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Mirsky NA, Slavin BV, Sheinberg DS, Stauber ZM, Parra M, Vivekanand Nayak V, Witek L, Coelho PG, Thaller SR. An Evaluation of Autologous Fat Injection as a Treatment for Velopharyngeal Insufficiency: A Review and Integrated Data Analysis. Ann Plast Surg 2024; 93:115-123. [PMID: 38775371 DOI: 10.1097/sap.0000000000003971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
BACKGROUND Velopharyngeal insufficiency (VPI) is a condition characterized by incomplete separation of the oral and nasal cavities during speech production, thereby leading to speech abnormalities and audible nasal emissions. Subsequently, this adversely impacts communication and potentially interpersonal social interactions. Autologous fat grafting (AFG) to the velopharynx, a minimally invasive technique, aims to improve oronasal separation by providing bulk and advancing the posterior pharyngeal wall toward the soft palate. Despite its potential, the relative novelty of AFG in treating VPI has resulted in reporting of inconsistent indications, varied surgical techniques, and mixed outcomes across existing literature. METHODS This systemic review examined the evidence of AFG for VPI treatment over the past decade (2013-2023). A thorough search across five electronic databases yielded 233 studies, with 20 meeting the inclusion criteria (e.g., utilized fat injection as their selected VPI treatment, conducted study in human subjects, did not perform additional surgical procedure at time of fat injection). Selected studies encompassed patient and surgical intervention characteristics, perceptual speech assessment (PSA) scores, gap sizes, nasalance measurements, and complications. RESULTS The majority of patients had a prior cleft palate diagnosis (78.2%), in which nasoendoscopy was the prevalent method for visualizing the velopharyngeal port defect. Fat harvesting predominantly occurred from the abdomen (64.3%), with an average injection volume of 6.3 mL across studies. PSA and subjective gap size scores were consistently higher preoperatively than postoperatively. PSA score analysis from seven studies revealed significant and sustained improvements postoperatively. Gap size score analysis from four studies demonstrated similar preoperative and postoperative differences. Complications were reported in 17 studies, yielding a 2.7% summative complication rate among 594 cases. CONCLUSIONS Autologous fat grafting has emerged as a minimally invasive, safe, and effective treatment for mild to moderate VPI. However, challenges remain because of variability in patient selection criteria, diagnostic modalities, and outcome measurements. This review underscores the need for randomized control trials to directly compare AFG with standard-of-care surgical interventions, providing more conclusive evidence of its clinical efficacy.
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Affiliation(s)
| | - Blaire V Slavin
- From the University of Miami Miller School of Medicine, Miami, FL
| | | | | | | | - Vasudev Vivekanand Nayak
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL
| | | | | | - Seth R Thaller
- DeWitt Daughtry Family Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL
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Qin C, Li J, Yang J, Cheng Y, Fu X. Soft Palate Dysplasia: Properties and Surgical Techniques. Plast Reconstr Surg 2024; 153:1368-1377. [PMID: 37257150 DOI: 10.1097/prs.0000000000010787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The authors aimed to report a hitherto undescribed class of patients with the obvious phenotype of a novel soft palate dysplasia (SPD) combining unilateral soft palate hypoplasia with a fully developed uvula. The authors also aimed to investigate and evaluate the corresponding surgical approaches. METHODS Twelve patients were clinically diagnosed with SPD. Clinical examination, including radiographic tests, was performed to characterize the congenital deformity. The effectiveness of velopharyngeal closure and speech were tested preoperatively and postoperatively. RESULTS SPD was featured with velopharyngeal insufficiency, food regurgitation, and speech disorders. It was commonly manifested as structural deformities of the soft palate, tongue palatine arch, pharyngeal palatine arch, and pterygomandibular fold, but with complete uvula shape. According to radiographic analysis, in five patients, the lateral pterygoid processes were poorly developed, and other malformations were present. Velopharyngoplasty based on the unilateral posterior pharyngeal flap can well restore the velopharyngeal closure and speech intelligibility without respiration obstruction. CONCLUSIONS SPD is characterized as congenital velopharyngeal insufficiency manifested as a primary soft palate defect. It is highly associated with other physical deformities but independent of conventionally known syndromes. The cause may be an abnormal development of the pterygoid process. Unilateral velopharyngoplasty based on the posterior pharyngeal flap is a great technique to repair SPD. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Chuanqi Qin
- From the The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University
| | - Jian Li
- From the The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology
| | - Jiegang Yang
- From the The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University
| | - Yibin Cheng
- State Key Laboratory of Biocatalysis and Enzyme Engineering, Hubei Key Laboratory of Industrial Biotechnology, School of Life Sciences, Hubei University
| | - Xiazhou Fu
- From the The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology
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Swanson D, Struyk G, Ba'th F, Chinnadurai S, Roby BB. The Incidence of Velopharyngeal Insufficiency in Stickler Syndrome. Cleft Palate Craniofac J 2024; 61:231-234. [PMID: 36443936 DOI: 10.1177/10556656221140675] [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: 12/27/2023] Open
Abstract
OBJECTIVE Stickler Syndrome (SS) is an inherited collagenopathy characterized by heterogenous orofacial, ocular, auditory, and skeletal abnormalities. The orofacial manifestations are variable and some patients present with cleft palate and velopharyngeal insufficiency (VPI). The incidence of VPI in SS is poorly studied and no studies have compared the incidence of VPI between Type I (COL2A1) and Type II (COL11A1) SS. The objective of this study is to compare the incidence of VPI between SS subtypes and discuss the surgical techniques used to treat them. DESIGN Single-institution, retrospective chart review. SETTING Tertiary pediatric hospital. PATIENTS/PARTICIPANTS Forty-three children were diagnosed with SS between January 2003 and December 2018. Genetic testing results, genetics notes, craniofacial clinic notes, and operative reports were reviewed. Patients without genetic testing or craniofacial/otolaryngologic evaluation were excluded. Thirty-one patients met criteria and were included. MAIN OUTCOME MEASURE Primary outcome was VPI incidence. RESULTS There were 18 patients with Type I SS and 13 with Type II SS. Five (16%) patients had VPI, 2 (11%) with Type I SS compared to 3 (23%) with Type II SS (P > .05). All patients with VPI underwent surgery with either sphincter pharyngoplasty (3) or pharyngeal flap (2). Two patients with Type II SS underwent revision sphincter pharyngoplasty, with one conversion to pharyngeal flap. CONCLUSION VPI is common for patients with SS. In this study, there was no significant difference in the incidence of VPI between SS subtypes. Future studies are needed to confirm these findings, which could be important for patient counseling and treatment planning.
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Affiliation(s)
- Daniel Swanson
- Georgetown University School of Medicine, Washington, DC, USA
| | - Griffin Struyk
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Fadlullah Ba'th
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sivakumar Chinnadurai
- Children's Minnesota ENT and Facial Plastic Surgery, Minneapolis, MN, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Brianne B Roby
- Children's Minnesota ENT and Facial Plastic Surgery, Minneapolis, MN, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
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Tio PAE, Rooijers W, de Gier HHW, Poldermans HG, Koudstaal MJ, Caron CJJM. Velopharyngeal insufficiency, speech, and language impairment in craniofacial microsomia: a scoping review. Br J Oral Maxillofac Surg 2024; 62:30-37. [PMID: 38057178 DOI: 10.1016/j.bjoms.2023.09.008] [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: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 12/08/2023]
Abstract
This review provides a comprehensive overview of the literature on velopharyngeal insufficiency, associated anomalies, and speech/language impairment in patients with craniofacial microsomia (CFM). A systematic search of the literature was conducted to identify records on VPI and speech impairment in CFM from their inception until September 2022 within the databases Embase, PubMed, MEDLINE, Ovid, CINAHL EBSCO, Web of Science, Cochrane, and Google Scholar. Seventeen articles were included, analysing 1,253 patients. Velopharyngeal insufficiency results in hypernasality can lead to speech impairment. The reported prevalence of both velopharyngeal insufficiency and hypernasality ranged between 12.5% and 55%, while the reported prevalence of speech impairment in patients with CFM varied between 35.4% and 74%. Language problems were reported in 37% to 50% of patients. Speech therapy was documented in 45.5% to 59.6% of patients, while surgical treatment for velopharyngeal insufficiency consisted of pharyngeal flap surgery or pharyngoplasty and was reported in 31.6% to 100%. Cleft lip and/or palate was reported in 10% to 100% of patients with CFM; these patients were found to have worse speech results than those without cleft lip and/or palate. No consensus was found on patient characteristics associated with an increased risk of velopharyngeal insufficiency and speech/language impairment. Although velopharyngeal insufficiency is a less commonly reported characteristic of CFM than other malformations, it can cause speech impairment, which may contribute to delayed language development in patients with CFM. Therefore, timely recognition and treatment of speech impairment is essential.
