Models for Predicting Velopharyngeal Competence Based on Speech and Resonance Errors and Velopharyngeal Area Estimation.

OBJECTIVE: To develop tools for predicting velopharyngeal competence (VPC) based on auditory-perceptual assessment and its correlation with objective measures of velopharyngeal orifice area. DESIGN: Methodological study. PARTICIPANTS AND METHODS: Sixty-two patients with repaired cleft palate, aged 6 to 45 years, underwent aerodynamic evaluation by means of the pressure-flow technique and audiovisual recording of speech samples. Three experienced speech-language pathologists analysed the speech samples by rating the following resonance, visual, and speech variables: hypernasality, audible nasal air emission, nasal turbulence, weak pressure consonants, facial grimacing, active nonoral errors, and overall velopharyngeal competence. The correlation between the perceptual speech variables and velopharyngeal orifice area estimates was analysed with Spearman's correlation coefficient. Two statistical models (discriminant and exploratory) were used to predict VPC based on the orifice area estimates. Sensitivity and specificity analyses were performed to verify the clinical applicability of the models. RESULTS: There was a strong correlation between VPC (based on the orifice area estimates) and each speech variable. Both models showed 88.7% accuracy in predicting VPC. The sensitivity and specificity for the discriminant model were 92.3% and 97.2%, respectively, and 96.2% and 94.4% for the exploratory model. CONCLUSION: Two predictor models based on ratings of resonance, visual, and speech variables and a simple calculation of a composite variable, SOMA (Eng. "sum"), were developed and found to be efficient in predicting VPC defined by orifice estimates categories based on aerodynamic measurements. Both tools may contribute to the diagnosis of velopharyngeal dysfunction in clinical practice.

Facial grimace during speech in cleft lip and palate: a proposal for classification. / Mímica facial durante a fala em fissura labiopalatina: uma proposta de classificação.

PURPOSE: To investigate the effectiveness of a proposal for classification of facial grimace (FG) and its correlation with objective evaluation of velopharyngeal closure (VPC). METHODS: Twenty individuals with repaired cleft lip and palate underwent velopharyngeal area measurement by means of rhinomanometry and speech sample recording. The FG was rated in two steps, by three speech-language pathologists. First the evaluators rated the FG using their own criteria as: 1= absent FG; 2=mild; 3=moderate; 4=severe. Subsequently, they were submitted to a training session that established the following FG rating criteria: 1=absent FG; 2=movement only of the nose or upper third of the face; 3=strong movement of the nose or upper third of the face; 4=movement of the nose and upper third of the face. The evaluators rated the FG using the established criteria. Intra- and inter-rater agreement were calculated using weighted Kappa coefficient. Correlation between the two stage ratings with the VPC was calculated by Spearman's correlation coefficient. RESULTS: In the first stage inter-rater agreement ranged from fair to substantial; in the second stage, from substantial to almost perfect. Intra-rater agreement ranged from moderate to almost perfect in the first stage, and from moderate to substantial in the second stage. The correlation between FG and velopharyngeal area was positive and significant in both stages. CONCLUSION: The proposed FG judgement proved to be effective in determining the symptom and reliable in diagnosing the severity of velopharyngeal dysfunction. The significant correlation between perceptual and instrumental methods suggests that FG can be used in predicting VPC.

