Nasoendoscopy of velopharynx before and during diagnostic therapy

Nasoendoscopy is an important tool for assessing velopharyngeal function. The purpose of this study was to analyze velar and pharyngeal wall movement and velopharyngeal gap during nasoendoscopic evaluation of the velopharynx before and during diagnostic therapy. Nasoendoscopic recordings of 10 children with operated cleft lip and palate were analyzed according to the International Working Group Guidelines. Ratings of movement of velum and pharyngeal walls, and size, location and shape of gaps were analyzed by 3 speech-language pathologists (SLPs). Imaging was obtained during repetitions of the syllable /pa/ during a single nasoendoscopic evaluation: (a) before diagnostic therapy, and (b) after the children were instructed to impound and increase intraoral air pressure (diagnostic therapy). Once the patients impounded and directed air pressure orally, the displacement of the velum, right, left and posterior pharyngeal walls increased 40, 70, 80, and 10%, respectively. Statistical significance for displacement was found only for right and left lateral pharyngeal walls. Reduction in gap size was observed for 30% of the patients and other 40% of the gaps disappeared. Changes in gap size were found to be statistically significant between the two conditions. In nasoendoscopic assessment, the full potential of velopharyngeal displacement may not be completely elicited when the patient is asked only to repeat a speech stimulus. Optimization of information can be done with the use of diagnostic therapy’s strategies to manipulate VP function. Assuring the participation of the SLP to conduct diagnostic therapy is essential for management of velopharyngeal dysfunction.

The nasoendoscopy study of velopharyngeal closure patterns in normal Thai volunteers.

The purpose of this study is to assess patterns of velopharyngeal closure in normal Thai subject. Ten volunteers with normal speech and no history of cranio-maxillo-facial abnormality, injury or surgery were included in this study. Their velopharyngeal closures were reviewed b y nasopharyngoscopy. Their articulation and resonation characteristics were also evaluated. The patterns of closure and related anatomy were studied. The results showed that all subjects achieved complete closure without a gap or nasal emission. Three patterns of velopharyngeal closure were found. A circular pattern was found in the majority of the subjects. More specifically, 6 subjects demonstrated circular closure patterns and 1 had a circular closure pattern with the Passavant’s ridge. The coronal pattern was found in the last 3 subjects. There was no correlation between patterns of closure and demographic data related to anatomy and resonation characteristics. In conclusion, 3 patterns of velopharyngeal closure were found and the circular type was the common. Further study was recommended with a larger group for gathering a database of Thai people.

Nasoendoscopy: Clinical implications.

The purpose of this study is to discuss the clinical use of nasoendoscopy examination of the velopharyngeal closure in patients with nasal speech and to describe the clinical implications of this technique. Three difference patients with hypernasal speech, one with cleft palate, one with hearing loss and one mental retardation, were studied velopharyngeal incompetence through direct assessment of the velopharyngeal closure by nasoendoscopy. An Olympus Nasoendoscope model ENFP3 was used and the Siriraj Speech Stimuli Resonation Test (Manochiopinig & Chuangsuwanich 2001) was used as a standard speech sample. After an explanation and informed consent, 10% of xylocaine was sprayed into a nostril for tropical anaesthesia. The first author performed the nasoendoscopy, meanwhile the second author stimulate the speech sample and velopharyngeal function. The same procedure and condition was conducted to each subject in an operation room. Excursion of the soft palate and pharyngeal wall, completeness, asymmetrical, leakage, adequacy, patterns of closure were observed during speech production. Descriptive analysis was used. The results indicate that intelligible speech production depend on a normal velopharyngeal closure mechanism. Abnormal coupling of the oral and nasal cavities of these patients are characterized by hypernasality, nasal emission, imprecise speech production and decrease speech intensity. These typical signs of velopharyngeal insufficiency could be due to either structural defect (cleft palate), physiological dysfunction (hearing loss) or mental status (mental retardation). Nasoendoscopy provides a direct approach to visualize the velopharyngeal closure. This technique helps clinicians to distinguish between those patients with nasal speech who appear to have the physiological potential for satisfactory velopharyngeal closure from those who do not. This distinction is clinically important because of the marked difference in treatment. Furthermore, in patients considered for a pharyngeal flap operation, pre-operative evaluation of the closure is vital. In conclusion, hypernasal speech alone is not a sign of velopharyngeal insufficiency from structural defect. Thus, a diagnosis is suggested to be made by a cranio-maxillo-facial team after complete evaluation. In addition, nasoendoscopy has been valuable in distinguish different groups of patient as well as planning treatment.