Protocol of assessment of velopharyngeal incompetence (original) (raw)
Related papers
International Archives of Otorhinolaryngology, 2014
Introduction: Velopharyngeal dysfunction may cause impaired verbal communication skills in individuals with cleft lip and palate; thus, patients with this disorder need to undergo both instrumental and auditory-perceptual assessments. Objective: To investigate the main methods used to evaluate velopharyngeal function in individuals with cleft lip and palate and to determine whether there is an association between videonasoendoscopy results and auditory-perceptual assessments. Method: We conducted a systematic review of the literature on instrumental and auditory-perceptual assessments. We searched the PubMed, Medline, Lilacs, Cochrane, and SciELO databases from October to November 2012. Summary of findings: We found 1,300 studies about the topic of interest published between 1990 and 2012. Of these, 56 studies focused on velopharyngeal physiology; 29 studies presented data on velopharyngeal physiology using at least 1 instrumental assessment and/or 1 auditory-perceptual assessment, and 12 studies associated the results of both types of assessments. Only 3 studies described in detail the analysis of both methods of evaluating velopharyngeal function; however, associations between these findings were not analyzed. Conclusion: We found few studies clearly addressing the criteria chosen to investigate velopharyngeal dysfunction and associations between videonasoendoscopy results and auditory-perceptual assessments.
Nasoendoscopy of velopharynx before and during diagnostic therapy
Journal of Applied Oral Science, 2008
asoendoscopy is an important tool for assessing velopharyngeal function. The purpose of this study was to analyze velar and pharyngeal wall movement and velopharyngeal gap during nasoendoscopic evaluation of the velopharynx before and during diagnostic therapy. Nasoendoscopic recordings of 10 children with operated cleft lip and palate were analyzed according to the International Working Group Guidelines. Ratings of movement of velum and pharyngeal walls, and size, location and shape of gaps were analyzed by 3 speech-language pathologists (SLPs). Imaging was obtained during repetitions of the syllable /pa/ during a single nasoendoscopic evaluation: (a) before diagnostic therapy, and (b) after the children were instructed to impound and increase intraoral air pressure (diagnostic therapy). Once the patients impounded and directed air pressure orally, the displacement of the velum, right, left and posterior pharyngeal walls increased 40, 70, 80, and 10%, respectively. Statistical significance for displacement was found only for right and left lateral pharyngeal walls. Reduction in gap size was observed for 30% of the patients and other 40% of the gaps disappeared. Changes in gap size were found to be statistically significant between the two conditions. In nasoendoscopic assessment, the full potential of velopharyngeal displacement may not be completely elicited when the patient is asked only to repeat a speech stimulus. Optimization of information can be done with the use of diagnostic therapy's strategies to manipulate VP function. Assuring the participation of the SLP to conduct diagnostic therapy is essential for management of velopharyngeal dysfunction.
Validation of the Mirror-Fogging Test as a Screening Tool for Velopharyngeal Insufficiency
Purpose: Comprehensive evaluation of velopharyngeal insufficiency (VPI) typically includes auditoryperceptual assessment, nasometry, and anatomical evaluations. At times, these examinations are limited by the resources, invasiveness, time and expertise required to perform them. In such instances, the mirror-fogging test would be an ideal screening tool for VPI as it can be performed simply and quickly with minimal resources. However, the sensitivity and specificity of this screening tool have yet to be documented. This study sought to validate the mirror-fogging test as a screening tool for VPI when compared to auditory-perceptual assessments and nasometry. Methods: The charts of 60 participants from our VPI clinic at a tertiary care hospital were retrospectively reviewed: 40 exhibited VPI and 20 were negative for VPI according to auditory-perceptual testing and nasometry. Nasometry scores identified a priori as two standard deviations above normal were judged to be diagnostic for VPI. Auditory-perceptual testing was deemed diagnostic for VPI with hypernasality and audible emission scores above 1 using the American Cleft Palate Association (ACPA) clinical scale for VPI. The sensitivity and specificity for the mirror-fogging test was determined using auditory-perceptual testing and nasometry as diagnostic standards. Results: The mirror-fogging test had a sensitivity of 0.95, a specificity of 0.95 and a positive predictive value of 0.97. Significantly higher auditory-perceptual scores were demonstrated for the features of hypernasality (p <0.008), audible nasal emission (p <0.001), and velopharyngeal function (p <0.001) in the mirror-fogging test positive group. Conclusion: The mirror-fogging test is highly correlated with both auditory-perceptual speech assessment and nasometry, thus, validating its utility as a screening tool for VPI.