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Affiliation(s)
- Pauline A E Tio
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands.
| | - Wietse Rooijers
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte H W de Gier
- Department of Otorhinolaryngology, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte G Poldermans
- Speech and Language Centre, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Maarten J Koudstaal
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Cornelia J J M Caron
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
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Reed CA, Birch A, Coward T. A custom nasal obturator for velopharyngeal dysfunction: A dental technique. J Prosthet Dent 2023; 130:940-943. [PMID: 35501186 DOI: 10.1016/j.prosdent.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
Abstract
Removable nasal obturators provide a treatment option for a range of patients presenting with velopharyngeal dysfunction without eliminating the possibility for future surgery, speech therapy, or the provision of other devices. The presented technique describes the fabrication of a 1-piece silicone nasal obturator to reduce hypernasality and nasal airflow errors without causing significant hyponasality. The obturator has minimal visibility and minimal risk of inhalation.
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Affiliation(s)
- Caroline A Reed
- Principal Maxillofacial Prosthetist, Academic Centre of Reconstructive Science, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom.
| | - Alison Birch
- Speech and Language Therapist, Evelina London Cleft Service, South Wing, St Thomas' Hospital. Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Trevor Coward
- Professor/Consultant in Maxillofacial Craniofacial Rehabilitation, Academic Centre of Reconstructive Science, King's College London, London, United Kingdom
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Mata-Pose L, Mayo-Yáñez M, Chiesa-Estomba CM, Lechien JR, Vaira LA, Maniaci A, Saibene AM, Calvo-Henríquez C, Cabo-Varela I. Velopharyngeal Incompetence in Musicians: A State-of-the-Art Review. J Pers Med 2023; 13:1477. [PMID: 37888088 PMCID: PMC10608608 DOI: 10.3390/jpm13101477] [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: 08/16/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023] Open
Abstract
The velopalatine sphincter is a muscular valve that creates a hermetic seal between the nasopharynx and the oropharynx. It guarantees phonation, swallowing, and breathing (forces expirations). In wind musicians, sphincter closure must be precise during sound generation. Its failure will cause velopharyngeal incompetence (VPI) and the end of professional success. The objective of this article was to conduct a state-of-art review of VPI in wind musicians with a systematic approach based on the PRISMA Statement. The etiology, epidemiology, clinic, diagnosis, and treatment of VPI in wind musicians were evaluated. The research was carried out in different databases (PubMed/MEDLINE, the Cochrane Library, Scielo) and through the Mergullador metasearch engine. A total of 20 publications were selected. VPI is a pathology that affects around one-third of wind musicians according to studies. It causes pharyngeal noises and nasal air emissions during performance. The main etiology seems to be the fatigue of the velopalatine sphincter muscles. The most used diagnostic techniques consist of clinical history, physical examination, and nasofibroscopy. There is no consensus among authors about therapeutic management. Future investigations are necessary to confirm that fatigue of velopalatine sphincter muscles and other factors that increase it are the main causes of VPI in wind musicians.
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Affiliation(s)
- Lucía Mata-Pose
- School of Medicine, Universidade de Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology—Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain;
- Otorhinolaryngology—Head and Neck Surgery Department, Hospital San Rafael (HSR) de A Coruña, 15006 A Coruña, Spain
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, 75000 Paris, France; (C.M.C.-E.); (J.R.L.); (L.A.V.); (A.M.); (A.M.S.); (C.C.-H.)
| | - Carlos M. Chiesa-Estomba
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, 75000 Paris, France; (C.M.C.-E.); (J.R.L.); (L.A.V.); (A.M.); (A.M.S.); (C.C.-H.)
- Otorhinolaryngology—Head and Neck Surgery Department, Hospital Universitario Donostia—Biodonostia Research Institute, 20014 Donostia, Spain
| | - Jérôme R. Lechien
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, 75000 Paris, France; (C.M.C.-E.); (J.R.L.); (L.A.V.); (A.M.); (A.M.S.); (C.C.-H.)
- Department of Otolaryngology, Polyclinique de Poitiers, Elsan Hospital, 86000 Poitiers, France
- Department of Otolaryngology—Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 91190 Paris, France
- Department of Human Anatomy and Experimental Oncology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Department of Otolaryngology—Head & Neck Surgery, Centre Hospitalier Universitaire Saint-Pierre, 1000 Brussels, Belgium
| | - Luigi A. Vaira
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, 75000 Paris, France; (C.M.C.-E.); (J.R.L.); (L.A.V.); (A.M.); (A.M.S.); (C.C.-H.)
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Antonino Maniaci
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, 75000 Paris, France; (C.M.C.-E.); (J.R.L.); (L.A.V.); (A.M.); (A.M.S.); (C.C.-H.)
- Faculty of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy
| | - Alberto M. Saibene
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, 75000 Paris, France; (C.M.C.-E.); (J.R.L.); (L.A.V.); (A.M.); (A.M.S.); (C.C.-H.)
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Christian Calvo-Henríquez
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, 75000 Paris, France; (C.M.C.-E.); (J.R.L.); (L.A.V.); (A.M.); (A.M.S.); (C.C.-H.)
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, 15701 Santiago de Compostela, Spain
| | - Irma Cabo-Varela
- Otorhinolaryngology—Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain;
- Health Sciences Programme, International Center for Doctorate (EIDUDC), Universidade da Coruña (UDC), 15001 A Coruña, Spain
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Phippen G. Articulating the issues: speech assessment and intervention in cleft lip and palate. Br Dent J 2023; 234:912-917. [PMID: 37349440 DOI: 10.1038/s41415-023-5954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
This paper describes the impact of cleft lip and palate on speech. It provides an overview for the dental clinician of the key issues affecting speech development and clarity. The paper summarises the complex speech mechanism and cleft-related factors that affect speech, including palatal, dental and occlusal anomalies. It outlines the framework for speech assessment throughout the cleft pathway and provides a description of cleft speech disorder, as well as describing treatment approaches for cleft speech and velopharyngeal dysfunction.This is followed by a spotlight on speech prosthetics for treating nasal speech, with an emphasis on joint management by the Speech and Language Therapist and Consultant in Restorative Dentistry. This includes the core multidisciplinary approach, clinician and patient-reported outcome measures, and brief discussion of national developments in this area.The importance of multidisciplinary cleft care is highlighted and, within this, the essential interaction between speech and dental clinicians in providing routine care, as well as in delivering a highly specialist speech prosthetics service.
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Affiliation(s)
- Ginette Phippen
- Lead Speech & Language Therapist, The Spires Cleft Centre, Salisbury NHS Foundation Trust/Oxford University Hospitals NHS Foundation Trust, United Kingdom.
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8
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Diallo-Hornez G, Khonsari RH, Mercier JM, Delaire J, Balandier S, Defay V, Isidor B, Rousteau G, Talmant JC, Perrin JP, Bertin H, Corre P. Could pharyngeal fat injection be a first-line treatment of velopharyngeal insufficiency? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e206-e211. [PMID: 34844018 DOI: 10.1016/j.jormas.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Garance Diallo-Hornez
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Roman Hossein Khonsari
- Hôpital Necker Enfants - Malades, Service de Chirurgie Maxillo-faciale et Chirurgie Plastique, Assistance Publique - Hôpitaux de Paris, Université de Paris , Paris, France
| | - Jacques-Marie Mercier
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean Delaire
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Sophie Balandier
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Virginie Defay
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Bertrand Isidor
- Service de Génétique clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Gabriel Rousteau
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Claude Talmant
- Chirurgie Plastique, Reconstructrice et Esthétique, Clinique Jules Verne, Nantes, France
| | - Jean-Philippe Perrin
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Hélios Bertin
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pierre Corre
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France.
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Nachmani A, Biadsee A, Masalha M, Kassem F. Compensatory Articulation Errors in Patients With Velopharyngeal Dysfunction and Palatal Anomalies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2518-2539. [PMID: 35858260 DOI: 10.1044/2022_jslhr-21-00679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of this study was to assess the frequency and types of compensatory articulations (CAs) in nonsyndromic patients with velopharyngeal dysfunction (VPD) and various palatal anomalies and to determine the relationship between the frequency of CAs, type of palatal anomaly, and phonological errors. METHOD A total of 783 nonsyndromic, Hebrew-speaking patients with VPD and various palatal anomalies (cleft lip and palate [CLP], cleft palate [CP], submucous CP [SMCP], occult submucous CP [OSMCP], or non-CP) were studied retrospectively. Perceptual VPD tests, including articulation and phonological assessment, were conducted. CAs were described as below the level of the defect in the vocal tract (abnormal backing of oral targets to post-uvular place) or in front of it within the oral cavity (palatalization) and at the velopharyngeal port. RESULTS Among 783 patients, 213 (27.2%) had CAs. Most CAs (18.4%) occurred below the level of the defect, followed by CAs at the velopharyngeal port (12.0%) or in front of it (4.9%). No differences were found in the frequency of CAs between patients with CP (47.8%) or CLP (52.6%) and between those with non-CP (13.6%) or OSMCP (14.7%). SMCP patients had lower frequency of CAs (29.8%) than CP (p = .003) and CLP (p = .002) patients but higher frequency than OSMCP (p = .002) and non-CP (p = .002) patients did. Among the 783 patients, 247 (31.5%) had phonological errors. A higher frequency of phonological errors was found in patients with CAs (55.4%) compared to those without (22.6%) and in all palatal anomaly groups except CLP (31.4% vs. 23.9%). CONCLUSIONS CAs in nonsyndromic patients with VPD remained relatively high in all age groups, up to adulthood. CAs are influenced by inadequate velar length following palatal repair, as well as by oral structural abnormalities, whereas poor muscle function due to OSMCP and/or abnormal size and/or shape of nasopharynx has less influence. Errors produced in front of the velopharyngeal port are influenced by the structural anomaly of CLP. This information may contribute to general phonetic and phonological theories and genetic investigations about CP anomalies.
