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Reliability of Hypernasality Rating: Comparison of 3 Different Methods for Perceptual Assessment
Renata Paciello Yamashita1, Elisabet Borg2, Svante Granqvist3
1Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, São Paulo, Brazil.
Objective:
To compare reliability in auditory-perceptual assessment of hypernasality for 3 different methods and to explore the influence of language background.
Design:
Comparative methodological study.
Participants And Materials:
Audio recordings of 5-year-old Swedish-speaking children with repaired cleft lip and palate consisting of 73 stimuli of 9 nonnasal single-word strings in 3 different randomized orders. Four experienced speech-language pathologists (2 native speakers of Brazilian-Portuguese and 2 native speakers of Swedish) participated as listeners. After individual training, each listener performed the hypernasality rating task. Each order of stimuli was analyzed individually using the 2-step, VISOR and Borg centiMax scale methods.
Main Outcome Measures:
Comparison of intra- and inter-rater reliability, and consistency for each method within language of the listener and between listener languages (Swedish and Brazilian-Portuguese).
Results:
Good to excellent intra-rater reliability was found within each listener for all methods, 2-step: κ = 0.59-0.93; VISOR: intraclass correlation coefficient (ICC) = 0.80-0.99; Borg centiMax (cM) scale: ICC = 0.80-1.00. The highest inter-rater reliability was demonstrated for VISOR (ICC = 0.60-0.90) and Borg cM-scale (ICC = 0.40-0.80). High consistency within each method was found with the highest for the Borg cM scale (ICC = 0.89-0.91). There was a significant difference in the ratings between the Swedish and the Brazilian listeners for all methods.
Conclusions:
The category-ratio scale Borg cM was considered most reliable in the assessment of hypernasality. Language background of Brazilian-Portuguese listeners influenced the perceptual ratings of hypernasality in Swedish speech samples, despite their experience in perceptual assessment of cleft palate speech disorders.
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