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.

Investigation of postoperative hypernasality after superiorly based posterior pharyngeal flap / 대한악안면성형재건외과학회지

BACKGROUND: Velopharyngeal insufficiency that accompanies speech resonance and articulation disorders can be managed through several intervention methods such as speech-language therapy, prosthetic aids, and surgery. However, for patients with severe hypernasality, surgical interventions are highly recommended. Among available surgical techniques, the posterior pharyngeal flap is most common. CASE PRESENTATION: Two adult males with high nasalance scores underwent superiorly based posterior pharyngeal flap surgery, followed by speech testing by an expert speech-language therapist. Nasalance scores and articulation accuracy were assessed up until 1 year after the surgery. Nasalance scores were measured five times using a nasometer, after which the average value was calculated. CONCLUSIONS: Consistent declines in hypernasality over time are not easy to explain since the pedicled pharyngeal flap narrowed over time, secondary to cicatrization. However, scar tethering of the soft palate in a posterior direction could reduce the velopharyngeal port size over time. Therefore, long-term follow-up with intensive speech therapy is suggested for patients with severe hypernasality.

The comparative study of resonance disorders for Vietnamese and Korean cleft palate speakers using nasometer / 대한악안면성형재건외과학회지

BACKGROUND: Nasalance is used to evaluate the velopharyngeal incompetence in clinical diagnoses using a nasometer. The aim of this study is to find the nasalance differences between Vietnamese cleft palate children and Korean cleft palate children by measuring the nasalance of five oral vowels. METHODS: Ten Vietnamese cleft palate children after surgery, three Vietnamese children for the control group, and ten Korean cleft palate children after surgery with the same age participated in this experimentation. Instead of Korean control, the standard value of Korean version of the simplified nasometric assessment procedures (kSNAP) was used. RESULT: The results are as follows: (1) the highest nasalance score among the Vietnamese normal vowels is the low vowel /a/; however, that of Korean normal vowels is the high vowel /i/. (2) The average nasalance score of Korean cleft palate vowels is 18% higher than that of Vietnamese cleft palate vowels. There was a nasalance score of over 45% among the vowels /e/ and /i/ in Vietnamese cleft palate patients and /i/, /o/, and /u/ in Korean cleft palate patients. CONCLUSION: These different nasalance scores of the same vowels seem to cause an ethnic difference between Vietnamese and Korean cleft palate 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.

The Relationship between Nasalance Score and Benign Vocal Fold Lesions / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Voice therapy using nasal stimulus sounds seems to facilitate a more easily produced, often better-sounding voice in benign vocal fold lesions. This study was designed (1) to determine whether nasalance score was different in patients with or without vocal fold masses, (2) to test if nasalance score was different from each disease group, and (3) to determine the difference between the normal and the disease group according to the reading materials. SUBJECTS AND METHOD: One hundred and sixty-eight subjects were evaluated. Each subject received a complete otolaryngological evaluation including physical examination, videostrobolaryngoscopy, objective voice measures, and evaluation by a speech-language pathologist. The control group consisted of 48 subjects with no nasal and vocal fold pathology. Subjects were evaluated on a nasometric assessment with three passages of oral-nasal sound. RESULTS: All disease groups demonstrated lower nasalance scores than the control group. CONCLUSION: There are significant differences in the nasalance scores between each disease group and the control group. Differences were also found according to the reading materials.

Objective Evaluation of Surgically Corrected Velopharyngeal Insufficiency with Nasalance on Nasometer

BACKGROUND AND OBJECTIVES: Various kinds of surgical correction have been performed for management of velopharyngeal insufficiency (VPI). This study was conducted to evaluate the efficacy of nasometer by comparing the speech evaluation with the nasalance change in patients who had undergone surgical correction of VPI. MATERIALS AND METHODS: Twelve cases of VPI, who had undergone surgical correction at Seoul National University Hospital between January 1996 and June 1999, were retrieved in this study. Nasality in all cases was evaluated by the speech evaluation and nasometer before and 3 months after the operation. RESULTS: Postoperative nasalance decreased from 49.0% to 40.9%. Seven of nine patients with decreased nasalance after the operation showed improved nasality by the speech evaluation. Three patients with increased nasalance or no change in nasalance did not show change of nasality by the speech evaluation. Seven cases of improved nasality by the speech evaluation represented significant decrease in nasalance. CONCLUSION: The speech outcome after surgical correction of VPI may be evaluated objectively with the change of nasalance.

The Effect of Tonsillectomy and Adenoidectomy on Nasality in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tonsillar and adenoid hypertrophy is one of the common causes of nasal obstruction, mouth breathing, snoring and sleep apnea in children. Tonsillectomy and adenoidectomy (T & A) could relieve these symptoms but may also cause voice changes after the operation. The aim of this study was to evaluate the voice changes objectively by nasometric and acoustic rhinometric analyses. MATERIALS AND METHODS: Thirty-eight patients who underwent T & A and twenty-two control children who had no sinonasal or tonsillar hypertrophy problems were selected. A visual analogue scale was used for determining the subjective nasality changes and nasometric analyses were used to determine the objective nasalance differences. Acoustic rhinometry was used to measure the nasopharyngeal volume changes and the removed adenoid tissue were directly measured. Data were collected prior to the operation, and on the second, 7th and 14th days after the operation. Data were compared and analyzed statistically. RESULTS: The volume of removed adenoid tissue was not statistically related with the subjective nasality changes which increased significantly after T R. A. Nasalance in the patient group increased significantly after the operation compared to that in the control group. The voiume of nasopharynx increased significantly after adenoidectomy, but it had a minimal statistical correlation with the volume of the removed adenoid tissue. CONCLUSION: Nasometric and acoustic rhinometric tests can serve as objective tools for evaluating the subjective nasality changes after T 5z A.

The Effect of Tonsillectomy and Adenoidectomy on Nasality / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The changes in voice that occur after tonsillectomy and adenoidectomy are mainly the nasal sound which can be measured with nasometer. This study was designed to estimate the postoperative changes in the voice, especially the nasal sound. MATERIALS AND METHODS: The subjects of this study included 26 patients who had received tonsillectomy and adenoidectomy. Thirty normal children were also selected as the control group. The nasalance and the each formants of /a/, /i/ of preoperative state were compared with those of postoperative 4 and 8 weeks. RESULTS: The preoperative nasality of the tonsillectomy and adenoidectomy group was significantly lower than that of the control group. Comparing the preoperative and postoperative 1 month state, there was significant increase in the nasalance, whereas it was recovered in the postoperative 2 months to the same level of the preoperatve state. The changes of the formants were not significantly noticed. CONCLUSION: Although the temporary increase in the nasalance does occur immediately after adenoidectomy, the postoperative 2 months state show no significant changes compared to the preoperative state. Therefore, the voice changes that come postoperatively could be considered as no concern for the non-professional voice user.