RESUMO
Cleft palate repair is done to allow for normal speech by separating the oral and nasal cavities and creating a functioning velopharyngeal valve. However, despite cleft palate repair, some patients demonstrate velopharyngeal insufficiency (VPI). An attempt was made to determine the effectiveness of a modified secondary Furlow Z-plasty in improving VPI. Fifty-five children aged between 12 and 15 years, with postoperative VPI following primary palatoplasty, were included in the study. These children underwent a modified Furlow Z-plasty. Nasometry was done to determine the change in velopharyngeal function due to the secondary Furlow Z-plasty by comparing the preoperative with the 1-year postoperative nasalance scores. A test-retest study was performed to determine the reliability of the nasometric measures. Reliability measurements of the nasometer passages revealed good reliability for 18 out of the 25 speech passages. There was a statistically significant reduction in VPI at 1 year postoperative in patients who were treated with the modified Furlow Z-plasty, with a P-value of <0.001 in all passages, except velar plosives, which had a P-value of 0.002. Patients with VPI after primary palatoplasty and treated using a modified Furlow Z-plasty had significantly lower nasalance scores at 1 year postoperative, indicating significantly improved velopharyngeal function.
Assuntos
Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Procedimentos de Cirurgia Plástica/métodos , Insuficiência Velofaríngea/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do TratamentoAssuntos
Sistemas de Informação Hospitalar , Hospitais Pediátricos/organização & administração , Controle de Custos , Eficiência Organizacional , Controle de Formulários e Registros , Hospitais Pediátricos/economia , Ohio , Inovação Organizacional , Recursos Humanos em Hospital , Técnicas de Planejamento , SoftwareRESUMO
We prospectively evaluated the neurodevelopmental outcome of infants with documented viral meningitis to determine (1) whether deficits in physical growth, development, speech and language, hearing, or intelligence occur; and (2) if so, at what age these deficits can be detected. Sixteen infants with documented enteroviral meningitis under the age of 90 days and a control group of 13 patients matched for age, race, sex, and socioeconomic status were followed up prospectively for 3 years with annual evaluations, which included a developmental evaluation by a pediatric developmentalist, articulation and language tests by a speech-language pathologist (Sequenced Inventory of Communication Development, Receptive-Expressive Emergent Language Scale (REEL), Preschool Language Scale (PLS), Revised Peabody Picture Vocabulary Test (PPVT-R), Photo Articulation Test, audiometric screening), and intelligence tests by a psychometrist (Bayley Scales of Infant Development [BSID] and Stanford-Binet). No deficits were demonstrated in growth, development, hearing, BSID, articulation, and expressive language. Subtle but significant (P < 0.05) deficits were documented in the study group compared with the control group in the receptive component of the REEL, all subsections of the PLS, the PPVT-R, and the verbal comprehension/language-processing section (Factor II) of the Stanford-Binet. These differences could be reliably detected by 3 years of age. We conclude that viral meningitis in young infants may cause subtle deficits in language skills, particularly receptive language. We recommend that children who have had enteroviral meningitis during early infancy be monitored carefully for language development and, perhaps, receive increased language stimulation in the home prior to school entry in order to optimize their learning potential.
Assuntos
Transtornos do Desenvolvimento da Linguagem/etiologia , Meningite Viral/complicações , Análise de Variância , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Testes de Linguagem , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Psicologia da Criança/métodos , Psicometria/métodos , Sensibilidade e Especificidade , Teste de Stanford-BinetRESUMO
The residual effect of premature loss due to extraction of the four maxillary primary incisors on speech production was studied. The articulation of twenty-six subjects who had their teeth extracted before the age of five years was evaluated at eight, nine, or ten years old and compared with the articulation of an age-matched comparison group with normal exfoliation of their incisors. T-tests for related measures revealed no statistically significant differences between the group with premature loss and the comparison group. These results suggest that loss of maxillary incisors in children younger than five years is not likely to result in defective articulation while the teeth are missing or when the permanent dentition is acquired.
