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Velopharyngeal incompetence in patients with cleft palate, flexible video pharyngoscopy and perceptual speech assessment: a correlational pilot study

Published online by Cambridge University Press:  22 October 2014

S Rajan ,
M Kurien ,
A K Gupta ,
S S Mathews ,
R R Albert  and
D Tychicus
S Rajan*
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
M Kurien
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
A K Gupta
Affiliation:
Department of Plastic Surgery, Christian Medical College, Vellore, Tamil Nadu, India
S S Mathews
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
R R Albert
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
D Tychicus
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
*
Address for correspondence: Dr S Rajan, Department of Otorhinolaryngology and Head Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, IndiaPIN-632004 Fax: +416-2232035 E-mail: [email protected]
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Abstract

Objectives:

To assess the role of video endoscopy in evaluating velopharyngeal incompetence and investigate a possible relationship between velopharyngeal incompetence type and speech defect in cleft palate patients.

Methods:

A prospective study of 28 pre- or post-operative cleft palate patients with speech defects who attended Plastic Surgery–Cleft Palate and ENT out-patient clinics was performed. The velar defect type was determined using a flexible endoscope and findings were video recorded. Speech pathology was assessed using the cleft palate audit protocol for speech.

Results:

A significant, clinically relevant relationship was noted between the perceived characteristics of hypernasality and velopharyngeal insufficiency type. Hypernasal speech was a definite clinical indicator of velopharyngeal incompetence, and the type 1 velopharyngeal defect was most common. Type 1 velopharyngeal coronal-type dysfunction was strongly associated with hypernasality (p < 0.05). When speech substitution was noted, type 2 velopharyngeal (or sagittal) incompetence could be predicted (p < 0.05).

Conclusion:

In the management of cleft palate patients, it is important that surgical correction of the defect and achieving velopharyngeal competency for speech are performed simultaneously. Pre-operative velopharyngeal endoscopy with speech assessment will define the anatomical and functional bases for velopharyngeal correction and assist in planning and tailoring the pharyngeal flap.

Keywords

Velopharyngeal InsufficiencyCleft PalateVideo RecordingSpeechDiagnostic Techniques and Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 11 , November 2014 , pp. 986 - 990
Copyright
Copyright © JLO (1984) Limited 2014 

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