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Affiliation(s)
- Ariela Nachmani
- Faculty of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ameen Biadsee
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Muhamed Masalha
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Firas Kassem
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
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Rohde R, Friedland DR. Clinical perspectives on nasopharyngeal morphology in humans. Anat Rec (Hoboken) 2022; 305:2065-2074. [PMID: 35388627 DOI: 10.1002/ar.24926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/12/2022] [Indexed: 12/11/2022]
Abstract
The nasopharynx is an integral component of the upper aerodigestive tract, whose morphologic features share an intimate relationship with a vast array of clinical, functional, and quality of life conditions related to contemporary humans. Its composite architecture and central location amidst the nasal cavity, pharyngotympanic tube, palate, and skull base bears implications for basic physiologic functions including breathing, vocalization, and alimentation. Over the course of evolution, morphological modifications of nasopharyngeal anatomy have occurred in genus Homo which serve to distinguish the human upper aerodigestive tract from that of other mammals. Understanding of these adaptive changes from both a comparative anatomy and clinical perspective offers insight into the unique blueprint which underpins many clinical pathologies currently encountered by anthropologists, scientists, and otorhinolaryngologists alike. This discussion intends to familiarize readers with the fundamental role that nasopharyngeal morphology plays in upper aerodigestive tract conditions, with consideration of its newfound clinical relevance in the era of the COVID-19 pandemic.
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Affiliation(s)
- Rebecca Rohde
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David R Friedland
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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11
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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] [MESH Headings] [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.
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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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13
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Kjellmer L, Raud Westberg L, Lohmander A. Treatment of active nasal fricatives substituting /s/ in young children with normal palatal function using motor-based intervention. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:593-603. [PMID: 33779422 DOI: 10.1080/17549507.2021.1891285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: The aim was to evaluate the effect of a motor-based, hierarchically structured intervention directed at active nasal fricatives substituting /s/ in young children with normal palatal function.Method: An experimental single-subject design was replicated across three children, aged 4-6 years, with normal palatal function, who substituted oral /s/ with active nasal fricatives. Treatment was performed weekly by a speech-language pathologist and included home training conducted by parents. Audio documented probes were registered regularly and /s/-production evaluated as oral or nasal.Result: All children achieved 98-100% oral production of /s/ in six probed linguistic contexts at treatment end and exhibited good maintenance at follow-up. The four-year-olds showed gradual or inconsistent response and slower progress, the six-year-old direct response and faster progress.Conclusion: The study provides preliminary evidence suggesting positive intervention effects for treating active nasal fricatives in children with normal palatal function. However, possible confounding effects such as maturation or repeated testing could not be ruled out; thus, results need to be replicated with increased experimental control. Nevertheless, the study adds to the currently meagre empirical evidence-base for the population. Individual treatment response and progress patterns were found and data suggests that the intervention may be beneficial from age 4.
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Affiliation(s)
- Liselotte Kjellmer
- Department of Special Education, Stockholm University, Stockholm, Sweden
| | - Liisi Raud Westberg
- Department of Reconstructive Plastic Surgery, Medical Unit, Speech and Language Pathology and Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden, and
| | - Anette Lohmander
- Department of Reconstructive Plastic Surgery, Medical Unit, Speech and Language Pathology and Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden, and
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
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Story BH, Bunton K. The relation of velopharyngeal coupling area to the identification of stop versus nasal consonants in North American English based on speech generated by acoustically driven vocal tract modulations. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:3618. [PMID: 34852618 DOI: 10.1121/10.0007223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to determine the threshold of velopharyngeal coupling area at which listeners switch from identifying a consonant as a stop to a nasal in North American English, based on V1CV2 stimuli generated with a speech production model that encodes phonetic segments as relative acoustic targets. Each V1CV2 was synthesized with a set of velopharyngeal coupling functions whose area ranged from 0 to 0.1 cm2. Results show that consonants were identified by listeners as a stop when the coupling area was less than 0.035-0.057 cm2, depending on place of articulation and final vowel. The smallest coupling area (0.035 cm2) at which the stop-to-nasal switch occurred was found for an alveolar consonant in the /ɑCi/ context, whereas the largest (0.057 cm2) was for a bilabial in /ɑCɑ/. For each stimulus, the balance of oral versus nasal acoustic energy was characterized by the peak nasalance during the consonant. Stimuli with peak nasalance below 40% were mostly identified by listeners as stops, whereas those above 40% were identified as nasals. This study was intended to be a precursor to further investigations using the same model but scaled to represent the developing speech production system of male and female talkers.
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Affiliation(s)
- Brad H Story
- Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona 85721-0071, USA
| | - Kate Bunton
- Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona 85721-0071, USA
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15
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Lambert EM, You P, Kacmarynski DS, Rosenberg TL. Adenoidectomy and persistent velopharyngeal insufficiency: Considerations, risk factors, and treatment. Int J Pediatr Otorhinolaryngol 2021; 149:110846. [PMID: 34329831 DOI: 10.1016/j.ijporl.2021.110846] [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: 02/05/2021] [Revised: 06/05/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
IMPORTANCE Persistent velopharyngeal insufficiency (VPI) is a rare but well-recognized complication of adenoidectomy. VPI can have a significant impact on the communication of a child. OBJECTIVE To describe the pathophysiology of post-adenoidectomy VPI, identify its associated risk factors, and illustrate the techniques used to treat the entity. EVIDENCE REVIEW A search of English or translated English articles concerning adenoidectomy, partial adenoidectomy, superior adenoidectomy; and velopharyngeal insufficiency, speech and voice from 1980 to 2021 was performed using Pubmed and Embase. Data from prospective and retrospective studies and their relevant references were pooled. RESULTS By objective measures, hypernasality is noted in many pediatric patients post-adenoidectomy, but this typically resolves in 3-6 months. Risk factors for the development of post-adenoidectomy VPI include low birth weight, family history of hypernasality, and history of speech problems or nasal regurgitation. The cleft palate, submucous cleft palate, poor palate mobility, and a deep pharynx may indicate susceptibility to VPI. Speech therapy is successful in up to 50% of patients, while surgical intervention may be tailored based on the diagnostic evaluation of the velopharynx with videofluoroscopy or nasoendoscopy. CONCLUSION We present a comprehensive review of the literature on the pathophysiology, risk factors, and treatment of post-adenoidectomy VPI. We hope to bring awareness to the factors that can lead to a rare but potentially devastating complication in one of the most common procedures performed by Otolaryngologists.
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Affiliation(s)
- Elton M Lambert
- Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street D.640, Houston, TX, 77030, USA.
| | - Peng You
- Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street D.640, Houston, TX, 77030, USA.
| | - Deborah S Kacmarynski
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
| | - Tara L Rosenberg
- Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street D.640, Houston, TX, 77030, USA.
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The impact of hearing loss on speech outcomes in 5-year-old children with cleft palate ± lip: A longitudinal cohort study. Int J Pediatr Otorhinolaryngol 2021; 149:110870. [PMID: 34385041 DOI: 10.1016/j.ijporl.2021.110870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate the impact of hearing loss (using longitudinal measurements of hearing) on speech outcomes at age 5 (5 years 0 months-5 years 11 months) in children born with cleft palate ± lip. Other variables which may impact upon the speech outcomes at age 5 in this population were also investigated. METHODS A retrospective longitudinal cohort study of children, without a named syndrome, born with cleft palate ± lip, and treated at a Cleft Centre in the United Kingdom. Data collected from infancy to 5 years 11 months, included hearing test results from three specific time points (7 months-1 year 2 months [age A]; 2 years 0 months-2 years 11 months [age B]; 5 years 0 months-5 years 11 months [age C]) and speech outcome data at age 5 years (5 years 0 months-5 years 11 months). Hearing test results at each age were compared to identify how hearing changes with age. Correlations between hearing test results and speech outcomes at age 5 were analysed. RESULTS Hearing loss was frequent but predominantly mild. There were no significant correlations between speech outcomes and hearing results at any age. Mild hearing loss remained prevalent at age 5, although a significant age-related hearing improvement was found. A significant relationship between cleft type and cleft speech characteristics was found (P < .001); children with Bilateral Cleft Lip and Palate achieved the poorest articulation outcomes. CONCLUSION Although mild hearing loss was common in the cohort, there was no association between hearing loss and the speech outcomes investigated. In contrast, the type of cleft was significantly associated with the presence of cleft speech characteristics. Further longitudinal measurement of hearing is required to substantiate the findings of this study.
