|Year : 2013 | Volume
| Issue : 4 | Page : 169-172
Speech disorders encountered in routine ENT practice and the role of speech therapy in its effective management
Jay Dave, Vikas Sinha, Dilavar Barot, Niral Modi, Deepanshu Gurnani, Toral Patel
Department of Otolaryngology and Head and Neck Surgery, M. P. Shah Government Medical College, Jamnagar, Gujarat, India
|Date of Web Publication||7-Jan-2014|
No. 8 Shivranjani Society Satellite Road Ahmedabad - 380 015 Gujarat
Source of Support: None, Conflict of Interest: None
Aim: To study speech disorders encountered in routine ENT practice and the role of speech therapy in its effective management. Material and Methods: The present study was carried out on 60 patients, who were presented to the out patient department of E.N.T., M.P.SHAH MEDICAL COLEGE, JAMNAGAR (Gujarat),for speech disorders. The OPD and Indoor patients of the E.N.T. department, who had a speech defect prior to or following surgical interference for organic Otorhinolaryngologic disorders were also included in this study. Results: Speech disorders like Dyslalia, Dysglossia, Stuttering were prevalent in both the sexes and in every level of society, though the disorders were more prevalent in males as compared to females. Stuttering was the most common disorder encountered and speech therapy had encouraging results. All the ten patients of Dyslalia were subjected to appropriate articulation training, following which eight patients improved satisfactorily whereas two patients missed follow-up. All the eight Deaf-Mute patients were given auditory training and speech and language stimulation therapy, following which, two patients acquired satisfactory speech level. All seven patients of Dysglossia improved satisfactorily after tongue tie release surgery and appropriate speech therapy. Conclusion: With the advent of newer treatment modalities and improved coordination between ENT surgeons and speech-pathologists for correct diagnosis of speech disorders, speech therapy is suitably individualized according to the expectation of the patients and limitation of the speech pathologists. A fuller understanding of the effectiveness of speech therapy amongst the patients has developed and it has emerged as an acceptable modality of treatment of various speech disorders.
Keywords: Rehabilitation, Speech, Speech therapy
|How to cite this article:|
Dave J, Sinha V, Barot D, Modi N, Gurnani D, Patel T. Speech disorders encountered in routine ENT practice and the role of speech therapy in its effective management. Indian J Otol 2013;19:169-72
|How to cite this URL:|
Dave J, Sinha V, Barot D, Modi N, Gurnani D, Patel T. Speech disorders encountered in routine ENT practice and the role of speech therapy in its effective management. Indian J Otol [serial online] 2013 [cited 2019 Dec 5];19:169-72. Available from: http://www.indianjotol.org/text.asp?2013/19/4/169/124506
| Introduction|| |
Speech is the vocalized form of human communication. It is based upon the syntactic combination of lexicals and names that are drawn from very large (usually to about 10,000 different words) vocabularies. Each spoken word is created out of the phonetic combination of a limited set of vowel and consonant speech sound units. These vocabularies, the syntax which structures them and their set of speech sound units differ, creating the existence of many thousands of different types of mutually unintelligible human languages. 
Speech is a cultural medium that is suitable to convey intellectual content, whereas voice is a natural medium, well-adapted to communicate emotional content.
Speech is merely one form of language, in which articulate sounds or words are used to convey meanings and it is said to be disordered or defective when the speech of individual differs significantly outside the range of acceptable variations in the same community, of the same age and sex with the underlying conditions causing such a deviation. 
Speech disorders may be congenital or acquired, functional or organic. These may result from purely psychological reasons or may be a consequence of surgery on the speech organs. When speech disorder is associated with hearing impairment, the problem becomes more serious.
| Materials and Methods|| |
The present study was carried out on 60 patients, who were presented to ear, nose and throat (ENT) Department of, M.P. Shah Government. Medical College, Jamnagar (Gujarat), for speech disorders. The out-patient department and inpatients of the ENT Department, who had a speech defect prior to or following surgical interference for organic otorhinolaryngologic disorders were also included in this study. All patients were worked up in speech and audiology unit of the Department of Otorhinolaryngology. The period of study extended from June 2010 to September 2012.
