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Lucas C, Torres-Guzman R, James AJ, Corlew S, Stone A, Powell ME, Golinko M, Pontell ME. Machine Learning for Automatic Detection of Velopharyngeal Dysfunction: A Preliminary Report. J Craniofac Surg 2024:00001665-990000000-01509. [PMID: 38709082 DOI: 10.1097/scs.0000000000010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/16/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Even after palatoplasty, the incidence of velopharyngeal dysfunction (VPD) can reach 30%; however, these estimates arise from high-income countries (HICs) where speech-language pathologists (SLP) are part of standardized cleft teams. The VPD burden in low- and middle-income countries (LMICs) is unknown. This study aims to develop a machine-learning model that can detect the presence of VPD using audio samples alone. METHODS Case and control audio samples were obtained from institutional and publicly available sources. A machine-learning model was built using Python software. RESULTS The initial 110 audio samples used to test and train the model were retested after format conversion and file deidentification. Each sample was tested 5 times yielding a precision of 100%. Sensitivity was 92.73% (95% CI: 82.41%-97.98%) and specificity was 98.18% (95% CI: 90.28%-99.95%). One hundred thirteen prospective samples, which had not yet interacted with the model, were then tested. Precision was again 100% with a sensitivity of 88.89% (95% CI: 78.44%-95.41%) and a specificity of 66% (95% CI: 51.23%-78.79%). DISCUSSION VPD affects nearly 100% of patients with unrepaired overt soft palatal clefts and up to 30% of patients who have undergone palatoplasty. VPD can render patients unintelligible, thereby accruing significant psychosocial morbidity. The true burden of VPD in LMICs is unknown, and likely exceeds estimates from HICs. The ability to access a phone-based screening machine-learning model could expand access to diagnostic, and potentially therapeutic modalities for an innumerable amount of patients worldwide who suffer from VPD.
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Affiliation(s)
- Claiborne Lucas
- Department of General Surgery, Prisma Health Greenville, Greenville, SC
| | | | - Andrew J James
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott Corlew
- Blavatnik Institute of Global Health & Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Amy Stone
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center
| | - Maria E Powell
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center
| | - Michael Golinko
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Division of Pediatric Plastic Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Matthew E Pontell
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Division of Pediatric Plastic Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN
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Arganbright J. Surgical Management of Velopharyngeal Dysfunction. Facial Plast Surg Clin North Am 2024; 32:69-83. [PMID: 37981418 DOI: 10.1016/j.fsc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Velopharyngeal dysfunction (VPD) is caused by inadequate closure of the velopharyngeal port. VPD can hinder a child's ability to communicate and can impact his/her quality of life. Evaluation of children with VPD is often completed in a multidisciplinary setting and often involves studies that allow for the visualization of the velopharyngeal closure during voluntary speech (ie, nasopharyngoscopy). Multiple surgical options exist for the treatment of VPD including pharyngeal flap, sphincter pharyngoplasty, buccal myomucosal flaps, Furlow palatoplasty, palate re-repair, intravelar veloplasty, and injection pharyngoplasty. Each speech surgery has its unique benefits and drawbacks and the decision on which surgery to recommend should be tailored to each patient's specific needs and weighing the risk/benefit profile for their specific surgeries.
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Affiliation(s)
- Jill Arganbright
- Children's Mercy Hospital, University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
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Kinter S, Kotlarek K, Meehan A, Heike C. Characterizing Speech Phenotype in Individuals With Craniofacial Microsomia: A Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:485-504. [PMID: 37931079 PMCID: PMC11001184 DOI: 10.1044/2023_ajslp-23-00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Craniofacial microsomia (CFM) is a complex congenital condition primarily affecting the ear, mandible, facial nerve and muscles, and tongue. Individuals with CFM are at increased risk of hearing loss, obstructive sleep apnea, and feeding/swallowing difficulties. The purpose of this scoping review was to summarize evidence pertaining to speech production in CFM. METHOD All articles reporting any characteristic of speech production in CFM were included and screened by two independent reviewers by title, abstract, and full text. Data charting captured details related to study population and design, CFM diagnostic criteria, speech outcome measurement, and key findings. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist guided reporting of results. Our protocol was registered on the Open Science Framework (https://osf.io/npr94/) and published elsewhere. RESULTS Forty-five articles were included in the detailed review. Most articles originated from the United States, were published in the past decade, and utilized case report/series study design. A speech-language pathologist authored 29%. The prevalence of velopharyngeal insufficiency ranged from 19% to 55% among studies. Oral distortion of alveolar and palatal fricatives and affricates primarily characterized articulation errors. Studies identified increased disordered speech and lower intelligibility in adolescents with CFM compared to unaffected peers. Evidence pertaining to phonatory and respiratory speech findings is limited. CONCLUSIONS Evidence supports that individuals with CFM are at increased risk of both velopharyngeal and articulatory speech differences. Additional information is needed to develop speech screening guidelines for children with CFM. Heterogeneity in study design and outcome measurement precludes comparisons across studies. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24424555.
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Affiliation(s)
- Sara Kinter
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle
- Craniofacial Center, Seattle Children's Hospital, WA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, WA
| | - Katelyn Kotlarek
- Division of Communication Disorders, College of Health Sciences, University of Wyoming, Laramie
| | - Anna Meehan
- Craniofacial Center, Seattle Children's Hospital, WA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, WA
| | - Carrie Heike
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle
- Craniofacial Center, Seattle Children's Hospital, WA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, WA
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Hofman L, van Dongen JA, van Rees RCM, Jenniskens K, Haverkamp SJ, Beentjes YS, van der Molen ABM, Paes EC. Speech correcting surgery after primary palatoplasty: a systematic literature review and meta-analysis. Clin Oral Investig 2023; 28:58. [PMID: 38157017 DOI: 10.1007/s00784-023-05391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES In cleft palate patients, the soft palate is commonly closed using straight-line palatoplasty, Z-palatoplasty, or palatoplasty with buccal flaps. Currently, it is unknown which surgical technique is superior regarding speech outcomes. The aim of this review is to study the incidence of speech correcting surgery (SCS) per soft palatoplasty technique and to identify variables which are associated with this outcome. MATERIALS AND METHODS A systematic literature search was carried out according to the PRISMA guidelines. Inclusion and exclusion criteria were applied to focus on the incidence of SCS after soft palatoplasty. Additional variables like surgical modification, cleft morphology, syndrome, age at palatoplasty, fistula and assessment of velopharyngeal function were reported. A modified New-Ottawa Scale (NOS) was used for quality appraisal. Pooled estimates from the meta-analysis were calculated using a random-effects model. RESULTS One thousand twenty-nine studies were found of which 54 were included in the analysis. The pooled estimate proportion of SCS after straight-line palatoplasty was 19% (95% CI 15-24), after Z-palatoplasty 6% (95% CI 4-9), and after palatoplasty with buccal flaps 7% (95% CI 4-11). CONCLUSIONS A lower SCS rate was found in patients receiving Z-palatoplasty when compared to straight-line palatoplasty. We propose a minimum set of outcome parameters which ideally should be included in future studies regarding speech outcomes after cleft palate repair. CLINICAL RELEVANCE Current literature reports highly heterogenous data regarding cleft palate repair. Our recommended set of parameters may address this inconsistency and could make intercenter comparison possible and of better quality.
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Affiliation(s)
- Lieke Hofman
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
| | - Joris A van Dongen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | | | - Kevin Jenniskens
- Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sarah J Haverkamp
- Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Yente S Beentjes
- Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Aebele B Mink van der Molen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Emma C Paes
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Charters E, Pelham C, Novakovic D, Madill C, Clark J. Velopharyngeal incompetence following transoral robotic surgery for oropharyngeal carcinoma: A scoping review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:540-548. [PMID: 35975948 DOI: 10.1080/17549507.2022.2104927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Following transoral robotic surgery (TORS) for oropharyngeal carcinoma (OPC), velopharyngeal incompetence (VPI) is a known consequence that may contribute to swallowing and speech disorders. As the incidence of OPC increases affecting a younger demographic, a better understanding of VPI is required to support speech and swallowing rehabilitation. METHOD A scoping review was conducted using Arskey & O'Malley's framework. Studies were identified from five databases between 2007 and 2020. The methodological quality was measured with the RevMan Risk of Bias Tool by two independent evaluators. RESULT A total of seven studies met the inclusion criterion. There was a combined total of 306 participants, their average age was 59.2 years. A high risk of bias and degree of heterogeneity across all seven cohort studies was observed. Validated and instrumental evaluations of VPI were present in two papers, with the majority only reporting the presence or absence of VPI. The incidence of VPI reported in each study ranged from 0 to 53%, (median 3.5%). CONCLUSION There are few high-quality studies and considerable heterogeneity in the terminology, inclusion criteria and measurement of VPI. Instrumentation, to date, has been rarely used but is necessary for a normed and validated approach to VPI. Based on this review, there is considerable need for larger studies which instrumentally and longitudinally assess VPI as a consequence of TORS, in order to guide patient education and management prior to, and following their surgery.
