Role of Speech Aid Prosthesis as Diagnostic and Therapeutic Aid for Velopharyngeal Insufficiency Defect: A Case Report

ABSTRACT@#Soft palate tumors pose the challenge during reconstructive and rehabilitating procedures. Surgical resection of these tumors leads to velopharyngeal insufficiency (VPI). The primary effects of VPI are hypernasality and air-flow escape, while the secondary effects are abnormalities in speech articulation. Surgical revision along with speech therapy is a common approach to the treatment of VPI. Prosthetic management by means of speech aid prosthesis helps to reduce resonance, nasal emission and consonants errors. This clinical report describes the different stages of rehabilitation of velopharyngeal insufficiency defect following resection of malignant melanoma of left posterior alveolar ridge and soft palate. The speech aid prosthesis helped to rehabilitate the velopharyngeal insufficiency defect and aided in the diagnosis of extent of speech function improvement by perceptual and objective methods.

Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip / Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip

Abstract Introduction: The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up. Objective: To evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency. Methods: Patients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p < 0.05). Results: Thirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5 ± 0.7) was significantly (p < 0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8 ± 0.4 and 1.7 ± 0.9, respectively). Conclusion: The buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.

Resumo: Introdução: A interpretação dos resultados de fala obtidos com o retalho miomucoso do músculo bucinador no tratamento da insuficiência velofaríngea em pacientes fissurados tem sido limitada pela restrição do número de pacientes e do tempo de seguimento pós-operatório. Objetivo: Avaliar o efeito do retalho miomucoso do músculo bucinador sobre a hipernasalidade da fala no tratamento de pacientes fissurados com insuficiência velofaríngea. Método: Foram avaliados pacientes com fissura palatina (± lábio) reparada, com retalho miomucoso do músculo bucinador bilateral para a correção cirúrgica da insuficiência velofaríngea. A hipernasalidade (escores 0 [ausente], 1 [leve], 2 [moderada] ou 3 [severa]) foi analisada por três avaliadores por meio da mensuração dos registros audiovisuais coletados nos períodos pré-operatório e pós-operatórios recente e tardio (3 e 12 meses, respectivamente). Os valores foram considerados significativos para um intervalo de confiança de 95% (p < 0,05). Resultado: Foram incluídos 37 pacientes fissurados com hipernasalidade moderada (16,2%) ou severa (83,8%) no período pré-operatório. As análises do período pós-operatório tardio revelaram que a hipernasalidade (0,5 ± 0,7) foi significativamente (p < 0,05) menor do que a hipernasalidade dos períodos pré-operatório e pós-operatório recente (2,8 ± 0,4 e 1,7 ± 0,9; respectivamente). Conclusão: O retalho miomucoso do músculo bucinador é eficaz na redução/eliminação da hipernasalidade nos pacientes fissurados com insuficiência velofaríngea.

A Case of Retrophareangeal Tuberculosis Presenting as a Hypernasal Speech

Tuberculosis of the retropharynx is extremely rare. The diagnosis is frequently delayed because of its anatomical location and atypical symptom. It would be crucial to consider tuberculosis infection as a possible source of abscess and should be mindful about the tests to diagnose it. We experienced a 23-year-old man with retropharyngeal abscess caused by tuberculosis presenting hypernasality and hoarseness in the throat. In this article, we reviewed the etiology, diagnosis, and treatment of this case, with a review of literatures.