A detailed history and complete ENT examination were undertaken and recorded. The clinical history and developmental milestones history was obtained from the patients themselves, their parents or close relatives, who knew the patients antecedents in detail. Speech behavior of all patients with or without hearing loss examined with regard to the articulation defect, vocabulary, mode of communications, disfluencies, etc., Appearance and functions of the peripheral organs of speech, including diadochokinesis of tongue and lips were noted. Writing, reading and comprehension abilities for language were examined.
The stammering  patients were made to read a standard text from a Hindi and Gujarati textbook, whose comprehension was compatible with the intelligence of a VII th standard student and the occurrence of manifestations of stammering, were observed. After reading the text, every patient was asked to narrate what he had read and the reactions were again noted. Children up to 10 years of age were asked to recite any story they had learnt and their spoken speech was observed. Patients were asked about the particular situation when they stammered most viz. with family members, friends, strangers, on telephone, in important situations, after exhaustion or during the emotional stress. Stammerers were taught various breathing exercises. 
Delayed speech and language development patients in addition to speech therapy, were treated with various occupational and physical therapies as well. Parents or guardians of such patients were asked to provide following activities at home in order to positively influence patients' speech development. Parents were instructed to read any text regularly loud and clear in front of the child. 
Positive reinforcement in the form of reward and appreciation of the child was part of this therapy. The parents were instructed to be patient in spite of not so successful therapy in the initial stage and not to lose temper either with the child or among themselves at any stage of therapy.
All patients were called for follow-up and speech therapy sessions every week.
| Results|| |
As shown in [Table 1] speech disorders were prevalent in both sexes and in every level of society, though the disorders were more prevalent in males as compared to females.
Speech disorders affect people in all ages, from infancy to old age. Patients having speech defect along with hearing impairment were presented mainly in first and second decades of life.
The incidence of speech defects in elderly age groups was much less and these patients had mainly stuttering or dyslalia.
But this may not be the representative, because speech disorders are usually overlooked by the patients and relatives and it may be the contributing factor in most of the late presentations.
| Discussion|| |
Out of eight patients of delayed speech and language development four were preterm babies while two had neonatal jaundice. Observations suggested that patients having delayed physical milestones and low intelligence quotient  also had associated delayed speech and language development. All eight patients of delayed speech and language development were treated with speech therapy with appropriate approaches. Out of eight patients, six patients improved, whereas two did not followed-up regularly. However, these patients when treated with appropriate speech therapy had satisfactory improvement in their speech and language development.
In the observations of dyslalia patients, it was found that the substituted sound is usually one of the sounds acquired earlier during the sequence of speech development. For example 'w' for 'r' as in 'wan' for 'ran' 't' for 'k' as in 'titty' for 'kitty'. It also showed that diadochokinetically faster sounds 't', 'd', 'p' and 'b' were substituted for slower sounds  , i.e., 's', 'z', 'k' and 'g' and phonetically easier, less precise sounds for phonetically harder sounds, which required more precise coordination and timing. All 10 patients of dyslalia were subjected to appropriate articulation training, following, which eight patients improved satisfactorily whereas two patients missed follow-up.
All eight deaf-mute patients were given auditory training and speech and language stimulation therapy  , following which, two patients acquired satisfactory speech level while three patients were less improved and three patients followed-up irregularly and had insignificant improvement.
This study suggests that evaluation of deaf mutes and their speech and auditory rehabilitation poses a challenge to speech and language pathologists.
All seven patients of dysglossia had tongue-tie, causing articulation disorder. All seven patients of tongue tie showed defects of linguadental and alveolar sounds as well as sibilants viz. 'd', 't', 'l', 's', 'z', etc. 
Tongue tie release surgery was done in all seven patients and was given speech therapy post-operatively. All patients improved satisfactorily.