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17
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Naidoo S, Roode GJ, Bütow KW, Meer S. Ectomesenchymal Chondromyxoid Tumor: A Rare Association With an Asymmetrical Soft Palate Cleft. Cleft Palate Craniofac J 2021; 59:932-937. [PMID: 34459667 DOI: 10.1177/10556656211035029] [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: 11/15/2022] Open
Abstract
Ectomesenchymal chondromyxoid tumor (ECT) is a rare oral lesion first described by Smith et al. in 1995. These tumors are typically painless, slow growing and benign masses occurring predominantly on the anterior tongue dorsum. Prior to this seminal report, many ECTs may have been misdiagnosed due to the histological similarities with other lesions. Immunohistochemical stains aid in definitive diagnosis of an ECT. A total of 39 papers since published have reported 96 patients with ECT. Most lesions involve the anterior aspect of the tongue, with only 6 occurring in the posterior tongue and 2 involving the hard palate. ECTs are considered to develop from ectomesenchymal cells of neural crest cells that have migrated to the tongue during embryological development. This paper is of a rare case of ECT of the posterolateral tongue occurring in association with an unusual asymmetrical soft palate cleft. It is postulated that since the tongue develops before the formation of the soft palate, an ECT lesion occurring on the posterior aspect may have a causal contribution to the development of the soft palate cleft.
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Affiliation(s)
- Sharan Naidoo
- Mediclinic Midstream Hospital, Pretoria, Gauteng, South Africa.,Facial Cleft Deformity Clinic, Department of Maxillofacial and Oral Surgery, 56410University of Pretoria, Pretoria, Gauteng, South Africa
| | - Gieljam J Roode
- Department of Anatomy, 72042Faculty of Basic Sciences, 56410University of Pretoria, Pretoria, Gauteng, South Africa
| | - Kurt W Bütow
- Life Wilgers Hospital, Wilgers, Pretoria, Gauteng, South Africa
| | - Shabnum Meer
- Department of Oral Pathology, 37708Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
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Abstract
PURPOSE OF REVIEW Velopharyngeal insufficiency in the absence of an overt cleft-palate is a less common and often missed cause of a resonance disorder. The purpose of this manuscript is to provide the reader with an overview of the clinical assessment. Highlight the need for multidisciplinary involvement. Discuss the process of decision-making related to a repair and finally comment on the preoperative, intra-operative, and postoperative considerations. RECENT FINDINGS With the advent of small calibre videonasendoscopes, evaluation of the size, location, and closure pattern of the velopharyngeal gap has improved the surgeons' ability to provide a tailored repair. Evolutions in technique including posterior pharyngeal wall augmentation and buccal flap advancement in palatal lengthening have all increased the options available to the patient and treating team. SUMMARY Multidisciplinary assessment by trained specialist from speech and language pathology and surgery remain the cornerstone in the evaluation and management of this patient cohort. Many have a chromosomal anomaly that should be tested for and managed accordingly. These patients are often diagnosed late and have developed additional compensatory speech disorders that often need to be addressed following repair of the palate. Targeted thoughtful assessment will allow for a greater likelihood of successful repair.
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Ertan E, Gürvit HI, Hanağası HH, Bilgiç B, Tunçer MA, Yılmaz C. Intensive voice treatment (the Lee Silverman Voice Treatment [LSVT ®LOUD]) for individuals with Wilson's disease and adult cerebral palsy: two case reports. LOGOP PHONIATR VOCO 2021; 47:262-270. [PMID: 34287100 DOI: 10.1080/14015439.2021.1951348] [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: 10/20/2022]
Abstract
Objective: In this case report, we aimed to examine the effects of an intensive voice treatment (the Lee Silverman Voice Treatment [LSVT®LOUD]) for Wilson's disease (WD), and adult cerebral palsy (CP), and dysarthria.Method: The participants received LSVT®LOUD four times a week for 4 weeks. Acoustic, perceptual (GRBAS) analyses were performed and data from the Voice Handicap Index (VHI) were obtained before and after treatment.Results: Besides the Harmonics-to Noise Ratio (HNR) value (dB) of the participant with WD, for both participants' fundamental frequencies (Hz), jitter (%), and shimmer (%) values showed significant differences (p < .05) after therapy. Both participants showed significant improvements (p < .05) in the duration (s) and the sound pressure level (dB, SPL) of sustained vowel phonation (/a/), in SPL (dB) of pitch range (high and low /a/) and reading and conversation (p < .01). There was a positive improvement in the high-frequency values (Hz) of both participants but not in the low-frequency values (Hz) in the participant with WD. Perceptual analysis with GRBAS judgements of sustained vowel (/a/) and paragraph reading of two participants also showed improvement. After therapy, perceived loudness of the participants' voice increased.Conclusions: The findings provide some preliminary observations that the individuals with WD and the adult individuals with CP can respond positively to intensive speech treatment such as LSVT®LOUD. Further studies are needed to investigate speech treatments specific to WD and adult CP.
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Affiliation(s)
- Esra Ertan
- Institut für Deutsche Sprache und Linguistik, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hakan I Gürvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haşmet H Hanağası
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Başar Bilgiç
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Müge A Tunçer
- Department of Speech and Language Therapy, Faculty of Health Science, Sıtkı Koçman University, Muğla, Turkey
| | - Cemil Yılmaz
- Department of Speech and Language Therapy, Faculty of Health Science, Anadolu University, Eskişehir, Turkey
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John HE, Koutsoulieri L, Shaw A, Lin JP, Rahman S, Ferguson L, Timoney N, Atherton D. The importance of neurology and genetic testing in the patient with non-cleft velopharyngeal dysfunction. Int J Pediatr Otorhinolaryngol 2021; 146:110776. [PMID: 34034100 DOI: 10.1016/j.ijporl.2021.110776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE A significant proportion of the referrals made to a speech investigation clinic in a cleft unit include patients with non-cleft velopharyngeal dysfunction (VPD). This study aims to quantify the underlying diagnoses of these patients and describe the investigative pathway and diagnostic information subsequent to presentation in our clinic. MATERIALS AND METHODS The case notes of 136 consecutive patients with non-cleft VPD who attended our Velopharyngeal Investigation (VPI) clinic from July 2014-December 2019 were reviewed. RESULTS In the paediatric group (n = 118) the most common cause was 22q11 chromosomal anomalies (n = 46), while post palatal tumour resection was the commonest cause of acquired non-cleft VPD in adults (n = 8). Fifty-nine patients were referred to the clinic with a known underlying pathology such as a syndromic diagnosis. Of those presenting without a known aetiology, fifty-eight were referred onto our genetics and/or neurology colleagues. Although a genetic or neurological cause could not be identified in some of those patients, thirty-one patients received a new diagnosis, with subsequent implications for ongoing care. CONCLUSION There are a wide range of diagnoses resulting in non-cleft VPD, but there are very few large-scale studies focusing on investigating these patients for an underlying aetiology. This study highlights the role of genetics and neurology in the diagnosis and management plan for this cohort of patients.
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Affiliation(s)
- Hannah Eliza John
- South Thames Cleft Service, Evelina Children's Hospital, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom.
| | - Leda Koutsoulieri
- South Thames Cleft Service, Evelina Children's Hospital, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom
| | - Adam Shaw
- Department of Clinical Genetics, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom
| | - Jean-Pierre Lin
- Department of Paediatric Neurology, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom
| | - Shakeel Rahman
- South Thames Cleft Service, Evelina Children's Hospital, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom
| | - Louisa Ferguson
- South Thames Cleft Service, Evelina Children's Hospital, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom
| | - Norma Timoney
- South Thames Cleft Service, Evelina Children's Hospital, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom
| | - Duncan Atherton
- South Thames Cleft Service, Evelina Children's Hospital, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom
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Carr M, Skarlicki M, Palm S, Bucevska M, Bone J, Gosain AK, Arneja JS. Through-and-Through Dissection of the Soft Palate for Pharyngeal Flap Inset: A "Good-Fast-Cheap" Technique for Any Etiology of Velopharyngeal Incompetence. Cleft Palate Craniofac J 2021; 59:785-793. [PMID: 34137284 PMCID: PMC9121530 DOI: 10.1177/10556656211021738] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the efficacy and resource utilization of through-and-through dissection of the soft palate for pharyngeal flap inset for velopharyngeal incompetence (VPI) of any indication. DESIGN Retrospective review. SETTING Tertiary care center. PATIENTS Thirty patients were included. Inclusion criteria were diagnosis of severe VPI based on perceptual speech assessment, confirmed by nasoendoscopy or videofluoroscopy; VPI managed surgically with modified pharyngeal flap with through-and-through dissection of the soft palate; and minimum 6 months follow-up. Patients with 22q11.2 deletion syndrome were excluded. INTERVENTION Modified pharyngeal flap with through-and-through dissection of the soft palate. MAIN OUTCOME MEASURE(S) Velopharyngeal competence and speech assessed using the Speech-Language Pathologist 3 scale. RESULTS The median preoperative speech score was 11 of 13 (range, 7 to 13), which improved significantly to a median postoperative score of 1 of 13 (range 0-7; P < .001). Velopharyngeal competence was restored in 25 (83%) patients, borderline competence in 3 (10%), and VPI persisted in 2 (7%) patients. Complications included 1 palatal fistula that required elective revision and 1 mild obstructive sleep apnea that did not require flap takedown. Median skin-to-skin operative time was 73.5 minutes, and median length of stay (LOS) was 50.3 hours. CONCLUSIONS This technique allows direct visualization of flap placement and largely restores velopharyngeal competence irrespective of VPI etiology, with low complication rates. Short operative time and LOS extend the value proposition, making this technique not only efficacious but also a resource-efficient option for surgical management of severe VPI.