Assessment of speech nasality in children with Robin Sequence / Avaliação da nasalidade de fala em crianças com Sequência de Robin

PURPOSE: To report the outcomes of primary palatoplasty in Robin Sequence (RS); to verify the relationship between modalities of assessment of nasality; to compare nasality between techniques at palatoplasty. METHODS: This study involved the identification of hypernasality in four modalities: live assessment with 4-point scale; live assessment with cul-de-sac test; multiple listeners' ratings of recorded phrase; nasometric assessment. Live ratings of speech nasality and nasalance scores were retrieved from charts, while a recorded phrase was rated by listeners for occurrence of hypernasality. Agreement between the modalities was established as well as association between nasality, nasal turbulence and age at surgery and at assessment. Fisher's exact test was used to compare findings between surgical techniques. RESULTS: Agreement between nasalance, live assessment with 4-point scale, live assessment with cul-de-sac, and multiple listeners' ratings of recorded samples ranged between reasonable (0.32) and perfect (1.00). Percentage occurrence of hypernasality varied largely between assessment modalities. Mean occurrence of hypernasality was lower for the group submitted to Furlow technique (26%) than the group that received von Langenbeck technique (53%). Only findings obtained live were statistically significant (scale: p=0.012; cul-de-sac: p<0.001). Listeners identified nasal turbulence for 22 (32%) samples out of the 69 recordings, and an association was found between hypernasality and nasal turbulence. CONCLUSION: Lower occurrence of hypernasality was identified for patients with RS in Furlow group. Identification of hypernasality varied largely among the four assessment modalities. .

OBJETIVO: Reportar os resultados da palatoplastia primária na Sequência de Robin (SR); verificar a relação entre modalidades de avaliação da nasalidade; comparar nasalidade entre técnicas na palatoplastia. MÉTODOS: Este estudo envolveu a identificação da hipernasalidade em quatro modalidades: avaliação ao vivo com escala de quatro pontos; avaliação ao vivo com teste cul-de-sac; julgamento de gravações por juízes e avaliação nasométrica. Julgamentos ao vivo da nasalidade e escores de nasalância foram obtidos em prontuários, enquanto uma frase gravada foi julgada por juízes para ocorrência de nasalidade. Concordância entre as quatro modalidades foi estabelecida assim como associação entre nasalidade, turbulência nasal e idades na cirurgia e na avaliação. Teste exato de Fisher foi usado para comparar achados entre as técnicas cirúrgicas. RESULTADOS: A concordância entre nasalância, avaliação ao vivo com escala de quatro pontos e com teste cul-de-sac e julgamentos de gravações por juízes variou entre razoável (0,32) e perfeita (1,00). Porcentagem de ocorrência de hipernasalidade variou muito entre as diferentes modalidades. Ocorrência média de hipernsalidade no grupo operado com técnica de Furlow foi menor (26%) do que no grupo que recebeu a técnica de von Langenbeck (53%). Somente os resultados avaliados ao vivo foram estatisticamente significantes (escala: p=0,012; cul-de-sac: p<0,001). Juízes ouviram turbulência nasal em 22 (32%) das 69 gravações e uma associação entre hipernasalidade e turbulência nasal foi encontrada. CONCLUSÃO: Ocorrência de hipernasalidade foi menor para os pacientes com SR que receberam a técnica de Furlow. Identificação da hipernasalidade variou grandemente entre as quatro modalidades de avaliação. .

Impacts of Tone on Auditory Perceptual Result of Hypernasality / 中国康复理论与实践

Objective To investigate how the tones impact the perceptual result of hypernasality for designing subjective evaluation ma-terial for hypernasality. Methods 20 normal children and 20 children with cleft palate were asked to read the material with different tones. The degree of hypernasality and nasality was recorded. Results There was no significant difference in the degree of perceived hypernasality and nasality rate among all the children in all the tones (P>0.05). Conclusion The impact of tones on perceived hypernasality can be ignored when designing the subjective evaluation material for hypernasality.

Impacts of Tone on Auditory Perceptual Result of Hypernasality / 中国康复理论与实践

@#Objective To investigate how the tones impact the perceptual result of hypernasality for designing subjective evaluation material for hypernasality. Methods 20 normal children and 20 children with cleft palate were asked to read the material with different tones.The degree of hypernasality and nasality was recorded. Results There was no significant difference in the degree of perceived hypernasality and nasality rate among all the children in all the tones (P>0.05). Conclusion The impact of tones on perceived hypernasality can be ignored when designing the subjective evaluation material for hypernasality.