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Affiliation(s)
- Emma Charters
- Department of Speech Pathology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Claire Pelham
- Department of Speech Pathology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Daniel Novakovic
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia
| | - Cate Madill
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jonathan Clark
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
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Haydon N, Semple H, Ho K, Boorer C. Does pharyngoplasty work? Outcomes of 100 consecutive operations over 10 years. ANZ J Surg 2023; 93:1944-1949. [PMID: 37283293 DOI: 10.1111/ans.18563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Velopharyngeal insufficiency is a commonly encountered problem in Cleft Surgery, with pharyngoplasty being the mainstay of surgical management. In this study we aim to investigate the indications and outcomes of a single institution's experience and compare to international literature. METHODS A retrospective review was performed looking at over 100 consecutive primary pharyngoplasty operations for velopharyngeal dysfunction over a 10-year period at a single institution. Aetiology, peri-operative course and speech outcomes for the cohort between January 2010 through January 2020 were assessed. A comprehensive literature review was performed for comparison and analysis of the studies' data. RESULTS Ninety-seven consecutive patients were included in the study on which 103 operations were performed. Average age at time of surgery was 7.25 years old. Approximately 37% of the patients had a diagnosed syndrome, sequence or chromosomal abnormality. Ninety-seven of the 103 operations were primary pharyngoplasties, 4 were revision pharyngoplasties and 2 return to theatre procedures. Regarding speech outcomes, 51% of the patients that had formal speech assessments were found to have a significant improvement, 42% moderate improvement and 7% had no improvement. 93% of the patients that underwent pharyngoplasty in this study had significant or moderate improvement in speech outcomes. These speech outcomes and post-operative complications such as obstructive sleep apnoea are analysed. CONCLUSION This study demonstrates that pharyngoplasty is a safe procedure for velopharyngeal insufficiency with a good overall success rate. The major outcomes assessed including complications & safety, revision rate and speech outcomes are comparative to previous international studies.
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Affiliation(s)
- Nicholas Haydon
- Department of Plastic & Reconstructive Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Harriet Semple
- Department of Plastic & Reconstructive Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Kevin Ho
- Department of Plastic & Reconstructive Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Catherine Boorer
- Department of Plastic & Reconstructive Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Wadhwa B, Selvaraj U, Bhandari S, Sharma A, Singh SP. Influence of speech aid prosthesis with speech therapy on speech outcomes in adult patients with persisting velopharyngeal insufficiency: A retrospective analysis. J Prosthet Dent 2023:S0022-3913(22)00756-9. [PMID: 36610846 DOI: 10.1016/j.prosdent.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 01/07/2023]
Abstract
STATEMENT OF PROBLEM Prosthetic intervention with a speech aid prosthesis (SAP) along with speech therapy has been reported to improve speech outcomes in patients with persisting velopharyngeal insufficiency (VPI). However, little is known regarding the impact of this treatment on different speech parameters over time in adult patients with VPI. PURPOSE The purpose of this retrospective study was to evaluate the change in speech parameters after rehabilitation with an SAP and speech therapy in adult patients with VPI using subjective and objective tests. MATERIAL AND METHODS Patients above 16 years of age who had received prosthetic treatment for VPI and had complete speech assessment records between 2017 and 2020 were included in the analysis. After completion of the prosthetic treatment, speech therapy comprising 2 sessions per week of 45 minutes was provided by a speech pathologist. Speech evaluation was performed using tests that included speech intelligibility calculation, nasal pinch test, audible nasal air emissions, acoustic analysis, and the nasalance check. Assessments were done at 4 time intervals: T0: without an SAP; T1: 1 week with an SAP; T2: 1 month with an SAP; and T3: 3 months with an SAP. A descriptive analysis was followed by a comparison between groups using the Friedman test for subjective assessments and repeated measures ANOVA for objective tests (α=.05). RESULTS Of 10 individuals who had received an SAP, 5 participants, 2 men and 3 women with a mean age of 38 years were included in the analysis. Statistically significant improvement in mean scores was observed from T0 to T3 concerning speech intelligibility (P<.001), hypernasality (P<.001), audible nasal air emission (P<.001), mean fundamental frequency (P=.034), shimmer percentage (P=.004), and nasalance (P=.004). Improvement in jitter percentage was not statistically significant (P=.218). CONCLUSIONS An SAP along with speech therapy should be considered as a conservative and effective treatment option for addressing speech issues in adult patients with VPI.
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Affiliation(s)
- Bhavita Wadhwa
- Assistant professor, Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Uvashri Selvaraj
- Senior Resident, Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudhir Bhandari
- Professor, Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anuradha Sharma
- Lecturer, Department of Otolaryngology, Audiology and Speech Therapy, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satinder Pal Singh
- Professor, Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Effectiveness of the Superiorly Based Pharyngeal Flap in Treating Velopharyngeal Insufficiency. Plast Reconstr Surg Glob Open 2022; 10:e4696. [PMID: 36583167 PMCID: PMC9750524 DOI: 10.1097/gox.0000000000004696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/11/2022] [Indexed: 12/31/2022]
Abstract
Velopharyngeal insufficiency (VPI) is a condition characterized by failure of the posterior part of the soft palate to reach the pharyngeal wall and separate the nasopharynx from the oropharynx during speech and swallowing. VPI may persist following cleft palate repair. This study aimed to determine the outcomes of the superiorly based pharyngeal flap to treat VPI post cleft palate repair. Methods A retrospective cohort study included patients with VPI post cleft palate repair who underwent secondary speech surgery. The criteria were based on clinical symptoms, physical examination, nasometry, and videofluoroscopy/nasoendoscopy findings. Data were analyzed by using SPSS program, version 22.0. A P value less than 0.05 was considered significant. Results Thirty-five patients were identified. VPI was reduced to 14.3% postoperatively. Before the surgery 25.7% of the patients had severe hypernasality, 68.6% had moderate hypernasality, and 5.7% had mild hypernasality. After the surgery, only 8.6% of the patients still had severe hypernasality, 22.9% had moderate hypernasality, 57.1% had mild hypernasality, and hypernasality became absent in 11.4%. Articulation disorders were present in 91.4% of patients before surgery, and decreased to 71.4% postoperatively. Speech intelligibility improved postoperatively in comparison with preoperative findings. Conclusion The present study concluded that the superiorly based pharyngeal flap was successful in treating VPI that persisted post cleft palate repair.
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de Blacam C, O'Dwyer A, Oderoha KE, Gilroy TC, Duggan L, Orr DJA. The case for the pharyngeal flap pharyngoplasty in the management of velopharyngeal dysfunction. J Plast Reconstr Aesthet Surg 2022; 75:3436-3447. [PMID: 35729045 DOI: 10.1016/j.bjps.2022.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/28/2022] [Accepted: 04/12/2022] [Indexed: 11/15/2022]
Abstract
Velopharyngeal dysfunction (VPD) occurs when there is inadequate closure of the velopharyngeal sphincter during speech. An incompetent velopharyngeal sphincter may require surgical intervention to create a functional seal between the oropharynx and the nasopharynx during speech. To date, no single pharyngoplasty procedure has emerged as superior to another, and the comparison of results between studies has been limited by variation in outcomes reporting. Here, we use the newly defined Core Outcome Set for VPD (COS-VPD) to report a consecutive series of 109 patients managed with a midline pharyngeal flap and simultaneous dissection and repositioning of the velar muscles. The overall 30-day postoperative complication rate was 3.6% (4 out of 109 patients). At 12-month follow-up, 79.3% of patients experienced a statistically significant improvement in hypernasality. Seven patients (6.4%) developed obstructive sleep apnoea (OSA) postoperatively, and this was confirmed with polysomnography, with four (3.6%) patients requiring takedown of the pharyngeal flap. Seven patients in total (7.3%) required takedown of the pharyngeal flap and sphincter pharyngoplasty because of insufficient improvement of their VPD following the initial procedure. Patient-reported outcomes were investigated using the Velopharyngeal Effects on Life Outcome (VELO) instrument, and a mean total score of 74.5 out of 100 was recorded. We conclude that cleft surgeons should not be dissuaded by historical concerns about high rates of perioperative complications and OSA and should consider including the pharyngeal flap in their armamentarium when managing patients with VPD.
