The assessment of velopharyngeal function using nasal ram pressure testing following palatoplasty

Objective : To compare nasal ram pressure (NRP) data with perceptual speech assessments in young children following palatoplasty. Design and Setting : NRP monitoring, a noninvasive technique using a two-pronged nasal cannula that detects nasal airflow during speech, was performed on patients 12 months following palatoplasty in our Craniofacial Center. Patients : Eighteen English-speaking nonsyndromic patients, aged 21 to 28 months, without hearing or language deficits, underwent NRP testing. Main Outcome Measured : During NRP measurement, the number of oral stop consonants produced spontaneously or following prompts was recorded. Stops were considered produced with velopharyngeal closure if NRP demonstrated no nasal airflow. The percentage of closed stops as measured by NRP was compared to the clinical assessment by craniofacial team speech-language pathologists. Results : Eight patients achieved 100% stop closure. Four patients obtained 90% to 96% stop closure. Three patients had stop closure of 85%, 78%, and 50%. Three patients had 0% stop closure; two of these patients subsequently underwent secondary palatal surgery. No significant clinical speech deficits were noted in patients with >90% closure. No association with defect size or cleft type was identified. Conclusions : NRP monitoring is well-tolerated in young children following palatoplasty. Achieving velopharyngeal (VP) closure for >90% of stops is associated with a clinical assessment of adequate speech and VP function. Postoperative NRP testing may serve as a useful adjunct to clinical speech evaluation for early identification of children who require more intensive speech therapy or secondary palatal surgery.