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Affiliation(s)
- Michael Carr
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | - Sheryl Palm
- Department of Audiology & Speech, University of British Columbia, Cleft Palate-Craniofacial Clinic, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Marija Bucevska
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey Bone
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Arun K Gosain
- Division of Pediatric Plastic Surgery, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Jugpal S Arneja
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.,Sauder School of Business, University of British Columbia, Vancouver, BC, Canada
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Hoi KK, Curtis SH, Driver L, Wisnosky E, Zopf DA, Bohm LA. Adoption of Telemedicine for Multidisciplinary Care in Pediatric Otolaryngology. Ann Otol Rhinol Laryngol 2021; 130:1105-1111. [PMID: 33629600 DOI: 10.1177/0003489421997651] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has introduced a period of social isolation that has challenged the ability of providers to uphold in-person patient care. Although commonplace in pediatric otolaryngology, multidisciplinary clinics pose a unique challenge during this time due to increased infection risk from multiple patient-provider interactions. Guidance on the application of telemedicine for multidisciplinary clinics in pediatric otolaryngology is limited. METHODS We provide comprehensive guidance on best practices for conducting telemedicine visits for a number of multidisciplinary otolaryngology clinics using our experiences at a single tertiary care children's hospital. A review of literature to support the adoption of telemedicine in multidisciplinary pediatric otolaryngology is also incorporated. RESULTS Telemedicine was successfully adopted for 7 multidisciplinary pediatric clinics with a variety of specialists: aerodigestive disorders, congenital hearing loss, microtia/aural atresia, orofacial clefting, sleep disorders, tracheostomy care, and velopharyngeal dysfunction. CONCLUSIONS Telemedicine is feasible for a variety of multidisciplinary clinics and its optimization is critical for providing care to complex pediatric otolaryngology patients during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Karen K Hoi
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stuart H Curtis
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Lynn Driver
- Department of Speech-Language Pathology, Michigan Medicine, Ann Arbor, MI, USA
| | - Erica Wisnosky
- Department of Speech-Language Pathology, Michigan Medicine, Ann Arbor, MI, USA
| | - David A Zopf
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, Michigan Engineering, Ann Arbor, MI, USA
| | - Lauren A Bohm
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
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23
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Kasthurirathne R, Forrest K, Ross J, Patel R. Nasalance in adolescents with autism spectrum disorders. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:517-525. [PMID: 31775529 DOI: 10.1080/17549507.2019.1691263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: Listener judgments indicate atypical nasal resonance in individuals with Autism Spectrum Disorders (ASD); however, listener perceptions are susceptible to bias and may give unreliable information about a speaker's production of nasal resonance. The current study used Nasometry to obtain an objective estimation of nasal resonance among adolescents with ASD and neurotypical controls.Method: The Nasometer II 6450 (PENTAX Medical, Lincoln Park, New Jersey) was used to collect nasalance from adolescents aged 15-17 years with ASD (n = 11) and matched controls (n = 11) across two separate speech tasks: (1) passage reading and (2) spontaneous speech.Result: Adolescents with ASD evidenced significantly higher nasalance scores compared to controls, particularly in the passage loaded with bilabial plosives and some nasals (Bobby) as well as non-nasal words extracted from spontaneous speech. In addition, adolescents with ASD had significantly higher nasalance ratios than controls. Significant group differences were driven by a subset of participants with ASD.Conclusion: Perceptual judgements of nasality noted in previous autism studies are quantified by an increase in nasal energy compared to oral energy. The current data suggest hypernasality is present in a subset of people with ASD rather than being a general feature of speech in autism.
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Affiliation(s)
- Rachel Kasthurirathne
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Karen Forrest
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Jared Ross
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Rita Patel
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
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Yang X, Pratama GB, Choi Y, You H, Tâm NPM, Kim GW, Jo YJ, Ko MH. Measurement of Nasalance Scores Without Touching the Philtrum for Better Comfort During Speech Assessment and Therapy: A Preliminary Study. Cleft Palate Craniofac J 2020; 58:446-454. [PMID: 32924600 DOI: 10.1177/1055665620953340] [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: 11/16/2022] Open
Abstract
OBJECTIVE The Kay Pentax nasometer uses a separator plate that touches the philtrum of a patient to separate the nasal and oral sound energies for nasalance measurement. However, the separator plate can restrict the natural movement of the patient's upper lip and generate unpleasant pressure on the patient's philtrum. The present study was intended to measure nasalance scores without touching the philtrum for better comfort during speech assessment and therapy. METHODS Nasalance scores of 10 males and 10 females having no speech disorders were measured under 4 levels (0, 5, 10, and 15 mm) of the gap between the plate and the philtrum (denoted as plate-to-philtrum gap) using Nasometer II 6450 for nasal (Nasal Sentences) and oral (Zoo Passage) stimuli. Regression formulas were established to examine the relationships between nasalance score and plate-to-philtrum gap for the stimuli. To provide nasalance scores equivalent to those measured for the contact condition, compensation factors for the 5 mm plate-to-philtrum gap measurement condition were identified for the stimuli. RESULTS The nasalance scores were significantly different between the 4 different plate-to-philtrum gaps for the stimuli. Compensation factors for the Nasal Sentences and the Zoo Passage were identified as 1.17 and 0.71, respectively. CONCLUSIONS The 5 mm plate-to-philtrum gap condition after multiplying the compensation factors can provide equivalent nasalance scores to the conventional contact measurement condition which may provide better comfort in speech assessment and therapy.
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Affiliation(s)
- Xiaopeng Yang
- School of Artificial Intelligence and Computer Science, 66374Jiangnan University, Wuxi, PR China
| | - Gradiyan Budi Pratama
- Department of Industrial Engineering, 89224Bandung Institute of Technology, Bandung, Indonesia
| | - Younggeun Choi
- Department of Industrial and Management Engineering, 34995Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Heecheon You
- Department of Industrial and Management Engineering, 34995Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Nguyễn Phu'ò'c Minh Tâm
- Department of Medicine, 90158Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, 90158Chonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of 65377Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Yun-Ju Jo
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of 65377Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, 90158Chonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of 65377Chonbuk National University Hospital, Jeonju, Republic of Korea
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25
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Kurnik NM, Weidler EM, Lien KM, Cordero KN, Williams JL, Temkit M, Beals SP, Singh DJ, Sitzman TJ. The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2020; 57:860-871. [PMID: 32070129 DOI: 10.1177/1055665620902883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Palate re-repair has been proposed as an effective treatment for velopharyngeal insufficiency (VPI) with a low risk of obstructive sleep apnea (OSA). The authors conducted a systematic review and meta-analysis to determine the proportion of patients achieving normal speech resonance following palate re-repair for VPI, the proportion developing OSA, and the criteria for patient selection that are associated with increased effectiveness. METHODS PubMed, Embase, and Scopus were searched from inception through April 2018 for English language articles evaluating palate re-repair for the treatment of VPI in patients with a repaired cleft palate. Inclusion criteria included reporting of hypernasality, nasal air emission, nasometry, additional VPI surgery, and/or OSA outcomes. Meta-analysis was conducted using random effects models. Risk of bias was assessed regarding criteria for patient selection, blinding of outcome assessors, and validity of speech assessment scale. RESULTS Eighteen studies met inclusion criteria. The incidence of achieving no consistent hypernasality follow palate re-repair was 61% (95% confidence interval [CI]: 44%-75%). The incidence of additional surgery for persistent VPI symptoms was 21% (95% CI: 12%-33%). The incidence of OSA was 28% (95% CI: 13%-49%). Criteria for selecting patients to undergo re-repair varied, with anterior/sagittal position of palatal muscles (33%) and small velopharyngeal gap (22%) being the most common. No specific patient selection criteria led to superior speech outcomes (P = .6572). CONCLUSIONS Palate re-repair achieves normal speech resonance in many but not all patients with VPI. Further research is needed to identify the specific examination and imaging findings that predict successful correction of VPI with re-repair.
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Affiliation(s)
- Nicole M Kurnik
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Erica M Weidler
- Department of Clinical Research, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kari M Lien
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - Kelly N Cordero
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - Jessica L Williams
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - M'hamed Temkit
- Department of Clinical Research, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Stephen P Beals
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - Davinder J Singh
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA.,Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Thomas J Sitzman
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA.,Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
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Jones HN, Fernandes S, Hannah WB, Kansagra S, Raynor EM, Kishnani PS. Adenotonsillectomy should be avoided whenever possible in infantile-onset Pompe disease. Mol Genet Metab Rep 2020; 23:100574. [PMID: 32090020 PMCID: PMC7026278 DOI: 10.1016/j.ymgmr.2020.100574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Harrison N. Jones
- Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University, Durham, NC, USA
| | - Samuela Fernandes
- Department of Pediatrics, Division of Medical Genetics, Duke University, Durham, NC, USA
| | - William B. Hannah
- Department of Pediatrics, Division of Medical Genetics, Duke University, Durham, NC, USA
| | - Sujay Kansagra
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Eileen M. Raynor
- Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, USA
| | - Priya S. Kishnani
- Department of Pediatrics, Division of Medical Genetics, Duke University, Durham, NC, USA
- Corresponding author.