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Affiliation(s)
- Catherine de Blacam
- Department of Plastic & Reconstructive Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland; Royal College of Surgeons in Ireland, Ireland.
| | - Aisling O'Dwyer
- Department of Speech & Language Therapy, Children's Health Ireland at Crumlin and St James's Hospital Dublin, Ireland
| | | | - Tanya C Gilroy
- Department of Speech & Language Therapy, Children's Health Ireland at Temple Street, Ireland
| | - Laura Duggan
- Dublin Cleft Centre, Children's Health Ireland at Crumlin and St James's Hospital Dublin, Ireland
| | - David J A Orr
- Department of Plastic & Reconstructive Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland; Department of Surgery and Paediatrics, Trinity College Dublin, Ireland
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Chen N, Shi B, Huang H. Velopharyngeal Inadequacy-Related Quality of Life Assessment: The Instrument Development and Application Review. Front Surg 2022; 9:796941. [PMID: 35402476 PMCID: PMC8988257 DOI: 10.3389/fsurg.2022.796941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022] Open
Abstract
Objective For the patient-reported outcome (PRO) measures related to patients with velopharyngeal inadequacy (VPI), different quality of life (QOL) instruments have been developed. The present systematic review was designated to identify current VPI-related QOL instrument development, validation, and applicability. Methods Pubmed, Cochrane, Embase, Web of Science, and EBSCO databases were searched in January 2022. “Velopharyngeal” or “palatopharyngeal” and “quality of life” or “life quality” were searched in title, abstract, and keywords. This study followed Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Two investigators independently reviewed abstracts and full texts of the identified literature. An established checklist was used to evaluate the measurement properties of each identified instrument. Results A total of 375 articles and 13 instruments were identified, which can be divided into nine types of families according to their development procedures. Developmental and measurement characteristics, evidence of conceptual model, content validity, reliability, construct validity, scoring, interpretation, respondent burden, and presentation for all instruments were shown. Conclusion The patient's self-report assessment and parent-proxy assessment are both valuable. The conclusion that any QOL instrument is absolutely the best for patients with velopharyngeal inadequacy could not be drawn. Understanding the development and characteristics of different QOL instruments, including their reliability, validity, aim, target, language, and resource, should be important before application in clinic or research.
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Affiliation(s)
- Nan Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- *Correspondence: Hanyao Huang
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Instrum R, Dzioba A, Dworschak-Stokan A, Husein M. Surgical interventions in velopharyngeal dysfunction: comparative perceptual speech and nasometric outcomes for three techniques. J Otolaryngol Head Neck Surg 2022; 51:3. [PMID: 35120565 PMCID: PMC8815226 DOI: 10.1186/s40463-021-00548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 10/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to evaluate speech outcomes following surgical intervention for velopharyngeal dysfunction (VPD). Perceptual speech outcome data were subsequently analyzed in conjunction with patient factors such as congenital abnormalities, presence of cleft lip and/or palate, and age of repair. We hope to aid in the eventual creation of treatment algorithms for VPD, allowing practitioners to tailor surgical technique selection to patient factors.
Methods A retrospective analysis was performed for all patients who underwent surgical correction of VPD at London Health Sciences Centre between the years 2005 and 2018. Two hundred and two consecutive VPD patients (median age 10.6 years) were followed for an average of 20.2 months after having undergone a superiorly based pharyngeal flap (121), Furlow palatoplasty (72), or sphincteroplasty (9). Speech outcomes were measured via the American Cleft Palate-Craniofacial Association (ACPA) perceptual speech assessment, and MacKay-Kummer Simplified Nasometric Assessment Procedures Revised (SNAP-R) was used to measure nasalence. Comparisons of mean preoperative and postoperative outcomes were made, as well as analyses regarding surgical procedure, syndrome, cleft status, and age. Results Mean perceptual scores improved significantly postoperatively (p < .0001), and successful perceptual resonance was identified in 86.1% patients (n = 174). Postoperative perceptual speech scores for three ACPA domains were superior with pharyngeal flap compared to both Furlow palatoplasty and sphincteroplasty ([hypernasality: p < .001, p < .02], [audible nasal emissions: p < .002, p < .05], [velopharyngeal function: p < .001, p < .05]). Success rate was higher in pharyngeal flap (94.2%) than in Furlow palatoplasty (75.0%, p < .001) or sphincter pharyngoplasty (66.7%, p < .001). No significant difference was identified in success rate based on syndrome or cleft status. Conclusion Operative management of VPD is highly effective in improving perceptual speech outcomes. Given proper patient selection, all three procedures are viable treatment options for VPD. For those patients identified as appropriate to undergo a pharyngeal flap, robust improvements in speech outcomes were observed. Graphical abstract ![]()
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Affiliation(s)
- Ryan Instrum
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital, London Health Sciences Centre, Victoria Hospital, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital, London Health Sciences Centre, Victoria Hospital, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | | | - Murad Husein
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital, London Health Sciences Centre, Victoria Hospital, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada. .,Thames Valley Children's Centre, London, ON, Canada.
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Sakran KA, Al‐Rokhami RK, Wu M, Chen N, Yin H, Guo C, Wang Y, Alkebsi K, Abotaleb BM, Mohamed AA, Al‐Watary MQ, Shi B, Huang H. Correlation of the Chinese velopharyngeal insufficiency-related quality of life instrument and speech in subjects with cleft palate. Laryngoscope Investig Otolaryngol 2022; 7:180-189. [PMID: 35155796 PMCID: PMC8823188 DOI: 10.1002/lio2.705] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/06/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Assessment of the hypothesized correlation between the Chinese Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument and measured speech parameters. METHODS A cross-sectional study was conducted in the Oral Clefts Center of West China Hospital of Stomatology between January 2019 and December 2019. Speech parameters including speech intelligibility deficit, VPI severity, VP gap, and need for speech therapy were evaluated by speech-language pathologists. All patients and their parents completed the VELO instrument. The correlation between aforementioned speech parameters and VELO scores was examined utilizing Spearman correlation coefficients. The reliability of VELO test-retest and parent proxy assessment was estimated utilizing intraclass correlation coefficients (ICC). A receiver operating characteristic curve was used to calculate the cutoff VELO score. RESULTS One hundred and forty patients with their parents were enrolled. The mean age was 12.58 ± 3.72 years. Both parent and youth VELO total and domain scores recorded moderate to strong correlations with all speech parameters (r > -.40, P ˂ .001) except the swallowing domain. Most VELO domain items have shown significant correlations with at least one speech parameter. Moreover, the scales of all speech parameters showed different VELO scores (P ˂ .001). The ICC reported test-retest correlation >.73 in all domains, and parent proxy correlation >.63 in most domains except the emotional and perception domains. The cutoff VELO score was 79.04 in parent version and 85.77 in youth version. CONCLUSIONS The correlations between VELO scores and measured speech parameters have provided evidence for test-retest and parent proxy reliability and criterion and construct validity of the Chinese version of the VELO instrument. A VELO score ≥79.04 (in parent version) or ≥85.77 (in youth version) mostly reflects proper speech-related quality of life. Hence, this instrument could serve as a simple tool to help clinicians understand the social, emotional, and physical influences of VPI.
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Affiliation(s)
- Karim Ahmed Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
| | | | - Min Wu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Nan Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth HospitalSichuan UniversityChengduChina
| | - Heng Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Chunli Guo
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Yan Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Khaled Alkebsi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
| | - Bassam Mutahar Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
| | - Abdo Ahmed Mohamed
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
- Department of Oral and Maxillofacial Surgery, Guanghua School of StomatologySun Yat‐sen UniversityGuangzhouChina
| | - Mohammed Qasem Al‐Watary
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
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Lynch CA, Rule DW, Klaben B, Oren L, Friedman AD, Khosla SM, Howell RJ. Surgical Treatment of Acquired Velopharyngeal Insufficiency in Adults With Dysphagia and Dysphonia. J Voice 2022:S0892-1997(21)00417-3. [PMID: 35027239 DOI: 10.1016/j.jvoice.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Velopharyngeal insufficiency (VPI) is a form of velopharyngeal dysfunction caused by abnormal or insufficient anatomy. This process is known to be associated with dysphagia and dysphonia but surgical interventions for these complex patients have not been well studied. The current study characterized a small cohort of adult patients with acquired VPI, dysphonia, and dysphagia, as well as associated surgical interventions. METHODS A retrospective descriptive case series of 22 (N = 22) adult patients over a 6-year period with acquired VPI and varying degrees of dysphagia and dysphonia was described from a multi-disciplinary voice and swallowing clinic. Perceptual assessment, nasopharyngoscopy, fluoroscopic swallowing assessment, and patient reported outcomes were reviewed to characterize the cohort. RESULTS VPI etiologies included: stroke (n = 4), head and neck cancer (n = 5), brainstem lesions (n = 5), trauma (n = 5), and other/unknown (n = 3). All 22 patients underwent nasopharyngoscopy and were categorized as having unilateral (n = 13), central (n = 4), or no (n = 5) velopharyngeal deficits. Seventeen patients (77.2%) underwent modified barium swallow studies, revealing that soft palate elevation scored least impaired among patients with no VPI, and most impaired among patients with unilateral VPI deficits. All 22 patients underwent some form of surgical intervention for VPI, with 14 (63.6%) of those patients requiring additional surgical revision. CONCLUSION This series is one of the first to the authors' knowledge to characterize a cohort of individuals with VPI, dysphagia, and dysphonia and associated surgical interventions.
