Nasopharyngoscopy in palatopharyngeal prosthetic rehabilitation: A preliminary report.

PURPOSE: Prosthetic rehabilitation of speech disorders related to palatopharyngeal dysfunction is accomplished through separation of the oral and nasal cavities. The ability to achieve this separation is challenged when the disorder or defect involves the soft palate. Prosthetic rehabilitation of soft palate disorders and defects has traditionally relied on functional contouring of a prosthesis using functionally adapted impression materials. However, there are limitations to this process, particularly in its inability to visualize function as it relates to the prosthesis in a 3-dimensional space. The aim of this study was to address this limitation by describing outcomes related to the use of nasopharyngoscopy (NPS) for visualization of the velopharyngeal port during assessment and treatment of palatopharyngeal dysfunction. MATERIALS AND METHODS: A retrospective analysis of speech data was conducted for 5 patients who were assessed before treatment, after prosthetic intervention using conventional functional impression techniques, and after prosthetic intervention using NPS. Nasalance and velopharyngeal orifice area outcome measurements were collected for each patient at clinically predetermined intervals. Perceptual assessment of speech samples was performed as well. RESULTS: Improvements in speech function were observed for all patients after treatment with a prosthesis designed via a conventional functional impression technique; however, no patient showed normal values for nasalance or velopharyngeal orifice area. With the use of NPS to adjust the wax impression-derived prosthesis, both nasalance and velopharyngeal orifice area measurements for all patients were within normal limits. Similarly, perceptual judgment of speech found that normal resonance balance was obtained after use of NPS. CONCLUSION: The addition of NPS into prosthetic treatment for palatopharyngeal disorders shows promise for improved speech results.

Consensus statements on the BAHA system: where do we stand at present?

After more than 25 years of clinical experience, the BAHA (bone-anchored hearing aid) system is a well-established treatment for hearing-impaired patients with conductive or mixed hearing loss. Owing to its success, the use of the BAHA system has spread and the indications for application have gradually become broader. New indications, as well as clinical applications, were discussed during scientific roundtable meetings in 2004 by experts in the field, and the outcomes of these discussions are presented in the form of statements. The issues that were discussed concerned BAHA surgery, the fitting range of the BAHA system, the BAHA system compared to conventional devices, bilateral application, the BAHA system in children, the BAHA system in patients with single-sided deafness, and, finally, the BAHA system in patients with unilateral conductive hearing loss.

Maxillary obturators: the relationship between patient satisfaction and speech outcome.

BACKGROUND: Patient satisfaction with a maxillary obturator has been studied in relation to extent of surgical defect, sociodemographic characteristics, scores on mental health inventories, and psychosocial adjustment to illness scales. However, review of the literature reveals limited study of the relationship between patient satisfaction with an obturator and clinical speech outcome measures. The purpose of this study is to relate patient satisfaction scores obtained by questionnaire with those obtained by means of clinical speech measurements. METHODS: Acoustical, aeromechanical, and perceptual measurements of speech were collected for 20 patients after receiving a definitive obturator. Patient satisfaction with their obturator was later measured with the Obturator Functioning Scale (OFS). RESULTS: Results reveal that poorer aeromechanical speech results were associated with patient-reported avoidance of social events, whereas lower speech intelligibility outcomes were related to overall poorer perception of speech function on the OFS. Several background patient characteristics were significantly related to several responses on the OFS and to the aeromechanical assessment outcomes. CONCLUSIONS: Results from instrumental assessments of speech seem to be informative regarding not only speech outcome but also a patient's satisfaction with the obturator. Consideration of background patient characteristics is important when interpreting both clinically obtained and patient-perceived outcomes.