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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: 5] [Impact Index Per Article: 1.0] [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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A Preliminary Dynamic Investigation on Velopharyngeal Movements During Blowing: A New Approach for Evaluation. J Craniofac Surg 2019; 31:464-467. [PMID: 31725505 DOI: 10.1097/scs.0000000000006013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To explore an alternative approach to evaluate velopharyngeal function on those speakers with compensatory misarticulation. METHOD Nasopharyngeal endoscopy was used to observe the velopharyngeal movement on 26 adult Mandarin speakers during articulation and different nonverbal state, including SCPS, DCPS, and ABS. RESULTS There were significant differences for the rate of velopharyngeal incompetence (RVPI) among the 4 different states. The RVPI was least for the Articulation State, followed by the Air Blowing and DCPS. The RVPI was largest for the SCPS. CONCLUSION The result indicated that the ABS may be used as an alternative approach to evaluate the velopharyngeal function instead of the articulation samples while patients cannot make clear articulation due to compensatory misarticulation habits. It merits further study on nonverbal activities, which could lay a foundation for exploring more effective approach for evaluation of the velopharyngeal function.
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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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Lo ESC, Wong AWK, Tse ACY, Ma EPM, Whitehill TL, Masters R. Effects of Error Experience on Learning to Lower Speech Nasalance Level. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:448-455. [PMID: 31136230 DOI: 10.1044/2018_ajslp-18-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose This research aims to examine the effects of error experience when learning to speak with lowered nasalance level. Method A total of 45 typical speakers were instructed to learn to lower speech nasalance level in either an errorless (restricted possibility for committing errors) or an errorful (unrestricted possibility for committing errors) learning condition. The nasality level of the participants' speech was measured by a nasometer and quantified by nasalance scores (in percent). Errorless learners practiced producing speech with lowered nasalance level with a threshold nasalance score of 50% (the easiest target) at the beginning, which gradually decreased to a threshold of 10% (the most difficult target) at the end. The same set of threshold targets was presented to errorful learners, but in reverse order. Errors were defined by the proportion of speech, with a nasalance score exceeding the threshold. Retention and transfer tests were administered. Results Errorless learners displayed fewer errors and lower mean nasalance scores than errorful learners during the acquisition phase. Furthermore, errorless learners achieved lower mean nasalance scores than errorful learners in the retention and transfer tests. Conclusion These results suggest that errorless learning is more effective than errorful learning and that error experience has a detrimental effect on the acquisition of a novel speech motor task that requires minimization of the nasality level. Errorless learning may be a useful paradigm for the intervention and management of hypernasality in clinical settings where behavioral treatments are needed.
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Affiliation(s)
- Eric Siu-Chung Lo
- Nam Shan Psychology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Andus Wing-Kuen Wong
- Nam Shan Psychology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Andy Choi-Yeung Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Estella Pui-Man Ma
- Division of Speech and Hearing Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Tara L Whitehill
- Division of Speech and Hearing Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Rich Masters
- Te Huataki Waiora Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton, New Zealand
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Ysunza PA, Chaiyasate K, Rontal M, Shaheen K, Bartholomew B. Comparison of three different surgical techniques for designing pharyngeal flaps according to findings of videonasopharyngoscopy and multiplanar videofluoroscopy. Int J Pediatr Otorhinolaryngol 2019; 120:123-129. [PMID: 30776570 DOI: 10.1016/j.ijporl.2019.02.022] [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: 11/19/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Velopharyngeal insufficiency (VPI) occurs when the velopharyngeal sphincter (VPS) is unable to completely seal anatomical closure between the nasal and oral cavities during speech. Palatal repair can restore VPS function but the prevalence of VPI after repair has been reported ranging from 20% to 40%. The combination of flexible videonasopharyngoscopy (FVNP) and multiplanar videofluoroscopy (MPVF) has been reported as the best approach for assessing the VPS mechanism and planning effective surgical procedures aimed to correct VPI. OBJECTIVE To study the outcome of three different techniques for performing pharyngeal flaps with the common denominator of individually designing the flap according to findings of VFNP and MPVF. MATERIAL AND METHODS A total of 140 cases of pharyngeal flap surgery were reviewed. Three surgeons performed 3 different surgical techniques. All cases underwent nasometry, VNP and MPVF preoperatively. All surgical procedures were carefully planned and designed according to findings of VNP and MPVF. RESULTS Nasal emission was completely eliminated in all cases. One-hundred-thirty-four patients (95%) demonstrated mean nasalance within normal limits after the surgical procedure whereas 6 patients persisted with mean nasalance scores above reference values postoperatively. There were no intraoperative or postoperative complications in any of the cases. No clinical data of sleep disordered breathing was detected in any of the cases after 2 months of postoperative follow-up. However, one case presented with clinical data of sleep disordered breathing 8 months postoperatively. CONCLUSIONS The results of this study suggest that as long as pharyngeal flaps are being designed according to the findings of imaging procedures, different surgical techniques can provide similar successful outcomes with minimal complications.
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Affiliation(s)
- Pablo Antonio Ysunza
- Ian Jackson Craniofacial and Cleft Palate Clinic, Beaumont Hospital, Royal Oak, MI, USA.
| | - Kongkrit Chaiyasate
- Ian Jackson Craniofacial and Cleft Palate Clinic, Beaumont Hospital, Royal Oak, MI, USA
| | - Matthew Rontal
- Ian Jackson Craniofacial and Cleft Palate Clinic, Beaumont Hospital, Royal Oak, MI, USA
| | - Kenneth Shaheen
- Ian Jackson Craniofacial and Cleft Palate Clinic, Beaumont Hospital, Royal Oak, MI, USA
| | - Blake Bartholomew
- Ian Jackson Craniofacial and Cleft Palate Clinic, Beaumont Hospital, Royal Oak, MI, 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: 18] [Impact Index Per Article: 3.6] [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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Guyton KB, Sandage MJ, Bailey D, Haak N, Molt L, Plumb A. Acquired Velopharyngeal Dysfunction: Survey, Literature Review, and Clinical Recommendations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1572-1597. [PMID: 30208483 DOI: 10.1044/2018_ajslp-17-0222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/10/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this study was to describe the clinical assessment recommendations for acquired velopharyngeal dysfunction (AVPD) and, through a literature review and online survey, summarize current practice patterns for evaluation and treatment pathway determination for this target population. METHOD An online survey to query current assessment procedures and treatment pathway recommendations for AVPD was developed. Following survey results, a literature review was completed to determine evidence-based recommendations for assessment procedures and intervention recommendations based on assessment findings. Literature search terms included the following: acquired velopharyngeal dysfunction, hypernasality, non-cleft velopharyngeal dysfunction, velopharyngeal dysfunction, velopharyngeal dysfunction AND iatrogenic, velopharyngeal dysfunction AND neurogenic, velopharyngeal dysfunction AND assessment OR evaluation, velopharyngeal dysfunction AND treatment OR intervention, velopharyngeal dysfunction AND practice patterns OR clinical guidelines, velopharyngeal insufficiency. Inclusion criteria were limited to practice patterns/recommendations for assessment and/or treatment recommendations for AVPD, English language articles published between 2000 and 2017, and peer-reviewed journals. Studies regarding solely congenital or cleft palate velopharyngeal dysfunction and intervention outcome studies were excluded. Forty articles met inclusionary criteria. RESULTS The online survey results indicated lack of consensus for AVPD assessment and treatment recommendation protocols, with 93% of respondents indicating the need for a clinical guide for developing treatment recommendations. The majority of recommendations were filtered into an algorithm for clinical decision making. CONCLUSIONS Clinical uncertainty among speech-language pathologists surveyed and the paucity of published clinical guidelines for assessing individuals with AVPD indicate the need for additional clinical research for this disorder, one that is heterogeneous and distinct from those with congenital velopharyngeal dysfunction. The proposed evidence-based clinical worksheet may assist in determining management for patients with AVPD and may serve as a starting place for validation of a clinical guideline.