OBJETIVO: Investigar a efetividade de proposta de classificação da mímica facial (MF), e sua correlação com avaliação objetiva do fechamento velofaríngeo (FVF). MÉTODO: Vinte indivíduos com fissura labiopalatina reparada foram submetidos à medida da área velofaríngea por meio da rinomanometria e à gravação de amostra de fala. A MF foi classificada em dois momentos, por três fonoaudiólogas. Inicialmente as avaliadoras classificaram a MF, utilizando critérios próprios, em: 1=MF ausente; 2=leve; 3=moderada; 4=grave. Posteriormente, foram submetidas a um treinamento com o estabelecimento dos seguintes critérios de classificação: 1=MF normal; 2=movimento somente de nariz ou terço superior da face; 3=movimento acentuado de nariz ou terço superior da face; 4=movimento de nariz e terço superior da face e, classificaram a MF utilizando os critérios estabelecidos. Concordância intra e interavaliadores foram calculadas pelo coeficiente Kappa ponderado. A correlação entre os resultados das etapas com o FVF foi feita pelo coeficiente de correlação de Spearman. RESULTADOS: Na primeira etapa, a concordância interavaliadores variou de regular a substancial e na segunda, de substancial a quase perfeita. A concordância intra-avaliadores variou de moderada a quase perfeita na primeira etapa, e de moderada a substancial, na segunda etapa. A correlação entre a MF e área velofaríngea na primeira e na segunda etapa foi positiva e significativa. CONCLUSÃO: A proposta de julgamento da MF mostrou-se efetiva na determinação do sintoma e confiável no diagnóstico da gravidade da disfunção velofaríngea. A correlação significativa entre os métodos perceptivo e instrumental sugere que a MF pode ser utilizada na previsão do FVF.

Mímica facial durante a fala em fissura labiopalatina: uma proposta de classificação / Facial grimace during speech in cleft lip and palate: a proposal for classification

RESUMO Objetivo Investigar a efetividade de proposta de classificação da mímica facial (MF), e sua correlação com avaliação objetiva do fechamento velofaríngeo (FVF). Método Vinte indivíduos com fissura labiopalatina reparada foram submetidos à medida da área velofaríngea por meio da rinomanometria e à gravação de amostra de fala. A MF foi classificada em dois momentos, por três fonoaudiólogas. Inicialmente as avaliadoras classificaram a MF, utilizando critérios próprios, em: 1=MF ausente; 2=leve; 3=moderada; 4=grave. Posteriormente, foram submetidas a um treinamento com o estabelecimento dos seguintes critérios de classificação: 1=MF normal; 2=movimento somente de nariz ou terço superior da face; 3=movimento acentuado de nariz ou terço superior da face; 4=movimento de nariz e terço superior da face e, classificaram a MF utilizando os critérios estabelecidos. Concordância intra e interavaliadores foram calculadas pelo coeficiente Kappa ponderado. A correlação entre os resultados das etapas com o FVF foi feita pelo coeficiente de correlação de Spearman. Resultados Na primeira etapa, a concordância interavaliadores variou de regular a substancial e na segunda, de substancial a quase perfeita. A concordância intra-avaliadores variou de moderada a quase perfeita na primeira etapa, e de moderada a substancial, na segunda etapa. A correlação entre a MF e área velofaríngea na primeira e na segunda etapa foi positiva e significativa. Conclusão A proposta de julgamento da MF mostrou-se efetiva na determinação do sintoma e confiável no diagnóstico da gravidade da disfunção velofaríngea. A correlação significativa entre os métodos perceptivo e instrumental sugere que a MF pode ser utilizada na previsão do FVF.

ABSTRACT Purpose To investigate the effectiveness of a proposal for classification of facial grimace (FG) and its correlation with objective evaluation of velopharyngeal closure (VPC). Methods Twenty individuals with repaired cleft lip and palate underwent velopharyngeal area measurement by means of rhinomanometry and speech sample recording. The FG was rated in two steps, by three speech-language pathologists. First the evaluators rated the FG using their own criteria as: 1= absent FG; 2=mild; 3=moderate; 4=severe. Subsequently, they were submitted to a training session that established the following FG rating criteria: 1=absent FG; 2=movement only of the nose or upper third of the face; 3=strong movement of the nose or upper third of the face; 4=movement of the nose and upper third of the face. The evaluators rated the FG using the established criteria. Intra- and inter-rater agreement were calculated using weighted Kappa coefficient. Correlation between the two stage ratings with the VPC was calculated by Spearman's correlation coefficient. Results In the first stage inter-rater agreement ranged from fair to substantial; in the second stage, from substantial to almost perfect. Intra-rater agreement ranged from moderate to almost perfect in the first stage, and from moderate to substantial in the second stage. The correlation between FG and velopharyngeal area was positive and significant in both stages. Conclusion The proposed FG judgement proved to be effective in determining the symptom and reliable in diagnosing the severity of velopharyngeal dysfunction. The significant correlation between perceptual and instrumental methods suggests that FG can be used in predicting VPC.

