Endoscopic evaluation of velopharyngeal function in cleft lip palate patients – A correlation with speech analysis

Abstract

Speech abnormalities due to velopharyngeal insufficiency (VPI) significantly affect communication skills, self-esteem, and scholastic performance. It leads to a poor social, emotional, educational, and behavioral development and a poor quality of life overall in cleft lip palate (CLP) patients. Its early diagnosis and severity assessment using video-nasoendoscopy and speech assessment can significantly contribute to management. The present study evaluated VPI in CLP patients using both tools. A total of 48 patients with repaired cleft palate were subjected to speech and video-nasoendoscopic assessment. Speech assessment measured severity of hypernasality, speech intelligibility, and voice quality. Video-nasoendoscopy evaluated velopharyngeal port closure to grade the severity of VPI. The speech assessment and video-nasoendoscopy findings were analyzed and correlated. There was a moderately strong statistically significant negative correlation between the grade of VPI and hypernasality (r=-0.542, p=0.000). There was a stronger statistically significant negative correlation of grade of velopharyngeal port insufficiency with speech intelligibility (r=-0.634, p=0.000). About 72% of the patients had abnormal voice quality. This study is the first attempt at diagnosing and grading VPI on a quantitative scoring based on a ratio scale for the motion of soft palate and pharyngeal walls. The strong correlation between endoscopic grading and speech analysis findings warrants further evaluation of nasoendoscopic grading of VPI in more studies.