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Affiliation(s)
- Kelsey B Guyton
- Department of Communication Disorders, Auburn University, AL
| | - Mary J Sandage
- Department of Communication Disorders, Auburn University, AL
| | - Dallin Bailey
- Department of Communication Disorders, Auburn University, AL
| | - Nancy Haak
- Department of Communication Disorders, Auburn University, AL
| | - Lawrence Molt
- Department of Communication Disorders, Auburn University, AL
| | - Allison Plumb
- Department of Communication Disorders, Auburn University, AL
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Asfar MM, Hutcheson KA, Won AM. Prosthetic Rehabilitation with Palatal Lift/Augmentation in a Patient with Neurologic/Motor Deficit Due To Cancer Therapy for Chondrosarcoma. J Prosthodont 2018; 28:234-238. [PMID: 30357985 DOI: 10.1111/jopr.12990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2018] [Indexed: 11/29/2022] Open
Abstract
This clinical report describes the prosthetic rehabilitation of a 25-year-old man with a history of grade II chondrosarcoma at the skull base who had undergone surgical resection and thereafter developed velopharyngeal incompetency (VPI), dysarthria, and dysphagia. Upon baseline fiberoptic endoscopic evaluation of swallowing (FEES), the patient had an atypical pattern of VPI with minimal to no velar lift during speech, blow, or suck tasks, but near complete velar lift and seal during swallowing. A palatal augmentation prosthesis combined with a resilient palatal lift extension was fabricated to enhance speech by displacing the soft palate and to decrease hypernasality, while avoiding interference with bolus transport. A resilient wrought wire extension was necessary to accommodate the velar movement upon swallowing while keeping the integrity of the velar lift during speech. In conclusion, this unique combination prosthesis was able to help the patient's atypical pattern of VPI by improving speech and preserving swallowing function, which was confirmed during a post-endoscopic evaluation.
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Affiliation(s)
- Midhat M Asfar
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexander M Won
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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GWAS reveals loci associated with velopharyngeal dysfunction. Sci Rep 2018; 8:8470. [PMID: 29855589 PMCID: PMC5981322 DOI: 10.1038/s41598-018-26880-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/22/2018] [Indexed: 01/25/2023] Open
Abstract
Velopharyngeal dysfunction (VPD) occurs when the muscular soft palate (velum) and lateral pharyngeal walls are physically unable to separate the oral and nasal cavities during speech production leading to hypernasality and abnormal speech reduction. Because VPD is often associated with overt or submucous cleft palate, it could be present as a subclinical phenotype in families with a history of orofacial clefting. A key assumption to this model is that the overt and subclinical manifestations of the orofacial cleft phenotype exist on a continuum and therefore share common etiological factors. We performed a genome-wide association study in 976 unaffected relatives of isolated CP probands, 54 of whom had VPD. Five loci were significantly (p < 5 × 10-8) associated with VPD: 3q29, 9p21.1, 12q21.31, 16p12.3 and 16p13.3. An additional 15 loci showing suggestive evidence of association with VPD were observed. Several genes known to be involved in orofacial clefting and craniofacial development are located in these regions, such as TFRC, PCYT1A, BNC2 and FREM1. Although further research is necessary, this could be an indication for a potential shared genetic architecture between VPD and cleft palate, and supporting the hypothesis that VPD is a subclinical phenotype of orofacial clefting.
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Abstract
This article describes how different types of clefts affect the child's function and, in particular, the child's communication abilities. This article also describes the evaluation process and various options for the treatment of affected speech. Because these children have many complicated needs over their entire growth period, it is important that they are referred by the pediatrician to a cleft palate/craniofacial team for the best care and best ultimate outcomes.
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Affiliation(s)
- Ann W Kummer
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4011, Cincinnati, OH 45229, USA.
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Trudel M, Laframboise R, Leclerc JE. Musculo-mucous web velum and velopharyngeal dysfunction associated with 8q22.1-22.2 microduplication. Int J Pediatr Otorhinolaryngol 2018; 104:134-137. [PMID: 29287853 DOI: 10.1016/j.ijporl.2017.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/18/2017] [Accepted: 11/14/2017] [Indexed: 11/18/2022]
Abstract
This report presents a rare case of isolated non-cleft velopharyngeal dysfunction (VPD). An eight-year-old child presented 1. a phenotypically unique band-gap pattern of the velar musculature with anteroposterior insertion; 2. a mosaic partial trisomy on chromosome 19 as well as microduplications on chromosomes 8 and 22. Following cytogenetic analysis, microduplication on chromosome 8 was found in another member of her family. A family history of VPI with hypernasality and nasal regurgitation was reported over three different generations on the patient's maternal side. Since only one case of velum malformation is found in this family, we cannot conclude to a link between the palatal anomaly or VPD and the DNA rearrangements.
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Affiliation(s)
- Mathieu Trudel
- Department of Otolaryngology - Head & Neck Surgery, Laval University, Quebec City, Canada
| | - Rachel Laframboise
- Department of Pediatrics - Medical Genetics Division, Centre Hospitalier Universitaire de Québec, Canada
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Koprowski S, VanLue MJ, McCormick ME. Treatment of Stress Velopharyngeal Incompetence With Injection of Hyaluronic Acid. Cleft Palate Craniofac J 2017; 55:615-618. [DOI: 10.1177/1055665617732788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Stress velopharyngeal incompetence (VPI) is a challenging clinical entity that can be managed by a variety of surgical and nonsurgical approaches. We describe the case of a clarinetist who presented with nasal air escape while playing. She had successful improvement in her symptoms after targeted injection of a hyaluronic acid compound to her posterior pharyngeal wall. Our objective is to describe the safety and efficacy of this technique, to emphasize the multidisciplinary management of patients with stress VPI, and to review the importance of both nasopharyngoscopy and videofluoroscopy in their evaluation.
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Affiliation(s)
| | - Michael J. VanLue
- Speech and Language Pathology Craniofacial Program, Masters Family Speech & Hearing Center, Children’s Hospital of Wisconsin, Milwaukee, WI, USA
| | - Michael E. McCormick
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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Wineland AM, Meinzen-Derr J, Willging P. Can overnight stenting be safely eliminated following a pharyngeal flap? A matched comparison study. Laryngoscope 2017; 128:750-755. [PMID: 29160561 DOI: 10.1002/lary.26974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/13/2017] [Accepted: 09/25/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Determine if overnight stenting is warranted after pharyngeal flap for management of velopharyngeal insufficiency (VPI) in pediatric patients METHODS: This is a retrospective age-matched cohort study from a single tertiary pediatric facility. Patients who underwent a posterior pharyngeal flap for VPI from January 1, 2013, to December 31, 2016, were included. Two equal groups were constructed based on when their nasal stents were removed, that is, postoperative day (POD) 0 or POD 1. Primary outcome measure was oxygen desaturation after surgery. Secondary outcome measures were total length of stay, need for narcotics, and oral intake based on POD. Additional information was gathered and evaluated as possible prognostic variables. RESULTS There were 27 matched pairs included in the study. One patient from each group required supplemental oxygen during the night of surgery. No escalation of care was needed in either case. The group whose stents were removed on POD 0 were discharged earlier than the group whose stents were removed on POD 1, P < 0.0001. The POD 0 group took significantly more oral intake on POD 0 than the POD 1 group, P = 0.03. The POD 0 group had significantly more genetic syndromes than the POD 1 group, P = 0.02. CONCLUSION There was no benefit with overnight stenting. Earlier discharge from the hospital was achieved in the POD 0 group. No patient experienced need for reintubation, escalation of clinical care, postoperative hemorrhage, or death. LEVEL OF EVIDENCE 4. Laryngoscope, 128:750-755, 2018.
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Affiliation(s)
- Andre M Wineland
- University of Arkansas School for Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Jareen Meinzen-Derr
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Paul Willging
- University of Cincinnati School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Bruneel L, Van Lierde K, Bettens K, Corthals P, Van Poel E, De Groote E, Keppler H. Health-related quality of life in patients with cleft palate: Validity and reliability of the VPI Effects on Life Outcomes (VELO) questionnaire translated to Dutch. Int J Pediatr Otorhinolaryngol 2017; 98:91-96. [PMID: 28583513 DOI: 10.1016/j.ijporl.2017.04.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Disease-specific health-related quality of life (HRQOL) questionnaires provide the clinician with important information regarding the impact of the disease on functioning and well-being. For patients with velopharyngeal insufficiency (VPI), the VPI Effects on Life Outcomes (VELO) questionnaire was developed and validated in English by Skirko et al. (2012). However, a valid and reliable Dutch translation of this questionnaire is not available yet. METHODS The English questionnaire was translated to Dutch following a forward-backward translation procedure. A linguistic validation and the evaluation of the internal consistency (Cronbach's α) of this Dutch version were performed based on the responses of 39 parents of patients with cleft (lip and) palate (mean age: 6.8 years) (parent report) and the responses of 14 patients older than 8 years (mean age: 9.5 years) (child report). Additionally, the concurrent validity was assessed by comparing the scores on the parent report to those on the pediatric voice handicap index. Furthermore, the validity of the parent proxy assessment and the relationship between age and responses on the VELO questionnaire were investigated. Based on the responses of an age and gender matched control group without cleft palate, the discriminant validity was evaluated. RESULTS The parent report was easy to complete for all parents. Nine of the fourteen (64%) patients were able to complete the child report independently. The median scores on the parent report and the child report were 82.7 and 95.1 respectively. The patient group had a significantly worse perception of HRQOL compared to the control group (p < 0.001; p = 0.029). There were no significant differences between the responses of the parent and their child's (p = 0.345). A significant positive correlation was found between the score on the parent report and the age of the patients (p = 0.001). Furthermore, a significant negative correlation was found between the parent report and the P-VHI (p < 0.001). Cronbach's α was 0.955 and 0.817 for the parent report and the child report respectively. CONCLUSION The Dutch VELO questionnaire is a valid, reliable and user-friendly tool that provides important information about HRQOL in patients with cleft (lip and) palate.