Borg scale: a new method for hypernasality rating. / Escala de Borg: um novo método para avaliação da hipernasalidade de fala.

PURPOSE: To investigate the reliability in auditory-perceptual assessment of hypernasality of the Borg centiMax scale and the influence of the speech material on the reliability of two scales. METHODS: Four experienced speech-language pathologists rated hypernasality of 80 audio recordings of patients with repaired cleft palate (40 single-word string and 40 sentences) using the 5-point ordinal scale and the Borg centiMax scale. Intra and inter-rater reliability were calculated for both scales and for both types of speech samples. The comparison between the agreement coefficients of the two speech samples was calculated using the Z test and between the scales was calculated by Spearman correlation coefficient, considering as significant p<0.05. RESULTS: A very high and statistically significant correlation was found between the Borg centiMax scale and the ordinal scale for both speech samples. Intra- and inter-rater reliability was higher for Borg scale as compared to ordinal scale. Good to excellent intra-rater reliability was found for Borg scale for both speech samples. Poor to excellent intra-rater reliability was found for ordinal scale for both stimuli. Higher inter-rater reliability was demonstrated for Borg scale than ordinal scale for both speech samples. There was a significant difference between the single words string and sentences for intra- and inter-rater reliability using Borg scale, and for inter-rater reliability using ordinal scale. CONCLUSION: The Borg centiMax scale showed better intra and inter-rater reliability. Additionally, the speech material comprising of single words string showed better reliability in most of the comparisons for both scales.

OBJETIVO: Investigar a confiabilidade da escala Borg centiMax como método de avaliação perceptivo-auditiva da hipernasalidade e a influência do tipo de amostra de fala sobre a confiabilidade das avaliações. MÉTODO: Quatro fonoaudiólogas experientes classificaram a hipernasalidade de 80 amostras de fala de pacientes com fissura de palato reparada (40 vocábulos e 40 sentenças) utilizando a escala ordinal de 5 pontos e a escala Borg centiMax. Os índices de concordância intra e interavaliadores foram estabelecidos para ambas as escalas e amostras. A comparação desses índices foi feita pelo teste Z e a comparação entre as escalas foi feita pelo coeficiente de correlação de Spearman (p<0,05). RESULTADOS: Verificou-se correlação muito alta e significante entre a Escala Borg centiMax e a escala ordinal, para ambas as amostras. Os índices de concordância intra-avaliadores (CCI) para a escala Borg centiMax variaram de excelente a bom e, para a escala ordinal (Kappa), de excelente a pobre, em ambas as amostras. A concordância interavaliadores (CCI) para a escala Borg centiMax variou de excelente a moderada e, para a escala ordinal (Kappa), variou de moderada a pobre, para vocábulos e sentenças. Diferença estatisticamente significante, com melhores índices de concordância intra e interavaliadores para vocábulos, foi obtida com a escala Borg centiMax. Para a escala ordinal, diferença significante entre vocábulos e sentenças foi observada apenas para a comparação interavaliador. CONCLUSÃO: A escala Borg centiMax apresentou melhores índices de concordância intra e interavaliadores. A amostra contendo vocábulos mostrou melhores índices de concordância na maioria das comparações, para ambas as escalas.