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Affiliation(s)
| | - David W Rule
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - Bernice Klaben
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - Liran Oren
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - Aaron D Friedman
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - Sid M Khosla
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - Rebecca J Howell
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio.
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14
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Jargaldavaa E, Gongorjav A, Badral B, Lkhamsuren K, Ichinkhorloo N. Primary palatoplasty: A comparison of results by various techniques - A retrospective study. Ann Maxillofac Surg 2022; 12:27-32. [PMID: 36199461 PMCID: PMC9527831 DOI: 10.4103/ams.ams_62_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction: To identify a better method for primary cleft palate (CP) repairs with respect to velopharyngeal function. Materials and Methods: A retrospective, longitudinal review of medical charts of patients with congenital CP who underwent four different techniques of palatoplasty, performed by three different surgeons in the Department of Maxillofacial Surgery of the National Center for Maternal and Child Health. Nasopharyngoscopy (NPS) was used for velopharyngeal function evaluation. CP was classified according to the Veau system and the “Golding-Kushner” scale for NPS results was used for assessing the patient’s velopharyngeal function and its association with cleft types and the primary palatoplasty techniques. Pearson’s Chi-square analysis and binary logistic regression were used for statistical analysis. Results: A total of 335 patients were included in the study. The mean age at primary palate repair was 22.9 ± 13.6 months. There were 56, 42, 177, and 60 patients with Veau-I, Veau-II, Veau-III, and Veau-IV types, respectively, whereas for primary palatoplasty 65 patients underwent Furlow, 148 patients – Mongolian, 108 patients – two flap, 34 patients – von Langenbeck technique. NPS assessment of adequate velopharyngeal function was followed by Furlow’s technique in 89.4% of cases, Mongolian technique in 62.2% of cases but by “two flap” only in 48.1% and von Langenbeck in 47.1% of cases. Discussion: The Furlow and Mongolian techniques were superior for maintaining velopharyngeal function after primary palatoplasty.
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Peck CJ, Pourtaheri N, Parsaei Y, Gowda AU, Yang J, Lopez J, Steinbacher DM. Race-Based Differences in the Utilization and Timing of Secondary Cleft Procedures in the United States. Cleft Palate Craniofac J 2021; 59:1413-1421. [PMID: 34662225 DOI: 10.1177/10556656211047134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary CL/P repair, revisions, and secondary procedures-cleft rhinoplasty, speech surgery, and alveolar bone grafting (ABG)-performed from 2014-2018 were identified from the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Utilization estimates were derived via univariable and multivariable logistic regression. A Kruskal-Wallis rank-sum test and multivariable linear regression were used to assess differences in timing for each procedure cohort. The primary outcome measures were the odds of a patient being a certain race/ethnicity, and the age at which patients of different race/ethnicity receive surgery. There were 23 780 procedures analyzed. After controlling for sex, diagnosis, and functional status, there were significant differences in utilization estimates across procedure groups. Primarily, utilization was lowest in patient who were Black for cleft rhinoplasty (OR = 0.70, P = .023), ABG (OR = 0.44, P < .001) and speech surgery (OR = 0.57, P = .012), and highest in patients who were Asian patients in all surgery cohorts (OR 2.05-4.43). Timing of surgery also varied by race, although differences were minimal. CONCLUSIONS Estimates of utilization and timing of secondary cleft procedures varied by race, particularly among patients who were Black (poor utilization) or Asian (high utilization). Further studies should identify the causes and implications of underutilized and/or delayed cleft care.
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Affiliation(s)
- Connor J Peck
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Navid Pourtaheri
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Yassmin Parsaei
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Arvind U Gowda
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Jenny Yang
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Joseph Lopez
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Derek M Steinbacher
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
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Lu L, Yakupu A, Wu Y, Li X, Zhang P, Aihaiti G, Xu H. Quality of Life in Patients With Velopharyngeal Insufficiency in West China. Cleft Palate Craniofac J 2021; 59:1024-1029. [PMID: 34460333 DOI: 10.1177/10556656211034107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the quality of life (QOL) of patients with cleft lip and palate and velopharyngeal insufficiency (VPI) in relation to sex, age, age at initial cleft lip surgery, and age at initial cleft palate surgery. DESIGN This is a cross-sectional study. SETTING The study was conducted in a tertiary medical center. PARTICIPANTS The participants were caregivers of 72 patients with cleft lip and palate and VPI aged 4 to 20 years. MAIN OUTCOME MEASURE(S) Participants completed the Chinese version of the caregiver report of the VPI Effects on Life Outcomes (VELO) questionnaire. The Mann-Whitney U test was used to evaluate the patients' sex, age, age at initial cleft lip repair, and age at initial cleft palate repair in relation to VELO total score and domains. Spearman correlation analysis was completed including all study variables. Associations between the study variables and the VELO total score were tested using a generalized linear mixed model. RESULTS In the univariate analysis, patients' age and age at initial cleft palate surgery influenced the QOL of patients with VPI. There were no differences in the VELO total score or domains based on sex or age at first cleft lip surgery. In the generalized linear mixed model, patients older than 8 years had higher VELO total scores. CONCLUSIONS By caregiver report, the QOL of patients under age 8 years with VPI was lower than older patients. In addition, the caregiver impact domain was higher for parents of children who had their initial cleft palate surgery at age 2 years or younger.
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Affiliation(s)
- Lidan Lu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Aipiziguli Yakupu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Yanhui Wu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Xiangnan Li
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Pengxin Zhang
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Guliziba Aihaiti
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Hui Xu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Stomatology School of Xinjiang Medical University, Urumqi, China
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17
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de Blacam C, Baylis AL, Kirschner RE, Smith S, Sell D, Sie KCY, Harris HE, Orr DJA. Core Outcome Set for Reporting Outcomes of Interventions for Velopharyngeal Dysfunction: Final Results of the COS-VPD Initiative. Cleft Palate Craniofac J 2021; 59:S84-S96. [PMID: 34398725 DOI: 10.1177/10556656211035026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To date, the recording of outcomes of interventions for velopharyngeal dysfunction (VPD) has not been standardized. This makes a comparison of results between studies challenging. The aim of this study was to develop a core outcome set (COS) for reporting outcomes in studies examining the management of VPD. DESIGN A two-round Delphi consensus process was used to develop the COS. PATIENTS, PARTICIPANTS The expert Delphi panel comprised patients and caregivers of patients with VPD, surgeons and speech and language therapists specializing in cleft palate, and researchers with expertise in VPD. INTERVENTIONS A long list of outcomes was derived from the published literature. In each round of a Delphi survey, participants were asked to score outcomes using the Grading of Recommendations, Assessment, Development, and Evaluations scale of 1 to 9, with 1 to 3 labeled "not important," 4 to 6 labeled "important but not critical," and 7 to 9 labeled "critical." MAIN OUTCOME MEASURE Consensus criteria were specified a priori. Outcomes with a rating of 75% or more of the panel rating 7 to 9 and 25% or fewer rating 1 to 3 were included in the COS. RESULTS A total of 31 core outcomes were identified from the Delphi process. This list was condensed to combine topic areas to produce a final COS of 10 outcomes, including both processes of care and patient-reported outcomes that should be considered for reporting in future studies of VPD. CONCLUSIONS Implementation of the COS-VPD will facilitate consistency of outcomes data collection and comparison of results across studies.