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Affiliation(s)
- Laura Bruneel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Kristiane Van Lierde
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Kim Bettens
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Paul Corthals
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Esther Van Poel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Evelien De Groote
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Hannah Keppler
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
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Ysunza PA, Bloom D, Chaiyasate K, Rontal M, VanHulle R, Shaheen K, Gibson D. Velopharyngeal videofluoroscopy: Providing useful clinical information in the era of reduced dose radiation and safety. Int J Pediatr Otorhinolaryngol 2016; 89:127-32. [PMID: 27619042 DOI: 10.1016/j.ijporl.2016.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The state of the art for correcting velopharyngeal insufficiency (VPI) is a surgical procedure which is customized according to findings on imaging procedures: multiplanar videofluoroscopy (MPVF) and flexible videonasopharyngoscopy (FVNP). Recently, the use of MPVF has been challenged because of the potential risk of using ionizing radiation, especially in children. OBJECTIVE To study whether using a protocol for performing MPVF can effectively decrease radiation dose in patients with VPI while providing useful information for planning surgical correction of VPI in combination with FVNP. The methodology used for performing the imaging procedures is described as well as the effectiveness of the surgical procedure. MATERIAL AND METHODS Eighty - nine patients (Age range = 3-17 years; median = 5.5 years) with VPI resulting from multiple etiologies were studied. All patients underwent MPVF and FVNP for planning surgical correction of VPI. Radiation dosage data in each case was recorded. Forty of the 89 patients also completed a postoperative evaluation. Eleven out of the remaining 49 patients have not completed a postoperative evaluation and 38 patients are still pending surgical correction. RESULTS Radiation dosage ranged from 1.00 to 8.75 miliSieverts (mSv); Mean = 2.88 mSv; SD = 1.575 mSv. Preoperative nasometry demonstrated mean nasalance ranging from 41%-95%; Mean = 72.30; SD = 4.54. Postoperatively mean nasalance was within normal limits in 36 (90%) out of 40 cases, ranging from 21% to 35%; Mean = 28.10; SD = 5.40. Nasal emission was eliminated postoperatively in all cases. CONCLUSION MPVF provides useful information for planning the surgical procedure aimed at correcting VPI. The combination of MPVF and FVNP is a reliable procedure for assessing velopharyngeal closure and to surgically correcting VPI with a highly successful outcome.
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Affiliation(s)
- Pablo Antonio Ysunza
- Speech Pathology Services, Ian Jackson Craniofacial and Cleft Palate Clinic, Neuroscience Program, Beaumont Health, Royal Oak, MI, USA.
| | - David Bloom
- Section of Pediatric Radiology, Beaumont Health, Royal Oak, MI, USA
| | - Kongkrit Chaiyasate
- Ian Jackson Craniofacial and Cleft Palate Clinic, Beaumont Health, Royal Oak, MI, USA
| | - Matthew Rontal
- Ian Jackson Craniofacial and Cleft Palate Clinic, Beaumont Health, Royal Oak, MI, USA
| | - Rachel VanHulle
- Section of Pediatric Radiology, Beaumont Health, Royal Oak, MI, USA
| | - Kenneth Shaheen
- Ian Jackson Craniofacial and Cleft Palate Clinic, Beaumont Health, Royal Oak, MI, USA
| | - Donald Gibson
- Section of Pediatric Radiology, Beaumont Health, Royal Oak, MI, USA
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Luyten A, Bettens K, D'haeseleer E, Hodges A, Galiwango G, Vermeersch H, Van Lierde K. Short-term effect of short, intensive speech therapy on articulation and resonance in Ugandan patients with cleft (lip and) palate. JOURNAL OF COMMUNICATION DISORDERS 2016; 61:71-82. [PMID: 27060419 DOI: 10.1016/j.jcomdis.2016.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 11/24/2015] [Accepted: 03/26/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of the current study was to assess the short-term effectiveness of short and intensive speech therapy provided to patients with cleft (lip and) palate (C(L)P) in terms of articulation and resonance. METHODS Five Ugandan patients (age: 7.3-19.6 years) with non-syndromic C(L)P received six hours of individualized speech therapy in three to four days. Speech therapy focused on correct phonetic placement and contrasts between oral and nasal airflow and resonance. Speech evaluations performed before and immediately after speech therapy, including perceptual and instrumental assessment techniques, were compared. RESULTS Post-therapy, improvement of speech was noted for most of the patients, although to varying degrees. Clinically relevant progress of objective nasalance values and/or articulation was obtained in four patients. Overall, two patients showed normal speech intelligibility, while three patients required additional speech therapy. CONCLUSION These preliminary short-term results demonstrate that short and intensive speech therapy can be effective for patients with C(L)P in countries with limited access to speech-language therapy. However, further research is needed on the long-term effectiveness and the advantages of applying this treatment protocol in countries with good access to speech therapy. LEARNING OUTCOMES The reader will be able to (1) list the challenges in resource poor-countries to achieve access to speech-language therapy services, (2) describe when the application of speech therapy is appropriate in patients with C(L)P, (3) describe the speech therapy that can be applied to reduce compensatory articulation and resonance disorders in patients with C(L)P, and (4) list the (possible) advantages of short, intensive speech therapy for both resource-poor and developed countries.
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Affiliation(s)
- A Luyten
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - K Bettens
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - E D'haeseleer
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - A Hodges
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda.
| | - G Galiwango
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda.
| | - H Vermeersch
- Ghent University, Department of Head and Neck Surgery, De Pintelaan 185 2P2, 9000 Gent, Belgium.
| | - K Van Lierde
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
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Abramyan J, Richman JM. Recent insights into the morphological diversity in the amniote primary and secondary palates. Dev Dyn 2015; 244:1457-68. [PMID: 26293818 PMCID: PMC4715671 DOI: 10.1002/dvdy.24338] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 02/06/2023] Open
Abstract
The assembly of the upper jaw is a pivotal moment in the embryonic development of amniotes. The upper jaw forms from the fusion of the maxillary, medial nasal, and lateral nasal prominences, resulting in an intact upper lip/beak and nasal cavities; together called the primary palate. This process of fusion requires a balance of proper facial prominence shape and positioning to avoid craniofacial clefting, whilst still accommodating the vast phenotypic diversity of adult amniotes. As such, variation in craniofacial ontogeny is not tolerated beyond certain bounds. For clarity, we discuss primary palatogenesis of amniotes into in two categories, according to whether the nasal and oral cavities remain connected throughout ontogeny or not. The transient separation of these cavities occurs in mammals and crocodilians, while remaining connected in birds, turtles and squamates. In the latter group, the craniofacial prominences fuse around a persistent choanal groove that connects the nasal and oral cavities. Subsequently, all lineages except for turtles, develop a secondary palate that ultimately completely or partially separates oral and nasal cavities. Here, we review the shared, early developmental events and highlight the points at which development diverges in both primary and secondary palate formation.
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Affiliation(s)
- John Abramyan
- Faculty of Dentistry, Life Sciences Institute, University of British Columbia, Vancouver BC, CANADA
| | - Joy Marion Richman
- Faculty of Dentistry, Life Sciences Institute, University of British Columbia, Vancouver BC, CANADA
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Danescu A, Mattson M, Dool C, Diewert VM, Richman JM. Analysis of human soft palate morphogenesis supports regional regulation of palatal fusion. J Anat 2015; 227:474-86. [PMID: 26299693 DOI: 10.1111/joa.12365] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 01/31/2023] Open
Abstract
It is essential to complete palate closure at the correct time during fetal development, otherwise a serious malformation, cleft palate, will ensue. The steps in palate formation in humans take place between the 7th and 12th week and consist of outgrowth of palatal shelves from the paired maxillary prominences, reorientation of the shelves from vertical to horizontal, apposition of the medial surfaces, formation of a bilayered seam, degradation of the seam and bridging of mesenchyme. However, in the soft palate, the mechanism of closure is unclear. In previous studies it is possible to find support for both fusion and the alternative mechanism of merging. Here we densely sample the late embryonic-early fetal period between 54 and 74 days post-conception to determine the timing and mechanism of soft palate closure. We found the epithelial seam extends throughout the soft palates of 57-day specimens. Cytokeratin antibody staining detected the medial edge epithelium and distinguished clearly that cells in the midline retained their epithelial character. Compared with the hard palate, the epithelium is more rapidly degraded in the soft palate and only persists in the most posterior regions at 64 days. Our results are consistent with the soft palate following a developmentally more rapid program of fusion than the hard palate. Importantly, the two regions of the palate appear to be independently regulated and have their own internal clocks regulating the timing of seam removal. Considering data from human genetic and mouse studies, distinct anterior-posterior signaling mechanisms are likely to be at play in the human fetal palate.
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Affiliation(s)
- Adrian Danescu
- Faculty of Dentistry, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - Melanie Mattson
- Faculty of Dentistry, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - Carly Dool
- Faculty of Dentistry, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - Virginia M Diewert
- Faculty of Dentistry, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - Joy M Richman
- Faculty of Dentistry, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
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