Comparação entre duas abordagens diferentes de tratamento cirúrgico da insuficiência velofaríngea / Comparison between two different approaches of surgical management for velopharyngeal insufficiency

RESUMO Introdução A palatoplastia secundária com veloplastia intravelar (VI) pode ser realizada previamente ao retalho faríngeo (RF), para o tratamento cirúrgico da insuficiência velofaríngea em pacientes com fissura palatina. Esta abordagem cirúrgica tem como finalidade melhorar as condições velofaríngeas, evitando, assim, a indicação de um retalho faríngeo largo e seus efeitos indesejáveis sobre a respiração. Objetivo Investigar os efeitos do retalho faríngeo realizado após a veloplastia intravelar para tratamento da insuficiência velofaríngea sobre a nasalidade e a respiração. Métodos Análise dos resultados pós-cirúrgicos da nasalidade de fala e da respiração de 50 indivíduos com fissura de palato reparada e insuficiência velofaríngea, sendo 23 submetidos ao retalho faríngeo após a veloplastia intravelar (Grupo VI+RF) e 27 submetidos unicamente ao retalho faríngeo (Grupo RF). A nasalidade foi determinada pela nasometria e o efeito da cirurgia sobre a respiração foi analisado pela medida da área de secção transversa mínima nasofaríngea, obtida pela técnica fluxo-pressão e pelo levantamento das queixas respiratórias, utilizando questionário específico. A comparação estatística entre os grupos foi realizada por meio do teste Mann-Whitney e teste t de Student, considerando significante o valor de p<0,05. Resultados Verificou-se que não houve diferença entre os grupos para os resultados de nasalidade, da medida da área nasofaríngea e do levantamento de queixas respiratórias. Conclusão Ambas as abordagens para tratamento cirúrgico da insuficiência velofaríngea mostraram resultados equivalentes, no que se refere à eliminação da hipernasalidade, bem como à condição da respiração, sugerindo que a realização do retalho faríngeo após a veloplastia intravelar não levou a melhores resultados de ressonância de fala e não favoreceu a respiração.

ABSTRACT Introduction Secondary palatoplasty with intravelar veloplasty (IV) may be performed before pharyngeal flap (PF) for surgical treatment of velopharyngeal insufficiency in individuals with cleft palate. This surgical approach aims to improve the velopharyngeal conditions, thus avoiding indication of a large pharyngeal flap and its undesirable effects on respiration. Purpose To investigate the effects of pharyngeal flap performed after intravelar veloplasty for the treatment of velopharyngeal insufficiency on nasality and respiration. Methods Analysis of postoperative outcomes of speech nasality and respiration in 50 individuals with repaired cleft palate and velopharyngeal insufficiency, being 23 submitted to pharyngeal flap after intravelar veloplasty (Group IV+PF) and 27 submitted only to pharyngeal flap (Group PF). Nasality was determined by nasometry, and the effect of surgery on respiration was assessed by measuring the minimum nasopharyngeal transverse section area, obtained by the pressure-flow technique and investigation of respiratory complaints, using a specific questionnaire. Statistical comparison between groups was performed by the Mann-Whitney test and Student t test, at a significance level of p<0.05. Results There was no difference between groups for the outcomes of nasality, measurement of nasopharyngeal area and investigation of respiratory complaints. Conclusion Both approaches for surgical treatment of velopharyngeal insufficiency demonstrated similar outcomes concerning the elimination of hypernasality, as well as for respiration, suggesting that accomplishment of pharyngeal flap after intravelar veloplasty did not provide better speech resonance outcomes nor favored respiration.

The influence of listener training on the perceptual assessment of hypernasality. / Influência do treinamento dos avaliadores no julgamento perceptivo da hipernasalidade.

