A Case Report of Nasopharyngeal Endoscopic Biofeedback Trial Therapy for Patients with Velopharyngeal Inadequecy

PURPOSE: The authors would like to introduce two patients who presented with velopharyngeal inadequacy. We emphasize the importance of nasaopharyngeal endoscopy in evaluating the velopharyngeal function and the usefulness of biofeedback trial therapy. METHODS: Two patients visited our clinic due to velopharyngeal inadequacy. Both of the patients showed hypernasality, nasal emission and compensatory articulation such as glottal stop. During oral examination and nasopharyngeal endoscopy both showed no evidence of structural deformities. One inconsistently showed a small gap during articulation. The other showed a rather large gap during compensatory articulation. Both received a simultaneous biofeedback trial therapy using the nasopharyngeal endoscope. RESULTS: Both patients were successfully diagnosed and treated at once using biofeedback trial therapy with nasopharyngeal endoscopy. By giving direct visual feedback to the patient, they were both able to achieve complete velopharyngeal closure during production of 2~3 nonsence syllables and hypernasality was not detected in both of them. CONCLUSION: The authors were able to help patients with velopharyngeal inadequacy to have velopharyngeal closure through biofeedback trial therapy. The accurate evaluation of velopharyngeal function and the possibility of closure prevented unnecessary operations.

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.

Treatment of Velopharyngeal Insufficiency in Kabuki Syndrome: Case Report

PURPOSE: Kabuki syndrome is a multiple malformation syndrome that was first reported in Japan. It is characterized by distinctive Kabuki-like facial features, skeletal anomalies, dermatoglyphic abnormalities, short stature, and mental retardation. We report two cases of Kabuki syndrome with the surgical intervention and speech evaluation. METHODS: Both patients had velopharyngeal insufficiency and had a superior based pharyngeal flap operation. The preoperative and postoperative speech evaluations were performed by a speech language pathologist. RESULTS: In case 1, hypernasality was reduced in spontaneous speech, and the nasalance scores in syllable repetitions were reduced to be within normal ranges. In case 2, hypernasality in spontaneous speech was reduced from severe level to moderate level and the nasalance scores in syllable repetitions were also reduced to be within normal ranges. CONCLUSION: The goal of this article is to raise awareness among plastic surgeons who may encounter such patients with unique facial features. This study shows that pharyngeal flap operation can successfully correct the velopharyngeal insufficiency in Kabuki syndrome and post operative speech therapy plays a role in reinforcing surgical result.

Velopharyngeal Insufficiency Induced by a Postoperative Palatal Fistula during Articulation Development Period: A Case Report

PURPOSE: Velopharyngeal insufficiency(VPI) during articulation development period can cause compensatory articulation like glottal stop, which can maintain VPI symptoms such as hypernasality and nasal emission despite of recovered velopharyngeal function. METHODS: A girl visited our department with speech problems such as hypernasality, compensatory articulation patterns, and nasal air emission. She had history of post-palatoplasty fistula which was repaired after 1 year follow-up. RESULTS: After treated with speech therapy without surgery, her hypernasal speech problem was corrected. From this, we could assume that the fistula during articulation development period induced VPI, which leads to glottal substitution and this compensatory articulation maintained VPI though the fistula was repaired. CONCLUSION: In this report, we could observe that palatal fistula in articulation development period can have detrimental effect on articulation, and also we could confirm that evaluation of soft palate mechanism with using speech sample without compensatory articulations prevent the patient from unnecessary operation.

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.

Preliminary Report on the Correlation of Auditory Cognitive Evoked Potential and Clinical Improvement in Schizophrenics / 신경정신의학

OBJECTIVES: The purpose of this study was to see the correlation between the auditory cognitive evoked potential and the clinical improvement in schizophrenics. METHOD: The subjects were 23 patients with schizophrenia. Auditory cognitive evoked potential was examined at pretreatment or the acute phase of treatment. The change of symptom was assessed by the PANSS(Positive and Negative Syndrome Scale) before drug treatment and in the 4th week of treatment. RESULTS: The results were as follows: 1) The change of positive subscale was positively correlated with P1 latency(p<.05), N1 latency (p<.05) and negatively correlated with P3 latency(p<.05), P2 amplitude(p<.05). 2) The change of negative subscale was negatively correlated with P3 latency(p<.05). 3) The change of general psychopathology subscale was negatively correlated with P3 latency(<.05). CONCLUSIONS:These results suggest that the auditory cognitive evoked potential in schizophrenic patients could be valuable on prediction of clinical improvement. But, further studies are required to support these results.