Altered speech following adenoidectomy: a 20 year experience

Area of Science:

• Otolaryngology
• Speech Pathology
• Pediatric Surgery

Background:

• Adenoidectomy, a common procedure, can rarely lead to velopharyngeal insufficiency and altered speech.
• Persistent speech changes post-adenoidectomy necessitate specialized investigation and management.

Purpose of the Study:

• To determine the incidence, clinical features, and causes of persistent altered speech following adenoidectomy.
• To evaluate the effectiveness of a selective treatment strategy for these patients.

Main Methods:

• Prospective data collection over 20 years from 42 patients referred to a multidisciplinary cleft team.
• Investigation included videofluoroscopy and nasopharyngoscopy.
• Treatment decisions based on multidisciplinary assessment and diagnostic findings.

Main Results:

• Incidence of persistent altered speech was 1 in 1200 adenoidectomies.
• Diagnoses included velopharyngeal disproportion, cleft palate variations, and developmental causes.
• Speech therapy benefited 13 patients; 23 required surgery (pharyngeal flap, sphincteric pharyngoplasty, intravelar veloplasty).
• Treatment led to significant speech improvement in 35 of 36 assessed patients, with 16 achieving normal speech.

Conclusions:

• Persistent altered speech is a rare but significant complication of adenoidectomy.
• Multidisciplinary assessment and multi-modality investigation are crucial for diagnosis and management.
• A selective treatment approach yields excellent outcomes in the majority of affected patients.