Introduction A high agreement in the perceptual assessment of hypernasality among different listeners is difficult to achieve. Prior listener training and the standardization of analysis criteria may be effective strategies to decrease the effect of perceptual assessment subjectivity and increase the agreement among listeners. Objective To investigate the influence of prior training on agreement among different listeners in the perceptual assessment of hypernasality. Methods Three experienced speech-language pathologists analyzed 77 audio-recorded speech samples of individuals with repaired cleft palate. During the first phase, the listeners classified hypernasality according to their own criteria, using a 4-point scale. Seventy days later, they were required to complete the training to define the stimuli to be used as anchors for the assessment in the following phase. During the second phase, the listeners analyzed the same samples and rated hypernasality in a 4-point scale, using the anchors defined during training as the criteria. Intra- and interrater agreement in both the phases were calculated by the kappa coefficient. These values were statistically compared using the Z-test. Results The intrarater agreement obtained between the two phases of the study ranged from 0.38 to 0.92, with a statistically significant difference for one of the listeners (p=0.004). The agreement for the hypernasality degree obtained among the three listeners after training (0.54) was significantly higher than that obtained before training (0.37; p=0.044). Conclusion Listener training and the definition of criteria to rate hypernasality lead to the increase of intra- and interrater agreement.

Influência do treinamento dos avaliadores no julgamento perceptivo da hipernasalidade / The influence of listener training on the perceptual assessment of hypernasality

RESUMO Introdução Alto índice de concordância no julgamento perceptivo da hipernasalidade entre diferentes avaliadores é difícil de ser alcançado. O treinamento prévio dos avaliadores e a padronização dos critérios de análise podem ser estratégias eficazes para minimizar o efeito da subjetividade do julgamento perceptivo e aumentar a concordância entre os avaliadores. Objetivo Investigar a influência do treinamento prévio sobre a concordância entre diferentes avaliadores no julgamento perceptivo da hipernasalidade. Métodos Três fonoaudiólogas experientes analisaram 77 amostras de fala, de indivíduos com fissura de palato reparada. Na primeira etapa, as avaliadoras classificaram a hipernasalidade utilizando seus próprios critérios, em uma escala de quatro pontos. Setenta dias depois, foram submetidas a um treinamento para a definição das amostras utilizadas como referências para o julgamento na etapa seguinte. Na segunda etapa as avaliadoras julgaram as mesmas amostras e classificaram a hipernasalidade com a mesma escala, utilizando como critério as referências definidas no treinamento. Índices de concordância intra e interavaliadores foram estabelecidos nas duas etapas utilizando-se o coeficiente Kappa e foram comparados por meio do teste Z. Resultados Os índices de concordância intra-avaliadores obtidos entre as duas etapas variou de 0,38 para 0,92, com diferença estatisticamente significativa para uma das avaliadoras (p=0,004). O índice de concordância quanto ao grau de hipernasalidade obtido entre as três avaliadoras após o treinamento (0,54) foi significativamente maior do que o obtido antes do treinamento (0,37; p=0,044). Conclusão O treinamento das avaliadoras e a definição de critérios para a classificação da hipernasalidade levam ao aumento do índice de concordância intra e interavaliadores.

ABSTRACT Introduction A high agreement in the perceptual assessment of hypernasality among different listeners is difficult to achieve. Prior listener training and the standardization of analysis criteria may be effective strategies to decrease the effect of perceptual assessment subjectivity and increase the agreement among listeners. Objective To investigate the influence of prior training on agreement among different listeners in the perceptual assessment of hypernasality. Methods Three experienced speech–language pathologists analyzed 77 audio-recorded speech samples of individuals with repaired cleft palate. During the first phase, the listeners classified hypernasality according to their own criteria, using a 4-point scale. Seventy days later, they were required to complete the training to define the stimuli to be used as anchors for the assessment in the following phase. During the second phase, the listeners analyzed the same samples and rated hypernasality in a 4-point scale, using the anchors defined during training as the criteria. Intra- and interrater agreement in both the phases were calculated by the kappa coefficient. These values were statistically compared using the Z-test. Results The intrarater agreement obtained between the two phases of the study ranged from 0.38 to 0.92, with a statistically significant difference for one of the listeners (p=0.004). The agreement for the hypernasality degree obtained among the three listeners after training (0.54) was significantly higher than that obtained before training (0.37; p=0.044). Conclusion Listener training and the definition of criteria to rate hypernasality lead to the increase of intra- and interrater agreement.