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Affiliation(s)
- Catherine de Blacam
- 575349Department of Plastic Surgery, 11595Children's Health Ireland at Crumlin, Dublin, Ireland.,8863Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Adriane L Baylis
- Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Richard E Kirschner
- Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Susan Smith
- 162839Department of General Practice, 8863Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Debbie Sell
- Speech and Language Therapy, 4956Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kathleen C Y Sie
- Pediatric Otolaryngology, 7274Seattle Children's Hospital, Seattle, Washington, USA
| | | | - David J A Orr
- 575349Department of Plastic Surgery, 11595Children's Health Ireland at Crumlin, Dublin, Ireland.,8809Trinity College Dublin, Dublin, Ireland
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Metanalysis of alloplastic materials versus autologous fat for injection augmentation pharyngoplasty treatment of velopharyngeal insufficiency. Int J Pediatr Otorhinolaryngol 2021; 146:110738. [PMID: 33957548 DOI: 10.1016/j.ijporl.2021.110738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/05/2021] [Accepted: 04/24/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Velopharyngeal insufficiency (VPI) can cause resonance, speech and feeding problems. While reconstructive palatoplasty and surgical pharyngoplasty techniques are the mainstay of treatment for severe VPI, injection augmentation pharyngoplasty offers a minimally invasive approach in patients with mild-to-moderate VPI. METHODS We conducted a systematic review of the literature available on PubMed and Embase from 1990 to 2019 including studies that addressed VPI, incompetence, or dysfunction managed with injection augmentation. Patient demographics, etiology of VPI, injection material, volume of injection, number of injections, complications and both subjective and objective outcomes were recorded. RESULTS Twenty-nine studies met our inclusion criteria encompassing 587 patients, ages 3-75 years (mean = 16) who underwent injection pharyngoplasty. Injection materials included glutaraldehyde cross-linked (GAX) collagen (n = 5), calcium hydroxyapatite (n = 36), dextranomer and hyaluronic acid (n = 72) and autologous fat (n = 471). Follow-up averaged 15.4 months (range = 2-60 months). Functional improvements in nasality were recorded in a large proportion of patients (0.79, 95% CI 0.75 to 0.82). However, a greater proportion of patients in the synthetic materials group demonstrated either reduced or resolved hypernasality compared with those receiving autologous fat injections (χ2 = 7.035, n = 91/103 vs. 255/338, p = 0.008). Complete velopharyngeal gap closure post-injection was achieved at a higher frequency with injection of synthetic materials compared with autologous fat (χ2 = 11.270, n = 61/69 vs. 58/91 p = 0.001).r CONCLUSION: Injection pharyngoplasty offers a minimally invasive alternative intervention for treatment of VPI secondary to small velopharyngeal gaps. Patients treated with synthetic materials experienced a greater improvement in velopharyngeal closure and a corresponding improvement in resonance balance.
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Complications and the Need for Long-Term Follow-Up after Secondary Speech Surgery: A National and Longitudinal Claims Analysis. Plast Reconstr Surg 2021; 146:1340-1346. [PMID: 33234965 DOI: 10.1097/prs.0000000000007339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although most patients attain normal speech after cleft palate repair, up to 20 percent require secondary speech surgery. Despite the frequency of these procedures, complications and rates of subsequent revisions of secondary speech surgery after all procedure types have never been reviewed using national, longitudinal data. METHODS The authors examined insurance claims from Clinformatics Data Mart between 2001 and 2017. Cases were categorized as palatalprocedures (i.e., palatoplasty, revision palatoplasty, secondary lengthening, palatal island flap) or pharyngeal procedures (i.e., pharyngeal flap, dynamic sphincter pharyngoplasty) (n = 846). Continuous enrollment from 180 days before to 30 days after surgery was required. Patients were excluded if they underwent palatoplasty, or any surgery at less than 3 years of age, without a speech diagnosis. Outcomes included 30-day complications and rates of subsequent revision secondary speech surgery. Multivariable logistic regression was used to evaluate the relationship between procedure type and complications. RESULTS In this cohort, 52.5 percent underwent pharyngeal procedures, and 47.5 percent underwent palatal procedures. Complications occurred in 10.9 percent of patients and included respiratory complications (4.0 percent), bleeding (1.2 percent), dehiscence (3.6 percent), and critical care episodes (3.0 percent). There was no difference in complications between procedure types (OR, 0.87; 95 percent CI, 0.56 to 1.37; p = 0.56). The subsequent revision rate was 12.7 percent, but was 21.7 percent in patients with 3 years of postoperative enrollment. CONCLUSIONS Although complication rates were comparable to those in recent literature, rates of subsequent revisions of secondary speech procedures were high in patients with longer postoperative enrollment. Thus, these patients merit prolonged follow-up, as velopharyngeal dysfunction may recur over time. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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20
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Pedersen HM, Goodie PA, Braden MN, Thibeault SL. Comparing Quality of Life and Perceptual Speech Ratings in Children With Cleft Palate. Cleft Palate Craniofac J 2020; 58:139-145. [PMID: 32799664 DOI: 10.1177/1055665620949435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To delineate the relationship between patient and parent-reported quality of life (QOL) ratings and perceptual characteristics of speech assigned by a speech-language pathologist (SLP) in children with repaired cleft palate. DESIGN Prospective. SETTING Academic Children's Hospital. PARTICIPANTS This population-based sample included children, aged 3 to 18 with a history of repaired cleft palate, and their parents. INTERVENTION Participants completed the Velopharyngeal Insufficiency Effects on Life Outcomes Questionnaire (VELO). Children's speech was judged perceptually by an expert SLP using the Pittsburgh Weighted Speech Scale (PWSS). MAIN OUTCOME MEASURE(S) Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire assessed participant and parent perceptions of impact of velopharyngeal function on QOL. Pittsburgh Weighted Speech Scale assessed nasal emissions, facial grimacing, nasality, quality of phonation, and articulation. RESULTS Enrollment included 48 participant parent dyads. Overall, participants reported high QOL scores within the 95% CI with children reporting slightly better yet not significantly different QOL (86.27 ± 8.96) compared to their parents (81.81 ± 15.2). Children received an average score of 1.38 ± 1.96 on the PWSS corresponding to borderline velopharyngeal competence. A significant moderate negative correlation was found between PWSS total score and parent VELO total score (r = -0.51103, P = .0002). Mild-moderate significant negative correlations were measured between PWSS total and the 5 subscales of the VELO. No significant correlations were measured between PWSS and child VELO total responses or between total scores and subscales. CONCLUSIONS Results suggest that as perceptual analysis of speech improves, overall QOL improves moderately.
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Affiliation(s)
- Hailey M Pedersen
- Division of Otolaryngology-Head and Neck Surgery, 5232University of Wisconsin, Madison, Wisconsin, WI, USA
| | - Paige A Goodie
- Department of Otolaryngology, 5718Vanderbilt University, Nashville, TN, USA
| | - Maia N Braden
- Division of Otolaryngology-Head and Neck Surgery, 5232University of Wisconsin, Madison, Wisconsin, WI, USA
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, 5232University of Wisconsin, Madison, Wisconsin, WI, USA
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de Blacam C, Baylis AL, Kirschner RE, Smith SM, Sell D, Sie KCY, Harris HE, Orr DJA. Protocol for the development of a core outcome set for reporting outcomes of management of velopharyngeal dysfunction. BMJ Open 2020; 10:e036824. [PMID: 32792441 PMCID: PMC7430341 DOI: 10.1136/bmjopen-2020-036824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Velopharyngeal dysfunction (VPD) is present in up to 40% of patients following cleft palate repair. Children with VPD display hypernasal speech, nasal air emission and are at a high risk for developing articulation disorders. The overall result is decreased intelligibility and acceptability of speech, as well as significant functional and social impairments. Although there are several surgical approaches for the management of children with VPD, standard treatment protocols have not been well defined. There is a need for a core outcome set (COS) to reduce outcome reporting bias and heterogeneity across studies of VPD. The COS-VPD Initiative is an international effort to establish a COS for the reporting of studies of the management of VPD. METHODS AND ANALYSIS The study has been developed according to the Core Outcome Set-STAandards for Development standards for the design of a COS study and will be carried out according to the guidance of the Core Outcome Measures in Effectiveness Trials (COMET) initiative. A long list of clinical and patient-reported outcomes will be identified from a systematic review of the literature. A two-stage Delphi consensus process will be used to refine this list into a COS. An international panel of key stakeholders including patients, parents and multidisciplinary clinical and academic experts will be invited to participate in this process. Consensus criteria will be specified a priori and the steering group will ratify the final COS. ETHICS AND DISSEMINATION The study has ethical approval through Children's Health Ireland at Crumlin Research and Ethics Committee, Ref: GEN/683/18. The study is registered with the COMET Initiative (http://www.cometinitiative.org/studies/details/1146?result=true). The COS will be disseminated by publication in the peer-reviewed literature, presentation at international research meetings and distribution to patient-representative organisations. This will facilitate the application of the COS in future studies of the management of VPD.