The nasal resonance acoustics of school-age children with spastic cerebral palsy / 中华物理医学与康复杂志

Objective To characterize the nasal resonance of children with spastic cerebral palsy by comparing it with that of ordinary school-age children.Methods The mean nasalance scores (MNSs) of 90 normal school-age children and 62 school-age children with spastic cerebral palsy were measured and compared.Results (1) Age has significant effects on the MNS of/a/,/i/and/m/ in ordinary children,but has almost no effect on the MNS of/u/.The MNS of/a/,/i/,/u/ and/m/ in children with spastic cerebral palsy does not change with age.(2) Sex only has a significant relationship with the MNS of/i/ in ordinary children,but does not significantly predict the other MNSs.(3) The MNS of/a/ of children with spastic cerebral palsy is significantly lower than that of ordinary children,and their MNS of/i/ and /u/ is significantly greater than those of ordinary children.Conclusions The MNS of /a/,/i/and /u/first increases and then decreases with age in ordinary children,while the MNS of/m/ increases gradually.Children with spastic cerebral palsy did not show the same trends and demonstrated a state of retardation of nasal resonance.Children with spastic cerebral palsy are more likely to display hypernasality than ordinary children.

Nasalance scores of Malay (Kelantan dialect) in children with and without palatal cleft

This study was designed to obtain and compare the nasalance scores produced by normal Malay children and those with repaired palatal cleft. Data from 103 noncleft children and 27 children with repaired clefts were included. All children were of Malay origin with the Malay language (Kelantan dialect) as their first language. Two short and simple test stimuli were constructed in the Malay language; one resembled the Nasal Sentences and the other resembled the Zoo Passage (oral passage) used in nasometer testing. Nasalance scores were obtained with the Nasometer II model 6400 by Kay Elemetrics. Calibration of the nasometer and collection of data followed the recommended protocol outlined in the manual. Nasalance scores for the Oral Passage was significantly higher (p < 0.001) for the children with repaired palatal clefts when compared to scores for children without clefts. However, no differences in nasalance scores were detected between both groups for the Nasal Passage. The normative nasalance scores for Malay children with Kelantan dialect was established, which can be used as an objective reference in the management of Malay patients with resonance disorders.

Insuficiencia velofaríngea en cirugía adenoamigdalina / Velopharyngeal insufficiency in adenotonsillar surgery

Introducción: Insuficiencia velofaríngea (IVF) es una posible complicación asociada a cirugía adenoamigdalina, cuya incidencia real es difícil de establecer, según la literatura, su frecuencia estimada es de 1 en 1.500-10.000 adenoidectomías. Sin embargo, no hay registro en la literatura de IVF transitoria posoperatoria. Nuestra hipótesis del trabajo: la IVF posoperatoria, tanto transitoria como definitiva, está subdiagnosticada o subregistrada. Objetivo: Evaluar la frecuencia y estudiar los factores predisponentes de IVF transitoria y definitiva posoperatoria en una población del Área Occidente de la Región Metropolitana de Chile, 2004-2007. Material y método: Estudio descriptivo y retrospectivo, Revisión de fichas clínicas y registros de la Unidad de Fonoaudiología de pacientes <15 años, operados de patología adenoamigdalina en el Servicio de Otorrinolaringología del Hospital San Juan de Dios, 2004-2007. Resultados: Se registraron 18 casos de IVF transitoria posoperatoria que corresponde a 1,2% (n =1.458). La frecuencia de IVF definitiva posoperatoria fue cero. Conclusión: No se logró analizar los posibles factores predisponentes de IVF posoperatoria. El porcentaje de IVF transitoria encontrado constituye una estadística de referencia para la elaboración del consentimiento informado. Es posible que la frecuencia encontrada pueda ser menor a la real debido al inadecuado registro y control posoperatorio. Creemos que es necesario un protocolo de estudio y de seguimiento de IVF posoperatoria en todos los pacientes intervenidos de cirugía adenoamigdalina.