Out of six patients of mental retardation (MR), two patients were able to walk; one of them was able to speak monoverbal sentences while the language of second was confined to babbling. Four patients were more independent and could even dress themselves, speech in one of them developed to babbling only while other three could speak some words. Four patients had normal hearing and two patients had hearing loss (one each in 61-70 dB, 71-80 dB). Each of four patients (who had normal hearing) was treated by speech therapy and behavioral training. Two patients improved while two patients lost follow-up. Other two patients, who had hearing impairment along with MR, were subjected to auditory training and speech therapy but both of them did not have satisfactory improvement.
It was observed in the study that incidence of stuttering was more in young adolescent age group. It could be concluded from the study that certain factors were associated with individuals having stuttering.
- Emotionally labile and sensitive nature.
- Family attitude.
- Peer pressure.
- Family atmosphere.
- Awareness amongst the parents.
Every one of 21 patients of stuttering was treated with speech therapy (progressive muscular relaxation therapy, modified mean airflow tech.)  parents and family members of all the patients were educated regarding stuttering and their role in treating the patient. Out of 21, 15 patients improved satisfactorily and six patients did not improve well. Out of six patients who did not improve, four patients did not do their exercises regularly at home. Even their families were not that keen. The results suggest that a multidisciplinary approach from the doctor and the family is necessary for favorable outcome of speech therapy in stuttering.
| Conclusion|| |
With the advent of newer treatment modalities and improved coordination between ENT surgeons and speech-pathologists for correct diagnosis of speech disorders, speech therapy  is suitably individualized according to the expectation of the patients and limitation of the speech pathologists. Also by this study it could be concluded that a fuller understanding of the effectiveness of speech therapy amongst the patients has developed and it has emerged as an acceptable modality of treatment to various speech disorders. Effectiveness of speech therapy depends upon a:
- Coordination between ENT surgeons and speech pathologist.
- Cooperation of patient.
- Expertise of speech therapist.
- Motivation and patience shown by the family members of the patient.
Thus, proper pre-speech therapy work-up and a realistic level of expectations in patients, speech pathologists and ENT surgeons' gives better results in greater majority of patients.
| References|| |
|1.||Perkins WH. Speech Pathology. 2 nd ed. Saint Louis: The C.V. Mosby co. 1977. p. 4-12, 233-40, 253-7, 301-37. |
|2.||Travis LE. Speech Pathology. New York: Appleton; 1931. p. 12-7. |
|3.||Harisinghani AS. How to Stop Stammering and Start Living. Bombay, India: Bombay popular Prakashan; 1986; 1985. p. 4-9 |
|4.||Harisinghani AS. How to Stop Stammering and Start Living. Bombay, India: Bombay Popular Prakashan; 1986. p. 4-9, 34-36, |
|5.||Travis LE. Aphasia in children; language development and language pathology. In: Handbook of Speech Pathology. 4 th ed.Appleton Century Crofts: New York; 1961. p. 213-5, 2132-5. |
|6.||Morgan CT. Introduction to Psychology. 7 th ed. NewYork: McGraw Hill; 2010. p. 531-2. |
|7.||Schneider SL, Sataloff RT. Voice therapy for the professional voice. Otolaryngol Clin North Am 2007;40:1133-49. |
|8.||Bakwin H. Delayed speech. Developmental mutism. Pediatr Clin North Am 1968;15:627. |
|9.||Beasley N. Scott-Browns Otorhinolaryngology, Head and Neck Surgery. 7 th ed., Vol. 2. Great Britain: Hodder Arnold p. 2166-67. |
|10.||Harisinghani AS. How to Stop Stammering and Start Living. Bombay, India: Bombay Popoular Prakashan 1986 ; 1985. p. 4-9,39-41. |
|11.||Perry A. Speech therapy in ENT practice. In: Scott Browns Otorhinolaryngology and head and neck surgery. 7 th ed., Vol. 2. Hodder Arnold p. 2216. |