Relationship between velopharyngeal closure, hypernasality, nasal air emission and nasal rustle in subjects with repaired cleft palate.

PURPOSE: To investigate the correlation among velopharyngeal closure, hypernasality, audible nasal air emission (NAE) and nasal rustle (NR), in individuals with repaired cleft palate. METHODS: One hundred patients with repaired cleft palate and lip, submitted to pressure-flow study for measurement of velopharyngeal orifice area (velopharyngeal area) and speech sample recordings. Velopharyngeal area was estimated during the production of the sound /p/ inserted in a sentence, and the velopharyngeal closure was classified as adequate, borderline or inadequate. Hypernasality was rated using a 4-point scale, NAE and NR were rated as absent or present, by three speech language pathologists, using recorded speech samples. Inter and intra-judge agreements were established. Statistical analysis was performed using the Spearman correlation coefficient considering p<0.05. An ordinal logistic regression model was developed to investigate whether the characteristics of speech can predict velopharyngeal closure. For this, the speech samples included in this analysis were those that obtained 100% agreement among raters as to the degree of hypernasality (43 out of 100). RESULTS: Significant correlation was found between hypernasality and velopharyngeal area; audible NAE and velopharyngeal area. A negative correlation was observed between the NR and velopharyngeal area. The regression analysis showed that the perceptual speech characteristics contributed significantly to predict the velopharyngeal closure. CONCLUSION: There is significant correlation between velopharyngeal closure and hypernasality, NAE and NR. It suggests that the perceptual speech characteristics can predict velopharyngeal closure, favoring the diagnosis and the definition of treatment conduct of velopharyngeal dysfunction.

Relationship between velopharyngeal closure, hypernasality, nasal air emission and nasal rustle in subjects with repaired cleft palate / Correlação entre o fechamento velofaríngeo, hipernasalidade, emissão de ar nasal e ronco nasal em indivíduos com fissura de palato reparada

PURPOSE: To investigate the correlation among velopharyngeal closure, hypernasality, audible nasal air emission (NAE) and nasal rustle (NR), in individuals with repaired cleft palate. METHODS: One hundred patients with repaired cleft palate and lip, submitted to pressure-flow study for measurement of velopharyngeal orifice area (velopharyngeal area) and speech sample recordings. Velopharyngeal area was estimated during the production of the sound /p/ inserted in a sentence, and the velopharyngeal closure was classified as adequate, borderline or inadequate. Hypernasality was rated using a 4-point scale, NAE and NR were rated as absent or present, by three speech language pathologists, using recorded speech samples. Inter and intra-judge agreements were established. Statistical analysis was performed using the Spearman correlation coefficient considering p<0.05. An ordinal logistic regression model was developed to investigate whether the characteristics of speech can predict velopharyngeal closure. For this, the speech samples included in this analysis were those that obtained 100% agreement among raters as to the degree of hypernasality (43 out of 100). RESULTS: Significant correlation was found between hypernasality and velopharyngeal area; audible NAE and velopharyngeal area. A negative correlation was observed between the NR and velopharyngeal area. The regression analysis showed that the perceptual speech characteristics contributed significantly to predict the velopharyngeal closure. CONCLUSION: There is significant correlation between velopharyngeal closure and hypernasality, NAE and NR. It suggests that the perceptual speech characteristics can predict velopharyngeal closure, favoring the diagnosis and the definition of treatment conduct of velopharyngeal dysfunction. .