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Affiliation(s)
- Catherine de Blacam
- Department of Plastic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Adriane L Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
- Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Richard E Kirschner
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
- Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Susan M Smith
- Department of General Practice, RCSI, Dublin, Ireland
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kathleen C Y Sie
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | | | - David J A Orr
- Department of Plastic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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22
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Optimizing speech outcomes for cleft palate. Curr Opin Otolaryngol Head Neck Surg 2020; 28:206-211. [PMID: 32520757 DOI: 10.1097/moo.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cleft lip with or without palate is one of the most common pediatric birth anomalies. Patients with cleft palate often have speech difficulties from underlying anatomical defects that can persist after surgery. This significantly impacts child development. There is a lack of evidence exploring, which surgical techniques optimize speech outcomes. The purpose of this update is to report on recent literature investigating how to optimize speech outcomes for cleft palate. RECENT FINDINGS The two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty has the strongest evidence for optimizing speech. One-stage palatal repair is favored at 10-14 months of age, while delays are associated with significant speech deficits. For postoperative speech deficits, there is no significant difference between the pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation. Surgical management should be guided by closure pattern and velopharyngeal gap but few studies stratify by these characteristics. SUMMARY According to recent evidence, the two-flap palatoplasty with IVVP and Furlow palatoplasty result in the best speech. The pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation are all viable techniques to correct residual velopharyngeal insufficiency. Future research should focus on incorporating standardized measures and more robust study designs.
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McCrary H, Pollard SH, Torrecillas V, Khong L, Taylor HM, Meier J, Muntz H, Skirko J. Increased Risk of Velopharyngeal Insufficiency in Patients Undergoing Staged Palate Repair. Cleft Palate Craniofac J 2020; 57:975-983. [PMID: 32207321 DOI: 10.1177/1055665620913440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the association of 2-stage cleft palate (CP) surgery on velopharyngeal insufficiency (VPI) incidence, speech surgeries, and cleft-related surgical burden. DESIGN Retrospective cohort with follow-up of 4 to 19 years. SETTING Academic, tertiary children's hospital. PATIENTS Patients who underwent CP surgery between 2000 and 2017. Exclusions included submucous CP or age at last contact under 3.9. INTERVENTIONS Cleft palate surgery, completed in either a single-stage or 2-stage repair. MAIN OUTCOME MEASURE(S) Rates of VPI diagnosis and speech surgery and total cleft surgeries; t tests, tests of proportion, and linear and logistic regression were performed. Total cleft-related surgeries were examined in a subset (n = 418) of patients with chart reviews. RESULTS A total of 1047 patients were included; 59.6% had 2-stage CP repair, 40.4% had single-stage repair. Approximately 32% of children with 2-stage CP repair were diagnosed with VPI, as opposed to 22% of single-stage patients (P < .001). Children with 2-stage CP repair were 1.8 times as likely to be diagnosed with VPI (P < .001). Speech surgery rates were similar across groups. Patients who had 2-stage repair received an average of 2.3 more cleft-related procedures, when excluding prosthesis management procedures. CONCLUSION Our data show an increased risk of VPI diagnosis and increased surgical burden among patients receiving 2-stage CP repair.
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Affiliation(s)
- Hilary McCrary
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Leon Khong
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Jeremy Meier
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | - Harlan Muntz
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | - Jonathan Skirko
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
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Lindeborg MM, Shakya P, Pradhan B, Rai SK, Gurung KB, Niroula S, Rayamajhi B, Chaudhary H, Gaire B, Mahato N, Rana L, Rokaya P, Shrestha N, Shrestha R, Tamang J, Joshi HD, Gaha P, Khorja DK, Mitnick CD, Rai SM, Shaye DA. Nepali Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcomes Instrument: VELO-Nepali. Cleft Palate Craniofac J 2020; 57:967-974. [PMID: 32054301 DOI: 10.1177/1055665620905173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To translate and validate the velopharyngeal insufficiency (VPI) effects on life outcomes (VELO) instrument into Nepali, and test its internal consistency and validity. DESIGN Quality-of-life instrument translation and validation. SETTING Community served by Nepal's craniofacial referral hospital. PARTICIPANTS Twenty-three postpalatoplasty children with VPI, 19 family guardians of VPI cases, and 29 non-VPI controls. INTERVENTIONS The VELO instrument was translated to Nepali by 2 independent bilingual translators, reconciled, backward-translated, compared, and modified using patient cognitive interviews. All VPI children, guardians, and controls completed the VELO-Nepali. MAIN OUTCOME MEASURE(S) The VELO internal consistency was evaluated using Cronbach α coefficient. Concurrent validity and discriminant validity were assessed using 2-sample t test: assuming unequal variances. RESULTS The VELO was translated and optimized using cognitive interviews. The VELO-Nepali demonstrated excellent internal consistency, with Cronbach α coefficients of 0.93, 0.94, and 0.90 for VPI cases, guardians of VPI cases, and non-VPI controls, respectively. The VELO-Nepali exhibited strong discriminant validity between VPI cases (x¯ = 45.4, standard deviation [SD] = 22.1) and non-VPI controls (x¯ = 84.9, SD = 12.3), (P < .001). The VELO-Nepali showed strong concurrent validity with similarities in VPI case scores (x¯ = 45.4, SD = 22.1), and guardian scores (x¯ = 52.9, s = 22.8; P = .473). CONCLUSION The translated VELO-Nepali demonstrates strong internal consistency, discriminant validity, and concurrent validity, and can assess quality of life for Nepali VPI patients. This instrument represents the first VPI quality of life assessment validated in Nepali, and supports the feasibility of its implementation in other low- and low-middle-income countries.
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Affiliation(s)
- Michael M Lindeborg
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Michael Lindeborg and Pramila Shakya are co-first authors
| | - Pramila Shakya
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal.,Michael Lindeborg and Pramila Shakya are co-first authors
| | - Bhawani Pradhan
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Shiba Kala Rai
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | | | - Suman Niroula
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Badri Rayamajhi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Hema Chaudhary
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Bhagwati Gaire
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Naina Mahato
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Lila Rana
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Phana Rokaya
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Nilam Shrestha
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Renuka Shrestha
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Januka Tamang
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Hemanta Dhoj Joshi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Pushpa Gaha
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Dhana Kumari Khorja
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Shankar Man Rai
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - David A Shaye
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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Brazilian-Portuguese Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcome Instrument. J Craniofac Surg 2020; 30:2308-2312. [PMID: 31233001 DOI: 10.1097/scs.0000000000005679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to conduct a linguistic validation of the velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for use in Brazilian-Portuguese patients with VPI. METHODS The original English version of the VELO instrument was translated into Brazilian-Portuguese, back-translated, and adapted among the Brazilian patients (n = 21) with VPI and their parents, based on the standardized guidelines for the cross-culture adaption process. Discrepancies in the forward and backward translation steps were computed. Comprehension rates were captured for each debriefing interview. The content validity index (CVI) per item (I-CVI) and of the scale (S-CVI universal agreement [S-CVI/UA] and averaging [S-CVI/Ave]) were calculated. RESULTS Reconciliation of the 2 forward translations and the comparison between the back translation and the original VELO version resulted in some item wordings with discrepancies which were reviewed by the research team (translators, expert committee, and original developers of instrument). Three rounds of cognitive interviews also led to some revisions of wording. Comprehension rates of patients and their parents were 60% to 100%, 80% to 100%, and 100% in the first, second, and third rounds of cognitive interviews, respectively. The I-CVI, S-CVI/AU, and SCI/Ave for the Brazilian-Portuguese VELO version were 0.83 (or higher), 0.83 (or higher), and 0.97, respectively. CONCLUSIONS The linguistic validation process of the VELO instrument created a cross-culturally equivalent Brazilian-Portuguese version for use in Brazilian-Portuguese speaking patients with VPI.
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Li L, Strum D, Larson S, Preciado D. Quality of life outcomes following velopharyngeal insufficiency surgery. Int J Pediatr Otorhinolaryngol 2019; 127:109643. [PMID: 31442731 DOI: 10.1016/j.ijporl.2019.109643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Velopharyngeal insufficiency (VPI) may be due to functional or anatomic causes, and can lead to speech deficits, communication difficulty, and emotional strain on patients and their caregivers. The VPI Effects on Life Outcomes (VELO) instrument quantifies quality of life outcomes in VPI patients both before and after VPI surgery. This study aims to identify pre-operative patient characteristics associated with better post-operative quality of life. METHODS This study is a retrospective chart review of 51 patients who underwent VPI surgery between 2009 and 2018 at a tertiary free-standing children's hospital. A 26-item parent-proxy VELO questionnaire was administered by telephone to parents to assess their child's quality of life post-VPI surgery. RESULTS Twenty-seven parents responded to the VELO questionnaire. Average post-operative VELO score was significantly higher in non-syndromic patients as compared with syndromic patients. Average post-operative VELO score was not significantly different between patients with and without submucous cleft (SMC) or those with mild to moderate versus severe pre-operative hypernasality. On multivariate analysis, absence of genetic syndrome, lack of submucous cleft, and presence of severe-pre-operative hypernasality were significantly and positively associated with increased post-operative VELO scores. CONCLUSION Children who undergo VPI surgery are more likely to have better post-operative quality of life outcomes if their VPI was not associated with a genetic syndrome or submucous cleft. Non-syndromic and non-SMC patients with severe pre-operative hypernasality may benefit significantly from VPI surgery and have improved post-operative quality of life.