Introduction: Velopharyngeal insufficiency (VPI) is a possible complication associated with adenotonsillar surgery, whose real incidence is difficult to establish, according to the literature, the estimated frequency is 1 in 1500-10000 adenoidectomies. However, there is no record in the literature of transient postoperative VPI. Hypothesis: The postoperative VPI, both transient and permanent, is underdiagnosed and underreported. Aim: To evaluate the frequency and predisposing factors study transient and permanent postoperative VPI in a population of the West Area of the Metropolitan Region of Chile, 2004-2007. Material and method: A retrospective study, clinical records and records from the Audiology Unit of patients <15 years, operated as adenotonsillar pathology in the Department of Otorhinolaryngology, Hospital San Juan de Dios, from 2004 to 2007. Results: There were 18 cases of transient postoperative VPI which corresponds to 1.2% (n =1458). The frequency of permanent postoperative VPI was zero. Conclusion: It was not possible to analyze the possible predisposing factors for postoperative VPI. The percentage of transient found VPI is a statistical reference for the development of informed consent. It is possible that the frequency found to be lower than actual due to inadequate recording and postoperative control. We believe that we need a study protocol and postoperative monitoring in all VPI patients undergoing adenotonsillar surgery.

Impact of delayed prosthetic treatment of velopharyngeal insufficiency on quality of life.

Palatopharyngeal dysfunction may take place when palatopharyngeal valve is unable to perform its own closing due to a lack of tissue (palatopharyngeal insufficiency) or lack of proper movement (palatopharyngeal incompetence). Palatopharyngeal insufficiency induces nasal regurgitation of liquids, hypernasal speech, nasal escape, disarticulations and impaired speech intelligibility. Prosthetic management of palatopharyngeal insufficiency requires a close co-operation between an otolaryngologist and a speech pathologist. As a result, the patient can be socially and physically rehabilitated with the improved speech quality as well as prevention of leakage of liquids.

Long-term Effectiveness of Post-operative Continuous Positive Airway Pressure(CPAP) Therapy for Treating Hypernasality: Case Report

PURPOSE: In some patients with velopharyngeal insufficiency(VPI), Hypernasality can persist after surgical management. Continuous Positive Airway Pressure(CPAP) is applied to these patients for treating hypernasality. The purpose of this study is to report follow-up results of postoperative CPAP therapy. METHODS: After performing palatal lengthening, CPAP therapy was applied to three patients for eight weeks from July of 2008 to November of 2009. Perceptual evaluation, nasometry, and nasopharyngeal endoscopy were performed to evaluate hypernasality, nasalance and size of the gap at velopharyngeal port. Each evaluation was made before surgery, right after CPAP therapy and during follow- up of more than a year after CPAP therapy. RESULTS: All of the patients showed improvement in hypernasality right after CPAP therapy according to the auditory perceptual evaluation, nasometry and nasopharyngeal endoscopy. But the improvement in hypernasality in these patients did not last during follow-up. CONCLUSION: In this study, our results suggest that CPAP therapy is effective in reducing hypernasality for postoperative VPI patients immediately after the therapy, but hypernasality may be worsen in some patients during follow-up. Therefore we recommend follow-ups after CPAP therapy to see if the efficacy of CPAP therapy lasts.

Post-operative Continuous Positive Airway Pressure (CPAP) Therapy in Velopharyngeal Insufficiency Patient

PURPOSE: There are several surgical methods for correcting a velopharyngeal insufficiency (VPI) but in some cases, it is not possible to achieve complete recovery of the velopharyngeal function. This paper introduces a new therapy for treating hypernasality without further surgery using continuous positive airway pressure (CPAP). METHODS: CPAP therapy was applied to seven VPI patients for eight weeks from April of 2007 to September of 2009. All patients underwent palatoplasty for the cleft palate and six patients underwent palatal lengthening for VPI before CPAP therapy. A speech pathologist performed an auditory perceptual evaluation to evaluate the improvement in hypernasality after 8-week CPAP therapy. RESULTS: Six patients showed an improvement in hypernasality after CPAP therapy according to the auditory perceptual evaluation. One patient with severe hypernasality responded to the early part of therapy but the hypernasality did not improve after therapy. CONCLUSION: CPAP therapy might be effective in reducing the hypernasality in patients with VPI by providing resistance training to strengthen the velopharyngeal closure muscles. In particular, CPAP therapy could be more effective for patients who show mild to moderate hypernasality after surgery.

