Effects of adenoidectomy on the speech of children with potential velopharyngeal dysfunction

Despite the absence of an overt or submucous cleft of the palate, certain children manifest persistent nasality after an adenoidectomy. Removal of the adenoid tissue has unmasked an underlying anatomic or physiologic deficit in the velopharyngeal mechanism. In an effort to identify the premonitory signs of potential difficulties, 40 children with suspected velopharyngeal dysfunction were studied prior to consideration of an adenoidectomy. Four evaluative techniques were used: (1) clinical speech evaluation, (2) cinefluorography, (3) cephalometrics, and (4) coordination pattern recordings. Each method of assessment contributed information that can serve as an “alert” to the potential consequences of a total adenoidectomy. The findings suggest the importance of careful evaluations and caution when considering a total adenoidectomy for children in whom there may exist only marginal indications of a potential velopharyngeal dysfunction. Where necessary for preservation of a child’s hearing, a lateral adenoidectomy, maintaining the midline adenoid pad, would seem indicated.