Assuntos
Transtornos da Articulação/etiologia , Incisivo , Extração Dentária/efeitos adversos , Dente Decíduo , Criança , Humanos , Incisivo/fisiologia , Incisivo/cirurgia , Maxila , Dente Decíduo/fisiologia , Dente Decíduo/cirurgiaAssuntos
Adenoidectomia/efeitos adversos , Resistência das Vias Respiratórias/fisiologia , Tonsilectomia/efeitos adversos , Distúrbios da Voz/etiologia , Qualidade da Voz/fisiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Sensibilidade e Especificidade , Acústica da Fala , Distúrbios da Voz/diagnósticoRESUMO
This paper presents a case of altered resonance secondary to hypertrophic tonsils. Through nasopharyngoscopy, the tonsils were found to be in the nasopharynx and interposed between the velum and posterior pharyngeal wall. This resulted in incomplete velopharyngeal closure and evidence of hypernasality. This large mass was also felt to obstruct sound transmission into both the oral and nasal cavities, causing a mixture of hyponasality and cul-de-sac resonance. Tonsillectomy resulted in an elimination of all of these characteristics. Resonance was judged to be normal on the postoperative assessment.
Assuntos
Tonsila Palatina/patologia , Insuficiência Velofaríngea/etiologia , Qualidade da Voz/fisiologia , Criança , Feminino , Humanos , Hipertrofia , Tonsilectomia , Insuficiência Velofaríngea/cirurgiaRESUMO
Velopharyngeal insufficiency was assessed using multiview videofluoroscopy on eight patients with hypernasality, 10 patients with hypernasality and audible nasal emission, and 10 patients with nasal turbulence (rustle). Patients demonstrating hypernasality, with or without audible nasal emission, were found to have a significantly larger velopharyngeal gap than those with nasal rustle. This finding suggests that the degree of the velopharyngeal insufficiency can be predicted to some extent based on perceptual assessment. If the presence of a nasal rustle suggests a small velopharyngeal gap, despite the severe distortion of speech, then speech therapy should be considered prior to surgery in those cases.
Assuntos
Palato Mole/patologia , Faringe/patologia , Distúrbios da Fala/patologia , Insuficiência Velofaríngea/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Cinerradiografia , Fenda Labial/fisiopatologia , Fissura Palatina/fisiopatologia , Fluoroscopia , Humanos , Movimento , Nariz/fisiopatologia , Palato Mole/fisiopatologia , Faringe/fisiopatologia , Distúrbios da Fala/fisiopatologia , Insuficiência Velofaríngea/fisiopatologiaRESUMO
The purpose of this investigation was to describe the occurrence of laryngeal pathologies and their distribution across age, sex, and race in a pediatric sample. Data were collected on 731 patients seeking evaluation or treatment at a children's hospital otolaryngology clinic. The most frequent laryngeal pathologies were subglottic stenosis, vocal nodules, laryngomalacia, and vocal fold paralysis. For the total sample, laryngeal pathologies were significantly more common to males than females. Laryngeal pathologies were most common in the youngest patients. The distribution of pathologies within each race was similar to that found throughout the total sample. Comparisons with similar investigations are made. Implications for management are discussed.
Assuntos
Doenças da Laringe/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Doenças da Laringe/terapia , Masculino , Otolaringologia/métodos , Grupos Raciais , Encaminhamento e Consulta , Fatores Sexuais , Patologia da Fala e LinguagemRESUMO
Articulation, resonance, and velopharyngeal function were evaluated before and after Le Fort I maxillary advancement in 16 patients (seven with cleft lip and palate, one with cleft lip only, and eight without clefts). On the postoperative evaluation, seven of 11 patients with preoperative articulation errors showed an improvement in articulation after surgery. Two patients without clefts showed slight changes in nasal resonance, and two patients (one with cleft lip and palate and one with cleft lip only) developed mild nasal emission. Nine patients showed diminished velopharyngeal contact during speech on videofluoroscopic studies. Compensatory changes in velopharyngeal function were also observed, which included velar stretching and lengthening and increased lateral pharyngeal wall movement.
Assuntos
Maxila/cirurgia , Osteotomia/métodos , Palato Mole/fisiologia , Faringe/fisiologia , Fala/fisiologia , Adolescente , Adulto , Transtornos da Articulação/fisiopatologia , Cinerradiografia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Fonética , Acústica da Fala , Distúrbios da Fala/fisiopatologiaRESUMO
This paper describes speech changes in three patients after tongue flap closure of various sized palatal fistulas. In all three patients articulation and lingual mobility appeared to be unaffected by excision of tongue tissue for the procedure. However, a large protruding tongue flap was noted to interfere with the articulation of sibilants in one patient. All patients showed a reduction in overall hypernasal resonance and nasal emission, although one patient developed nasal turbulence postoperatively and another required a pharyngeal flap for total elimination of hypernasality. This paper points out the need for a systematic investigation into the effects of this surgery on speech.