OBJETIVO: Investigar a correlação entre as dimensões do orifício velofaríngeo, hipernasalidade, emissão de ar nasal (EAN) audível e ronco nasal (RN), em indivíduos com fissura palatina reparada. MÉTODOS: Foram avaliados cem pacientes com fissura labiopalatina reparada, submetidos à medida da área do orifício velofaríngeo (área velofaríngea) por meio da técnica fluxo-pressão e à gravação de fala. A partir da área velofaríngea, determinada durante a produção de /p/ inserido numa frase, o fechamento velofaríngeo foi classificado em adequado, marginal e inadequado. A hipernasalidade foi classificada em escala de quatro pontos, EAN e RN em presente-ausente, por três fonoaudiólogas utilizando amostra de fala gravada. A concordância inter e intra-avaliadores foi estabelecida e a correlação entre as variáveis foi analisada por meio do coeficiente de correlação de Spearman, considerando p<0,05. Um modelo de regressão logística ordinal foi elaborado para investigar se as características da fala podem predizer o fechamento velofaríngeo. Para tanto, foram incluídas somente 43 amostras de fala que obtiveram 100% de concordância quanto ao grau de hipernasalidade entre as avaliadoras. RESULTADOS: Correlação significativa entre hipernasalidade e área velofaríngea; EAN audível e área velofaríngea. Correlação negativa foi verificada entre RN e área velofaríngea. O modelo logístico mostrou que as características da fala contribuíram significativamente para a previsão do fechamento velofaríngeo. CONCLUSÃO: Existe correlação entre dimensões do orifício velofaríngeo e hipernasalidade, EAN e RN, sugerindo que as características perceptivas da fala podem predizer o fechamento velofaríngeo, favorecendo o diagnóstico e a definição de conduta de tratamento da disfunção velofaríngea. .

Impact of inter-judge agreement on perceptual judgment of nasality.

PURPOSE: To investigate the effect of perceptual inter-judge agreement of hypernasality on velopharyngeal (VP) closure prediction. METHODS: Two logistic regression models were developed aiming to verify the possibility of predicting the VP closure using the following characteristics: rating of VP closure (adequate, borderline, inadequate), determined by the pressure-flow technique, degree of hypernasality (absent, mild, moderate, severe), and the presence/absence of nasal air emission and nasal rustle determined perceptually by three experienced speech language pathologists. In the first model, 100 speech samples with a moderate agreement rate of hypernasality (kappa coefficient: 0.41) were used. In the second model, 43 speech samples with a perfect agreement among judges were included. The χ²-test was used to compare the models (p≤0.05). RESULTS: In the first model, 65 of the 100 samples were rated in the correct VP closure category, with 42 adequate and 23 inadequate. The borderline VP closure was not predicted. The second model rated 31 of the 43 samples in the correct category, with 21 adequate VP closure, 5 in the borderline VP closure, and 5 inadequate. There was no difference (p=0.526) between the two models. However, the second model showed a higher proportion of accuracy (7%) than the first one, and it has also predicted the borderline VP closure. CONCLUSION: These results showed the importance of high index of inter-judge agreement when using subjective parameters of speech evaluation, especially when compared to an instrumental evaluation. This suggests the need for strategies for training and calibration of judges in the perceptual judgment to improve the reliability of auditory-perceptual assessment.

Surgical outcome of pharyngeal flap surgery and intravelar veloplasty on the velopharyngeal function / Resultado cirurgico do retalho faringeo e da veloplastia intravelar sobre a funcao velofaringea