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Affiliation(s)
- Lilun Li
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA
| | - David Strum
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA
| | - Stephen Larson
- Department of Otolaryngology, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38163, USA
| | - Diego Preciado
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA.
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Bak SY, Oh WS, Erman A. Treatment of velopharyngeal dysfunction: A clinical report. J Prosthet Dent 2019; 123:888-891. [PMID: 31787271 DOI: 10.1016/j.prosdent.2019.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 11/24/2022]
Abstract
Current tumor therapies can impair velopharyngeal function and lead to the development of hypernasality and nasal regurgitation. This article describes a prosthetic restoration of velopharyngeal dysfunction with a multidisciplinary approach including a speech pathologist and videofluoroscopic and nasal endoscopic procedures.
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Affiliation(s)
- Sun-Yung Bak
- Clinical Assistant Professor, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Mich.
| | - Won-Suk Oh
- Clinical Professor, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Mich
| | - Andrew Erman
- Director, Speech Pathology Clinic, UCLA Health System, Los Angeles, Calif
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Collett BR, Chapman K, Wallace ER, Kinter SL, Heike CL, Speltz ML, Werler M. Speech, Language, and Communication Skills of Adolescents With Craniofacial Microsomia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1571-1581. [PMID: 31580699 PMCID: PMC7251598 DOI: 10.1044/2019_ajslp-19-0089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
Purpose Youth with craniofacial microsomia (CFM) have anomalies and comorbidities that increase their risk for speech, language, and communication deficits. We examined these outcomes in youth with and without CFM and explored differences as a function of CFM phenotype and hearing status. Method Participants included youth ages 11-17 years with CFM (n = 107) and demographically similar controls (n = 306). We assessed speech intelligibility, articulation, receptive and expressive language, and parent and teacher report measures of communication. Hearing status was also screened at the study visit. Group differences were estimated using linear regression analyses with standardized effect sizes (ES) adjusted for demographic characteristics (adjusted ES) or negative binomial regression. Results Youth with CFM scored lower than unaffected peers on most measures of intelligibility, articulation, expressive language, and parent- and-teacher-rated communication. Differences were most pronounced among participants with CFM who had mandibular hypoplasia plus microtia (adjusted ES = -1.15 to -0.18). Group differences were larger in youth with CFM who failed the hearing screen (adjusted ES = -0.73 to 0.07) than in those who passed the hearing screen (adjusted ES = -0.34 to 0.27). Conclusions Youth with CFM, particularly those with mandibular hypoplasia plus microtia and/or hearing loss, should be closely monitored for speech and language concerns. Further research is needed to identify the specific needs of youth with CFM as well as to document the course of speech and language development in children with CFM.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA
| | - Kathy Chapman
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Erin R Wallace
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | | | | | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA
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Santillana R, Skirko J, Roth C, Tollefson TT. Spanish Linguistic Validation for the Velopharyngeal Insufficiency Effects on Life Outcomes. JAMA FACIAL PLAST SU 2019. [PMID: 29522150 DOI: 10.1001/jamafacial.2018.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rosario Santillana
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
| | - Jonathan Skirko
- Department of Otolaryngology, University of Utah, Salt Lake City
| | - Christina Roth
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
| | - Travis T Tollefson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
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30
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Bruneel L, Alighieri C, Bettens K, Musasizi D, Ojok I, D'haeseleer E, Van Lierde K. Assessing health-related quality of life in patients with cleft palate in resource-limited countries: A preliminary evaluation of the VELO questionnaire in Uganda. Int J Pediatr Otorhinolaryngol 2019; 124:39-46. [PMID: 31158570 DOI: 10.1016/j.ijporl.2019.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/15/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Studies evaluating health-related quality of life (HRQoL) in patients with cleft palate living in resource-limited countries such as Uganda are scarce. The VELO questionnaire evaluates the impact of speech (and swallowing) difficulties on the patient's HRQoL. The aim was to evaluate an adapted English version of the VELO questionnaire with reduced response options in Ugandan patients with a cleft lip and palate in order to identify influencing factors and future perspectives to implement HRQoL assessement in this population. METHODS Based on the responses of 16 parents of patients with cleft palate, 6 adolescent/adult patients with cleft palate and 12 control participants without cleft palate, observations regarding linguistic and cultural difficulties were noted and the discriminant validity and internal consistency of this adapted version of the questionnaire were evaluated. Additionally, the relationship between these responses and perceptually assessed speech parameters was assessed. RESULTS Half of the participants (11/22) completed the questionnaire independently, frequently resulting in incomplete responses (8/11). Difficulties with wording and cultural aspects influencing the responses were identified. The subscales showed excellent internal consistency, with the exception of the subscale 'swallowing problems'. The score on the subscale 'perception by others' of the parent report showed no significant difference with the score of the control group. The total score on the parent report and the youth report was (borderline) significantly related to the speech variables speech understandability, speech acceptability and the VPC-SUM. DISCUSSION AND CONCLUSION Promising results regarding the validity and internal consistency of the adapted instrument were found, indicating the potential of the VELO questionnaire for HRQoL assessment at the CoRSU hospital in Uganda. However, results should be interpreted cautiously, given that all participants had a primary language other than English, the small sample size with skewed distribution of speech characteristics, and the bias induced by socially desirable responses. In future studies, adaptations based on qualitative research to account for linguistic and cultural aspects, followed by a rigorous forward-backward translation of the questionnaire to English and Luganda are needed.
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Affiliation(s)
- Laura Bruneel
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium.
| | - Cassandra Alighieri
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Kim Bettens
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Duncan Musasizi
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Isaac Ojok
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Evelien D'haeseleer
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Kristiane Van Lierde
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
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Denadai R, Raposo-Amaral CE, Sabbag A, Ribeiro RA, Buzzo CL, Raposo-Amaral CA, Hung M, Skirko JR. Measuring Patient-Reported Health-Related Quality of Life in Velopharyngeal Insufficiency: Reliability and Validity of the Brazilian Portuguese Version of the VELO Instrument. Cleft Palate Craniofac J 2019; 56:1195-1205. [PMID: 31079479 DOI: 10.1177/1055665619846763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To test the Brazilian Portuguese velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for reliability and validity. DESIGN Cross-sectional methodological study. SETTING Tertiary craniofacial medical center. PARTICIPANTS Participants with VPI (VPI group, n = 60), with cleft and without VPI (no VPI/cleft group, n = 60), and with no cleft nor VPI (no VPI/no cleft group, n = 60) and their parents (n = 180). INTERVENTIONS All patients with VPI 8+ years old and their parents completed the Brazilian-Portuguese VELO instrument and other questionnaires (Pediatric Quality of Life Inventory4.0, PedsQL4.0; Pediatric Voice-Related Quality of Life, PVRQOL; and Intelligibility in Context Scale, ICS) at baseline; patients with VPI and their parents completed the VELO instrument again 2 weeks later. MAIN OUTCOME MEASURES The VELO instrument was tested for internal consistency, test-retest reliability, discriminant validity (participants with VPI against participants with no VPI), concurrent validity against other questionnaires, criterion validity against hypernasality severity, and construct validity against nasal air emission and overall velopharyngeal competence (speech construct) and velopharyngeal gap (anatomic construct). RESULTS The VELO had excellent internal consistency (Cronbach α 0.99 for parents and 0.98 for participants with VPI) and test-retest reliability (all intraclass correlation coefficient > 0.87). The VELO discriminated well between VPI group and unaffected groups (all P < .05). The VELO was significantly correlated with the PedsQL4.0, PVRQOL, and ICS (-r > 0.75; P < .001). The VELO met criterion validity, speech construct validity, and anatomic construct validity (r > 0.7; P < .001). CONCLUSIONS The Brazilian-Portuguese VELO instrument demonstrated reliability (internal consistency and test-retest) and validity (discriminant, concurrent, criterion, and construct).
