Factors That Limit Evaluation of Velopharyngeal Closure During Nasopharyngoscopy

ObjectiveTo assess the quality of nasopharyngoscopy video recordings used for velopharyngeal insufficiency (VPI) surgical planning and identify factors that limit evaluation of velopharyngeal closure.DesignProspective observational study.SettingMetropolitan-based hospitals with craniofacial clinics in the United States and Canada.ParticipantsOne-hundred and forty-two (142) patients with VPI across 10 hospitals.Assessment(s)Nasopharyngoscopy video recordings used for VPI surgical planning .Main Outcome Measure(s)Ratability of nasopharyngoscopy video recordings, with "ratable" defined as the video (1) visualized the velum, lateral pharyngeal wall, and posterior pharyngeal walls at some point during speech production and (2) contained an oral speech sample at the phrase level or above.ResultsOne-hundred and forty-two (142) nasopharyngoscopy video recordings were obtained from patients undergoing VPI evaluation, of which 59.9% (n=85) were ratable. A multilevel logistic regression model was used to identify factors that influenced the quality of nasopharyngoscopy video recordings. Factors associated with unratable nasopharyngoscopy videos were age (P=.030), sex (P=.005*), type of scope camera used (P=.039), presence of compensatory misarticulations (P=.008), and a limited speech sample (P=.040).ConclusionsA substantial proportion of nasopharyngoscopy video recordings obtained during VPI evaluation are not sufficient for rating velopharyngeal closure. Lack of ratability could impact the surgery selected to treat VPI. Younger patients, those with limited speech samples, or patients with extensive compensatory articulations may be more successful in completing other VPI imaging techniques, such as videofluoroscopy or magnetic resonance imaging.