PURPOSE: To investigate the postoperative outcomes of pharyngeal flap surgery (PF) and secondary palatoplasty with intravelar veloplasty (IV) in the velopharyngeal insufficiency management regarding nasalance scores and velopharyngeal area. METHODS: Seventy-eight patients with cleft palate±lips submitted to surgical treatment for velopharyngeal insufficiency, for 14 months on an average, were evaluated: 40 with PF and 38 with IV, of both genders, aged between 6 and 52 years old. Hypernasality was estimated by means of nasalance scores obtained by nasometry with a cutoff score of 27%. The measurement of velopharyngeal orifice area was provided by the pressure-flow technique and velopharyngeal closure was classified as: adequate (0.000-0.049 cm2), adequate/borderline (0.050-0.099 cm2), borderline/inadequate (0.100-0.199 cm2), and inadequate (≥0.200 cm2). RESULTS: Absence of hypernasality was observed in 70% of the cases and adequate velopharyngeal closure was observed in 80% of the cases, in the PF group. In the IV group, absence of hypernasality was observed in 34% and adequate velopharyngeal closure was observed in 50% of the patients. Statistically significant differences were obtained between the two techniques for both evaluations. CONCLUSION: PF was more efficient than the secondary palatoplasty with IV to reduce hypernasality and get adequate velopharyngeal closure. .

OBJETIVO: Investigar os resultados cirúrgicos do retalho faríngeo (RF) e da palatoplastia secundária com veloplastia intravelar (VI) no tratamento de indivíduos com insuficiência velofaríngea (IVF) secundária quanto ao escore de nasalância e à área velofaríngea. MÉTODOS: Foram avaliados 78 pacientes com fissura de palato±lábio submetidos ao tratamento cirúrgico da IVF há 14 meses, em média, sendo 40 com RF e 38 com VI, de ambos os sexos, faixa etária de seis a 52 anos. A hipernasalidade foi estimada a partir da medida de nasalância obtida por meio da nasometria, considerando-se o escore de 27% como limite de normalidade. A medida da área do orifício velofaríngeo foi obtida por meio da técnica fluxo-pressão, sendo o fechamento velofaríngeo classificado em: adequado (0,000-0,049 cm2); adequado/marginal (0,050-0,099 cm2); marginal/inadequado (0,100-0,199 cm2); e inadequado (≥0,200 cm2). RESULTADOS: Ausência de hipernasalidade foi observada em 70%, e fechamento velofaríngeo adequado em 80% dos casos no grupo RF. No grupo VI, ausência de hipernasalidade foi observada em 34% e fechamento velofaríngeo adequado em 50% dos casos. Diferenças estatisticamente significantes foram obtidas entre as duas técnicas cirúrgicas nas duas modalidades de avaliação. CONCLUSÃO: A cirurgia de retalho faríngeo foi mais eficiente do que a palatoplastia secundária com veloplastia intravelar na redução da hipernasalidade e na adequação do fechamento velofaríngeo. .

Surgical outcome of pharyngeal flap surgery and intravelar veloplasty on the velopharyngeal function.

PURPOSE: To investigate the postoperative outcomes of pharyngeal flap surgery (PF) and secondary palatoplasty with intravelar veloplasty (IV) in the velopharyngeal insufficiency management regarding nasalance scores and velopharyngeal area. METHODS: Seventy-eight patients with cleft palate±lips submitted to surgical treatment for velopharyngeal insufficiency, for 14 months on an average, were evaluated: 40 with PF and 38 with IV, of both genders, aged between 6 and 52 years old. Hypernasality was estimated by means of nasalance scores obtained by nasometry with a cutoff score of 27%. The measurement of velopharyngeal orifice area was provided by the pressure-flow technique and velopharyngeal closure was classified as: adequate (0.000-0.049 cm²), adequate/borderline (0.050-0.099 cm²), borderline/inadequate (0.100-0.199 cm²), and inadequate (≥0.200 cm²). RESULTS: Absence of hypernasality was observed in 70% of the cases and adequate velopharyngeal closure was observed in 80% of the cases, in the PF group. In the IV group, absence of hypernasality was observed in 34% and adequate velopharyngeal closure was observed in 50% of the patients. Statistically significant differences were obtained between the two techniques for both evaluations. CONCLUSION: PF was more efficient than the secondary palatoplasty with IV to reduce hypernasality and get adequate velopharyngeal closure.