Using the speech aid for treatment of velopharyngeal incompetency in incomplete cleft palate: a case report

Perception of Hypernasality and its Physical Correlates / Oral Science International

To clarify the relationship between the perceptual diagnoses of hypernasality and its physical correlates, we conducted three experiments using the Japanese vowel /i/. We performed a spectral analysis of hypernasality on five cleft palate patients and six velum resection patients to investigate the spectral features related to hypernasality (experiment 1). Psychoacoustic experiments were conducted using various spectrally modified vowels to investigate the relationships between the spectral features and auditory perceptions of hypernasality (experiment 2). We analyzed the estimated spectral envelopes using an articulatory speech synthesis model to clarify the relationship between the spectral features and the velopharyngeal opening (experiment 3). Experiments 1 and 2 suggested four spectral features as the characteristics of hypernasality: (1) broadening of the F1 bandwidth, (2) an additional peak at around 1 kHz [P1], (3)^* a decrease in the magnitude of F2, and (4)^* a dip between F2 and F3 [D2]. In particular, the simultaneous modification of the decrease in the magnitudes of F2 and D2 is a very important cue for the auditory perception of hypernasality. Experiment 3 showed that the dips caused by nasal coupling resulted in the spectral modifications. In addition, the dip regions appeared to spread from the low-frequency region (around F1) to the high-frequency region (above F2), as the velopharyngeal opening enlarged. This suggests that the decrease in the magnitude of F2 and the dip between F2 and F3 [D2] are related to excessive acoustic coupling of the nasal cavity.^* New findings.

Velopharyngeal Insufficiency Accompanied with Hypertrophic Tonsils: A Case Report

It is well documented that adenoidectomy is attributed to hypernasality in certain cases, but not clear that the enlarged tonsils affect the quality of speech. Hypertrophied tonsils may cause and complicate the problem of velopharyngeal incompetency. The huge tonsils prevent lateral pharyngeal walls from a medial movement and interfere velar elevation, being hypernasality. Hyponasality developes as the tonsils encroach in nasopharyngeal space. Voluminous tonsils also interfere airflow in the oropharyneal passage and produce the phenomenon of cul-de-sac resonance or muffled sound. The authors and et al. present a case of velopharyngeal insufficiency accompanied with hypertrophic tonsils. Improving the lateral constricting pharyngeal wall and velar elevation after tonsillectomy minimized the velopharyngeal gap. Accordingly, the procedures of sphincter pharyngoplasty and palatal lengthening resolved the problem of hypernasality instead of pharyngeal flap. Tonsillectomy prior to pharyngeal flap surgery tends to reduce the postoperative airway problems. Sometimes, however, only tonsillectomy does without pharyngeal flap. Surgical approach by stages and intermittent evaluation are recommended at intervals of at least six weeks.

A Study of the change of nasalance using CPAP in normal adults

Hypernasality correlates with acoustics and aerodynamics

Classification of congenital velopharyngeal insufficiency / 实用口腔医学杂志

Objective: To study the classification of congenital velopharyngeal insufficiency(CVPⅠ).Methods:30 patients with CVPI were divided into 2 groups.The patients in group I were with submucous cleft palate,those in group Ⅱwere without noticible abnormality.A11 patients received oral examination and 1ateral cephalogram examination. ANS-PNS(1ength of hard palate),PNS-U(velar 1ength),PNS-PPW(pharyngeal depth),SPT(thickness of soft palate),need ratio, elongation and upward angle of soft palate were measured. Results:PNS-U was shorter and PNS-PPW was longer in the patients than in the health controls (P