Voice parameters and videonasolaryngoscopy in children with vocal nodules: a longitudinal study, before and after voice therapy.

BACKGROUND: Vocal Nodules (VN) are a functional voice disorder associated with voice misuse and abuse in children. There are few reports addressing vocal parameters in children with VN, especially after a period of vocal rehabilitation. OBJECTIVE: The purpose of this study is to describe measurements of vocal parameters including Fundamental Frequency (FF), Shimmer (S), and Jitter (J), videonasolaryngoscopy examination and clinical perceptual assessment, before and after voice therapy in children with VN. Voice therapy was provided using visual support through Speech-Viewer software. MATERIALS AND METHODS: Twenty patients with VN were studied. An acoustical analysis of voice was performed and compared with data from subjects from a control group matched by age and gender. Also, clinical perceptual assessment of voice and videonasolaryngoscopy were performed to all patients with VN. After a period of voice therapy, provided with visual support using Speech Viewer-III (SV-III-IBM) software, new acoustical analyses, perceptual assessments and videonasolaryngoscopies were performed. RESULTS: Before the onset of voice therapy, there was a significant difference (p<0.05) in mean FF, S and J, between the patients with VN and subjects from the control group. After the voice therapy period, a significant improvement (p<0.05) was found in all acoustic voice parameters. Moreover, perceptual voice analysis demonstrated improvement in all cases. Finally, videonasolaryngoscopy demonstrated that vocal nodules were no longer discernible on the vocal folds in any of the cases. CONCLUSIONS: SV-III software seems to be a safe and reliable method for providing voice therapy in children with VN. Acoustic voice parameters, perceptual data and videonasolaryngoscopy were significantly improved after the speech therapy period was completed.

Maxillary growth in patients with complete cleft lip and palate, operated on around 4-6 months of age.

BACKGROUND: The controversy about timing of cleft palate repair has been focused on early closure for improved speech versus delayed repair for enhancing maxillary growth. Early palatal repair enhances phonological development decreasing the frequency of articulation disorders associated with velopharyngeal insufficiency (VPI). In contrast, it has been described that early surgery adversely affects maxillary growth. OBJECTIVE: The purpose of this paper is to study maxillary growth in a group of cleft palate patients operated on around 4-6 months of age, and receiving further orthodontic treatment. MATERIALS AND METHODS: A group of 20 cleft palate patients, who were subjected to early minimal incision palatopharyngoplasty around 4-6 months of age, were followed for a minimum of 10 years (range: 10-14 years). All patients received the same orthodontic management, starting at 4 years of age. None of the patients had orthognatic surgery or alveolar bone grafting. After orthodontic treatment, their cephalometric data were compared with a group of subjects without cleft lip and palate, matched by gender and who were within the age range of the cleft palate group. RESULTS: SNA, SNB, ANB, and WITS cephalometric measures were compared. A non-significant difference was found in all measurements between the two groups. CONCLUSION: Early cleft palate repair enhances phonological development. Although maxillary growth is affected in cleft palate patients, appropriate orthodontic treatment can achieve normal maxillary growth as measured during adolescence.

Surgical planning for restoring velopharyngeal function in velocardiofacial syndrome.

BACKGROUND: Velocardiofacial syndrome (VCFS) is one of the most common multiple anomaly syndromes in humans. Around 70% of the cases show velopharyngeal insufficiency (VPI), as a consequence of cleft palate. VPI is much more frequent due to special abnormal conditions inherent to VCFS including: platybasia, hypotrophy of adenoid, enlarged tonsils, hypotonia and abnormal pharyngeal muscles. OBJECTIVE: To evaluate the surgical treatment of VPI in VCFS patients. MATERIALS AND METHODS: In the Hospital Gea Gonzalez at Mexico City, all cases of VCFS from January 2000 to July December 2007 were studied. All patients subjected to velopharyngeal surgery for correcting VPI were selected. Twenty-nine patients underwent velopharyngeal surgery. All operations were planned according to findings of videonasopharyngoscopy (VNP) and multiview video fluoroscopy (MVF). RESULTS: Twenty patients underwent pharyngeal flap operations, and 9 patients were operated on with a sphincter pharyngoplasty. After a pharyngeal flap, 17 cases (85%) improved to normal nasal resonance or mild hypernasality. Three flaps showed moderate hypernasality postoperatively. From the 9 sphincter pharyngoplasties, 6 cases (66%) improved to moderate hypernasality. Four patients (33%) persisted with severe hypernasality postoperatively. There were no complications. CONCLUSIONS: Tailor-made pharyngeal flaps seem to be the best option for restoring velopharyngeal function in cases of VPI in VCFS patients. The use of VNP and MVF is useful for planning the operations for VPI, and they are also useful for indicating the removal of tonsils in cases with high risk of obstruction. Moreover, VNP is also useful for preventing damage to the internal carotids which are usually displaced in VCFS patients.

Videonasopharyngoscopy is useful for identifying children with Pierre Robin sequence and severe obstructive sleep apnea.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) commonly appears in patients with Pierre Robin sequence (PR). Polysomnography (PS) is the gold standard for the diagnosis of OSAS. Videonasopharyngoscopy (VNP) is the best diagnostic tool for visualizing the vocal tract and detecting structural abnormalities which can be associated with OSAS. OBJECTIVE: The purpose of this paper is to study whether VNP can be useful for identifying severe OSAS in a population of children with PR. MATERIALS AND METHODS: Fifty-two children with PR who were present with sleep-disordered breathing were studied. All the parents completed a questionnaire concerning the children's sleeping habits and sleep complaints before consultation. Each child underwent a general pediatric examination and an evaluation of craniofacial features and upper airway permeability. In all children, a PS was performed. Also, all children underwent a VNP. RESULTS: The diagnosis of OSAS was confirmed by PS in 31 patients. VNP showed 87% sensitivity and 100% specificity for the detection of OSAS. VNP findings showed a significant correlation with apnea-hypopnea index, arousal index, snoring time, percentage of sleep time spent at saturation of oxygen <90% and a significant inverse correlation with total sleep time, sleep efficiency and the mean saturation of oxygen during sleep. CONCLUSION: This study shows that in children with PR, airway obstruction as detected by VNP seems to be a risk factor for OSAS. VNP appears to be a safe and reliable tool for the evaluation of sleep-disordered breathing in children with PR.