Abstract
To analyze the velopharyngeal (VP) activity of subjects with velopharyngeal dysfunction (VPD) by acoustic rhinometry, as compared to rhinomanometry. This was a prospective clinical study conducted in 41 adults, both genders, with repaired cleft palate, with or without a previously repaired cleft lip, and residual VPD on clinical assessment, without compensatory articulations for [p], [t], and [k]. The outcome measures were as follows: (1) on acoustic rhinometry, nasopharyngeal volumetric change (ΔV) during [p], [t], and [k], relatively to rest condition (decreases by <3 cm3 considered as absence of VP activity); (2) on modified anterior rhinomanometry, VP orifice area (areas ≥0.05 cm2 considered as inadequate closure). The plosive [p] was used when comparing the techniques (n=24). (1) A mean ΔV decrease of 18% was observed during [k], which was significantly lower (p<0.05) than the decrease reported for individuals without VPD (30%). ΔV values suggesting VPD were observed in 59% subjects. Similar results were obtained for [p] and [t], which shall be used as stimulus, given that they do not involve the use of the tongue to lift the velum during VP closure, differently from the velar plosive [k]. (2) Inadequate closure was seen in 85% subjects. No correlation was observed between ∆V and VP orifice area. Agreement between techniques was observed in 51% cases. Acoustic rhinometry had low accuracy as a diagnostic method of VPD when compared to the gold standard method. Nevertheless, the technique shows potential as a method for monitoring the outcomes of clinical and surgical treatment of VPD aimed at increasing velar and pharyngeal activity.
Highlights
Failure to achieve velopharyngeal closure in the production of oral sounds is generically designated as velopharyngeal dysfunction (VPD), which has significant effect on the resonance and other aspects of speech and may lead to hypernasality, nasal air emission, low intraoral pressure, and compensatory articulations[1,2].The auditory-perceptual assessment is the first approach to estimate signs and symptoms of VPD[2,3,4]
All patients included in the study presented VPD in clinical diagnosis, and 59% (24/41) were considered to have marginal velopharyngeal function, and the remaining 41% (17/41) inadequate velopharyngeal function
In the group with VPD, the average volume decreased to 17.4 cm3 during speech, corresponding to an average reduction of 3.9 cm3 in absolute terms, and 18% in relative values
Summary
Failure to achieve velopharyngeal closure in the production of oral sounds is generically designated as velopharyngeal dysfunction (VPD), which has significant effect on the resonance and other aspects of speech and may lead to hypernasality, nasal air emission, low intraoral pressure, and compensatory articulations[1,2].The auditory-perceptual assessment is the first approach to estimate signs and symptoms of VPD[2,3,4]. There is consensus that the subjective evaluation of VPD should be complemented with instrumental methods such as nasopharyngoscopy, videofluoroscopy, nasometry, and rhinomanometry The latter, known as pressure-flow technique, assesses the aerodynamic aspects of velopharyngeal activity, that is, the functional state of velopharyngeal mechanism, providing quantitative data contributing to the evaluation of therapeutic results[9,10,11]. Sondhi and Gopinath[14] introduced this method to assess nasal geometry This technique allows consecutive measurements of the cross-sectional area and volume of different segments of nasal cavity, from the nostrils to the nasopharynx. Thereby it helps to identify the exact location of the constrictions that contribute to nasal resistance, in a quick, noninvasive manner and without any active participation of the patient[15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
