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Assessment of velopharyngeal competence: a long-term process
D R Van Demark1, M A Hardin, H L Morris
1Department of Otolaryngology--Head and Neck Surgery, University Hospital, University of Iowa, Iowa City.
The Cleft Palate Journal
|October 1, 1988
Summary
Longitudinal perceptual assessments of speech can identify patients at risk for secondary palatal management. Declining articulation and increasing nasality over time signal potential need for further intervention.
Area of Science:
- Speech-Language Pathology
- Craniofacial Surgery
- Pediatric Otolaryngology
Background:
- Secondary palatal management is crucial for improving speech outcomes in patients with cleft palate.
- Longitudinal monitoring of speech parameters is essential for timely intervention.
- Velopharyngeal closure (VPC) is a key factor in speech production, and its competency can be affected by palatal surgery.
Purpose of the Study:
- To compare longitudinal perceptual speech ratings in patients requiring secondary palatal management versus those who did not.
- To determine if perceptual data can effectively discriminate between patients needing further treatment and those who do not.
- To identify speech characteristics indicative of increased risk for secondary palatal management.
Main Methods:
- Longitudinal perceptual ratings of articulation defectiveness, nasality, and velopharyngeal competency were collected.
- Speech data were compared between a group of 13 subjects requiring secondary palatal management and a control group.
- Lateral x-rays were evaluated to assess velopharyngeal closure variability.
Main Results:
- Longitudinal perceptual data did not reliably differentiate between patients who ultimately required secondary management and those who did not.
- A decline in articulation scores and an increase in nasality and articulation defectiveness over time were observed in patients at risk for secondary management.
- Patients requiring secondary operations showed greater variability in velopharyngeal closure on lateral x-rays compared to the control group.
Conclusions:
- Speech deterioration over time, including decreased articulation and increased nasality, indicates a risk for secondary palatal management.
- Variability in velopharyngeal closure, rather than adenoidal involution, appears more significant in predicting the need for secondary operations.
- Objective speech assessment and longitudinal tracking are vital for managing patients with velopharyngeal dysfunction.