented research study captures a set of 60 children who are in the program of a children‘s day hospital for children with neurodevelopmental communication disorders, who are in deferment of compulsory schooling, with an average age of 6.5 years, in the time period of 12 months of 2024. The Czech experimental version of the screening examination was used, based on the content and creation of diagnostic markers in the test “Dynamic evaluation of motor speech skill” (DEMSS) (Strand E McCauley R 2019), developed for the Czech language. Results: The results obtained show a representation of CAS symptomatology in the range corresponding to the English language studies (2–3%) and a more strongly represented group with suspicion of coexistence of SLI and CAS (10%), which points to the need to address the diagnostic differentiation at the level of severe phonological disorder – developmental speech dyspraxia. Conclusion: Differential diagnosis of CAS requires specific targeting, revealing diagnostic markers of this disorder, especially inconsistency of motor speech segments, lability of vowel sounds, and deviations in prosody and cadence of speech. The development of specific diagnostics in this area in the Czech language will be the next task of the continuous research focus of the future continual research study.

Selective mutism – the pilot study to map the correlation between the Selective mutism questionnaires DSM and the SMQ

B. Richtrová                                                                                                                                                          doi: 10.48095/ccorl2025S1_94

Clinical Speech Therapy and Counselling, Davle, Czech Republic

Introduction: Selective mutism (SM) is considered an uncommon psychiatric disorder characterized by an inability to communicate verbally in a variety of social situations, although it is possible in other settings. In the Czech environment, an assessment tool for evaluating the severity of SM has so far been lacking. The Selective mutism questionnaire (DSM) was developed as a standard for SM. Because of the need to validate this assessment tool, in a pilot study we compared the DSM with the internationally recognized and most widely used SMQ. Aims: The main aim of the pilot study was to map the correlation between the DSM and the SMQ and to describe the structure of SM severity in the research sample in order to have a validated assessment tool for SM severity in the Czech environment. Secondary objectives were to validate other research parameters. Materials and Methods: As part of the validation of the DSM, 48 probands with SM have been included in the study so far. As part of the pilot study, we completed the DSM and SMQ questionnaires with all probands and compared the scores obtained. The obtained data were analyzed using descriptive statistical methods. Results: There is a strong correlation between the questionnaires used (SMQ and DSM) and the structure of the SM severity score is normally distributed. Thus, it can be assumed that the DSM is a valid tool for diagnosing SM in this respect. Conclusion: The results support the use of DSM questionnaires to assess the severity of SM and to evaluate potential treatment effects in future studies. So far, the pilot study predicts that the DSM is a reliable and valid tool for screening and clinical evaluation of SM in Czech-speaking children.