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Affiliation(s)
- Rafael Denadai
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | | | - Anelise Sabbag
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Rafael Andrade Ribeiro
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Celso Luiz Buzzo
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | | | - Man Hung
- 2 College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA.,3 Department of Orthopaedic Surgery Operations, University of Utah, Salt Lake City, UT, USA
| | - Jonathan R Skirko
- 4 Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Bruneel L, Bettens K, Van Lierde K. The relationship between health-related quality of life and speech in patients with cleft palate. Int J Pediatr Otorhinolaryngol 2019; 120:112-117. [PMID: 30776568 DOI: 10.1016/j.ijporl.2019.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In health-care, current efforts focus on providing patient-centered care. Specifically for patients with velopharyngeal insufficiency, and by extent patients with cleft palate, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire (Skirko et al., 2012; 2013) allows the clinician to map the impact of speech and swallowing difficulties on the patient's health-related quality of life (HRQoL). The current study evaluated the hypothesized association between this speech-related HRQoL measure and perceptually and instrumentally assessed speech variables, to provide evidence for the construct validity of the Dutch version of the VELO questionnaire. MATERIALS AND METHODS Thirty participants, twenty-five patients with cleft palate and five controls, were enrolled. Perceptual speech assessment was conducted following the recently developed Belgian Dutch outcome tool for perceptual speech assessment in patients with cleft palate. In addition, nasalance values and the Nasality Severity Index (NSI) 2.0 were determined. The relationship between these speech outcomes and the scores on the VELO parent report was determined using Spearman rank-order correlation coefficients. RESULTS Moderate to strong correlations were found between the total score on the VELO parent report and five speech variables: the VPC-SUM score (rs = -0.476), speech understandability (rs = -0.657), passive CSC's (rs = -0.654), speech acceptability (rs = -0.591) and the need for C(L)P-related speech therapy (rs = -0.711). Furthermore, these variables were associated with at least one subscale of the VELO questionnaire. DISCUSSION AND CONCLUSION Correlations between speech outcomes and the Dutch version of the VELO questionnaire provide evidence for the construct validity of this version of the instrument. Furthermore, insights in these associations may lead the way to efficient therapy approaches, targeting speech features with the greatest impact on the patient's health-related quality of life.
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Affiliation(s)
- Laura Bruneel
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium.
| | - Kim Bettens
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium
| | - Kristiane Van Lierde
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium; University of Pretoria, Faculty of Humanities, Department of Speech-Language Pathology and Audiology, Pretoria, South Africa
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Jackson O, Crowley TB, Sharkus R, Smith R, Jeong S, Solot C, McDonald-Mcginn D. Palatal evaluation and treatment in 22q11.2 deletion syndrome. Am J Med Genet A 2019; 179:1184-1195. [PMID: 31038278 DOI: 10.1002/ajmg.a.61152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/21/2018] [Accepted: 02/27/2019] [Indexed: 01/23/2023]
Abstract
Palatal involvement occurs commonly in patients with 22q11.2 Deletion Syndrome (22qDS), and includes palatal clefting and velopharyngeal dysfunction in the absence of overt or submucous clefts. The reported incidence and distribution of palatal abnormalities vary in the literature. The aim of this article is to revisit the incidence and presenting features of palatal abnormalities in a large cohort of patients with 22qDS, summarize the surgical treatments performed in this cohort, and provide an overview of surgical treatment protocols and management guidelines for palatal abnormalities in this syndrome. Charts of 1,121 patients seen through the 22q and You Center at the Children's Hospital of Philadelphia were reviewed for palatal status, demographic factors, deletion size, and corrective surgical procedures. Statistical analysis was performed using Pearson's chi-squared test to identify differences between gender, deletion size, and palatal abnormality. Of the patients with complete evaluations, 67% were found to have a palatal abnormality. The most common finding was velopharyngeal dysfunction in 55.2% of patients, and in 33.3% of patients, this occurred in the absence of palatal clefting. There was no significant difference in the incidence of palatal abnormalities by gender; however, a difference was noted among race (p < 0.01) and deletion sizes (p < 0.01). For example, Caucasian and Asian patients presented with a much higher prevalence of palatal abnormalities, and conversely those with nested deletions presented with a much lower rate of palatal defects. Overall, 26.9% of patients underwent palatal surgery, and the most common indication was velopharyngeal dysfunction. Palatal abnormalities are a hallmark feature of 22q11.2 Deletion Syndrome; understanding the incidence, presenting features, and treatment protocols are essential for practitioners counseling and treating families affected with this disorder.
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Affiliation(s)
- Oksana Jackson
- Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - T Blaine Crowley
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert Sharkus
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert Smith
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie Jeong
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cynthia Solot
- Department of Speech Language Pathology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Donna McDonald-Mcginn
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Health-related quality of life in patients with cleft palate: Reproducibility, responsiveness and construct validity of the Dutch version of the VELO questionnaire. Int J Pediatr Otorhinolaryngol 2019; 119:141-146. [PMID: 30708181 DOI: 10.1016/j.ijporl.2019.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/13/2018] [Accepted: 01/19/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Recently, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire, which evaluates the impact of speech and swallowing difficulties on health-related quality of life (HRQoL) in patients with VPI (Skirko et al., 2012), was translated to Dutch (Bruneel et al., 2017). The purpose of this study was to evaluate the reproducibility, responsiveness and construct validity of this Dutch version of the questionnaire. METHODS To evaluate the reproducibility, 50 parents and 14 children with cleft palate re-completed the questionnaire after two weeks. Thirty-five parents and 8 children with cleft palate completed the VELO questionnaire after one year for the evaluation of the responsiveness. The correlation between age and the VELO questionnaire (construct validity), and the internal consistency (Cronbach's α) were re-determined based on the responses of 73 parents and 24 children. RESULTS Based on descriptive statistics, results of the Wilcoxon signed rank-test, and the absolute (SEM) and relative (ICC) consistency, the questionnaire showed good reproducibility. VELO scores did not significantly differ after one year, neither when performing separate analyses for the intervention (speech therapy) and the non-intervention group. Correlations indicated higher HRQoL, as perceived by the parents, with increasing age. The reverse was the case for the youth report. Cronbach's α showed excellent internal consistency for both reports. CONCLUSIONS The VELO questionnaire showed good reproducibility and internal consistency. Moreover, results reconfirmed the age effect on VELO scores. To understand the implications of the results regarding the questionnaire's responsiveness, future research should focus on the identification of factors influencing the patient's evolution in HRQoL.
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Huang H, Chen N, Yin H, Skirko JR, Guo C, Ha P, Li J, Shi B. Validation of the Chinese Velopharyngeal Insufficiency Effects on Life Outcomes Instrument. Laryngoscope 2019; 129:E395-E401. [PMID: 30671957 DOI: 10.1002/lary.27792] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Hanyao Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Nan Chen
- Key Laboratory of Birth Defects and Related Diseases of Women and Children and Office of Educational AdministrationWest China Second University Hospital, Sichuan University Chengdu China
| | - Heng Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Jonathan R. Skirko
- Pediatric Otolaryngology (ENT) and Pediatric Facial Plastic SurgeryUniversity of Utah and Primary Children's Medical Center Salt Lake City Utah U.S.A
| | - Chunli Guo
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Pin Ha
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
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Spanish Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcomes: VELO-Spanish. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1986. [PMID: 30881793 PMCID: PMC6414130 DOI: 10.1097/gox.0000000000001986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/05/2018] [Indexed: 11/26/2022]
Abstract
Background: Quality of life (QOL) assessments are useful tools that measure a patient’s health status and monitor patient-reported outcome measures. This study highlights the process of linguistic validation of a QOL assessment to serve Spanish-speaking families and ultimately help decrease language barriers in the treatment of velopharyngeal insufficiency (VPI). Methods: The standardized linguistic validation process included forward and backward translation, reconciliation, and cognitive interviews with patients and families. Preliminary instrument test-retest measurement was assessed. Eligibility for cognitive interviews included families with familiarity of velopharyngeal insufficiency. Exclusion criteria included illiteracy and parent and child respondents who do not speak Spanish. Reliability was tested by intraclass correlation (ICC) on VPI Effects on Life Outcomes (VELO)–Spanish instruments completion on 2 measurements from the medical record. Results: The instrument was optimized through a standardized forward and backward translation process. Further problematic language was identified during cognitive interviews with families and their children. In the second interview, only minimal changes were needed. Twenty-one patients (8 males and 13 females) were included. Mean (SD) age was 8.0 (5.3) years (range, 3–21 years). The mean (SD) Velo-Spanish score was 65 (22.1); range 32.7–100. The VELO-Spanish instrument demonstrated excellent test–retest reliability [ICC = 0.91; n = 21 and internal consistency (α = 0.96)]. Conclusions: The Spanish VELO has been developed and refined for use in Spanish-speaking populations as a VPI-specific QOL instrument. The linguistic validation process including cognitive interviews and initial reliability testing. The instrument may improve the understanding of patient-reported outcomes and potential disparities from linguistic and cultural barriers in VPI treatment
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