The Use of the Aerophonoscope for Assessing Velo-Pharyngeal Incompetence and Therapeutic Decisions
Aerophonoscope is an ultra sensitive and original instrument for detecting nasal airflow and analysing the Velo-Pharyngeal Sphincter-VPS-movements. It reveals the aerodynamic function of the VPS, in the usual conditions of speaking and breathing. It has been created for patients with facial cleft, of 4 years old upwards, after primary surgery and during their growth, in a harmless, non-invasive way. There are several sorts of assessments of Velo-Pharyngeal Incompetence (VPI): from an anatomical point of view, a perceptive, acoustic, aerodynamic one. The Aerophonoscope belongs to the latter one. We know the difficulties to treat this pathology in the fields of surgery and speech therapy mostly because of misunderstanding VP physiology and physiopathology, which are complex. Then aerophonoscopy allows us to understand this complexity. So we are able to easily assess excessive Nasal Loss-NL-factors. The NL is linked mainly with a VPS persistent lack of closing, of course. But it varies according to its stiffness, tonicity, and its smaller and slower movements. The latters are according to each phoneme or syllable, and they have more or less speedy succession of the "phonological verbal chain". So we aim at presenting this instrument that enables an aerodynamic assessment of the VPS precisely. We can analyse many characteristics of its pathological movements with different tests in our protocol (passive, active, effort, successive movements and so on) and show the results of about 652 individuals. These data contribute to guide therapeutic decisions, (choice of type of surgery, targets of rehabilitation), such as to restore the VPS physiology at the very most. Furthermore, it provides a pleasant and efficient means of rehabilitation of the VPS
PubMed, 1980
A questionnaire designed to survey methods of diagnosis and management of velopharyngeal insufficiency associated with cleft palate was distributed to over 1,000 speech pathologists in the United States and Canada. There was a 60% response, and 65% of those responding were associated with cleft palate teams. Findings included: (1) 90% of responding cleft palate team members primarily rely on listener judgment, oral examination, and articulation testing in the diagnosis of velopharyngeal insufficiency (VPI) and for the recommendation of pharyngoplasty. (2) Only 11% indicated that their team had a radiologist. (3) More than half of those responding said that they would prefer palatal repair to be completed after the age of two. (4) 60% of those responding regarded VPI as a voice disorder, yet 84% treated the symptoms of VPI with articulation therapy rather than voice therapy.
Velopharyngeal insufficiency: diagnosis and management
Current Opinion in Otolaryngology & Head and Neck Surgery, 2009
Purpose of Review-Journal articles relevant to the diagnosis and treatment of velopharyngeal insufficiency (VPI) were reviewed. All articles ascertained by PubMed search were included. Recent Findings-Articles reported on the application of magnetic resonance scanning, reliability tests of the International Working Group diagnostic protocol, the use of nasometry, and techniques designed to assess the function of the velopharyngeal mechanism. Treatment papers focused on outcomes in small samples of cases and complication rates from pharyngeal flap. One paper discussed ineffective speech therapy procedures. Summary-There were relatively few papers this past year. Those that were published were hindered by small and heterogeneous sample sizes, and occasionally by inappropriate methods for assessing outcomes. None of the findings will have a major impact on the current state-of-the-art for diagnosis of VPI. The speech therapy paper has a very important message that should be taken to heart by all clinicians involved in the management of children with clefts and craniofacial disorders.
Effective Velopharyngeal Ratio: A More Clinically Relevant Measure of Velopharyngeal Function
Journal of Speech, Language, and Hearing Research
Purpose Velopharyngeal (VP) ratios are commonly used to study normal VP anatomy and normal VP function. An effective VP (EVP) ratio may be a more appropriate indicator of normal parameters for speech. The aims of this study are to examine if the VP ratio is preserved across the age span or if it varies with changes in the VP portal and to analyze if the EVP ratio is more stable across the age span. Method Magnetic resonance imaging was used to analyze VP variables of 270 participants. For statistical analysis, the participants were divided into the following groups based on age: infants, children, adolescents, and adults. Analyses of variance and a Games–Howell post hoc test were used to compare variables between groups. Results There was a statistically significant difference ( p < .05) in all measurements between the age groups. Pairwise comparisons reported statistically significant adjacent group differences ( p < .05) for velar length, VP ratio, effective velar length, ad...
International Congress Series, 2003
On the basis of the experience with 5300 various types of orofacial cleft operations, including 1130 velopharyngoplasties performed during 1959-2001, and of the 60-70 cases with velopharyngeal insufficiency (VPI) without cleft examined yearly, the author stresses that all functional consequences of velopharyngeal valve incompetence (respiratory, sucking, swallowing, speech, hearing and maxillofacial developmental disorders) should be properly assessed and managed by a multidisciplinary team. In cases with Robin-sequence, polysomnography is recommended to predict prognosis, risks and optimal time of palatoplasty which may increase respiratory problems. For assessment of oropharyngeal dysphagia due to facial clefts and VPI, cinefluoroscopy and videonasopharyngoscopy are appropriate. In the diagnosis of speech disorders, the auditive-perceptive evaluation, articulatory, speech intelligibility and teachability tests with five-point rating scale are fundamental. Among the instrumental procedures, endoscopic and radiological methods and nasometry are the most informative; to detect neuromyogen causes, electrophysiological examinations are indicated. The development of the maxillofacial complex may be followed by lateral cephalometry. Hearing disorders should be revealed continuously with subjective and objective methods (ERA, OAE, tympanometry). The management of VPI depends on the etiology. Phoniatric/logopedic and phonosurgical therapy is indicated only when neuromyogen processes are undoubtedly excluded. Regarding ear and hearing disorders, grommet and adenoidectomy may be considered as alternative methods. In developing countries, the assessment and management of VPI are recommended on three levels. On the first level basic diagnostic methods; on the second level nasopharyngo-endoscopy, X-ray methods and speech 0531-5131/ D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved.