Nasoendoscopy of velopharynx before and during diagnostic therapy

Abstract

Nasoendoscopy is an important tool for assessing velopharyngeal function. The purpose of this study was to analyze velar and pharyngeal wall movement and velopharyngeal gap during nasoendoscopic evaluation of the velopharynx before and during diagnostic therapy. Nasoendoscopic recordings of 10 children with operated cleft lip and palate were analyzed according to the International Working Group Guidelines. Ratings of movement of velum and pharyngeal walls, and size, location and shape of gaps were analyzed by 3 speech-language pathologists (SLPs). Imaging was obtained during repetitions of the syllable/pa/during a single nasoendoscopic evaluation: (a) before diagnostic therapy, and (b) after the children were instructed to impound and increase intraoral air pressure (diagnostic therapy). Once the patients impounded and directed air pressure orally, the displacement of the velum, right, left and posterior pharyngeal walls increased 40, 70, 80, and 10%, respectively. Statistical significance for displacement was found only for right and left lateral pharyngeal walls. Reduction in gap size was observed for 30% of the patients and other 40% of the gaps disappeared. Changes in gap size were found to be statistically significant between the two conditions. In nasoendoscopic assessment, the full potential of velopharyngeal displacement may not be completely elicited when the patient is asked only to repeat a speech stimulus. Optimization of information can be done with the use of diagnostic therapy's strategies to manipulate VP function. Assuring the participation of the SLP to conduct diagnostic therapy is essential for management of velopharyngeal dysfunction.

Velopharyngeal insufficiency: diagnosis and management

“…The reason for this recommendation is that experienced clinicians recognize that movement in the velopharyngeal valve often varies for different sounds, and maximum movement can be seen on sustained fricatives because the pressure demands are high. However, this study11 did not determine if the movement seen on sustained /ssssss/ or /ffffff/ was the same as that seen for the “diagnostic therapy.” It is far easier to obtain these sounds during the examination than performing the maneuver suggested by the authors. The International Working Group also recommended that assessment of the velopharyngeal mechanism should include both nasopharyngoscopy and multi-view videofluorscopy in at least frontal and lateral views.…”

“…In 2008, journal articles discussing direct observation of the velopharyngeal valve were limited to two reports on nasopharyngoscopy11,12 and two utilizing magnetic resonance imaging13,14.…”

“…Pegoraro-Krook et al11 described “diagnostic therapy.” A sample of 10 children with repaired unilateral cleft lip- palate who had VPI and normal articulation were assessed with nasopharyngoscopy. A speech sample was obtained and the video recorded.…”

Concordância entre os testes perceptivos e a videofluoroscopia no diagnóstico da disfunção velofaríngea

“…Instrumental methods such as videofluoroscopy and nasoendoscopy can provide information on the functional anatomy of the VPM, as well as nasometry and the pressure-flow technique can respectively measure the acoustic and aerodynamic parameters of the velopharyngeal function (4) . They may also provide the perceptual critical finding trial, enable the diagnosis of the velopharyngeal function in cases where the clinical diagnosis by itself was not possible, and also determine the effectiveness of the proposed treatment (5)(6)(7)(8)(9) . Among the various methods for perceptual evaluation described in the literature, few of them provide the differential diagnosis of VPD, as the Tests of Hypernasality (THYPER) and Nasal Air Emission (TNAE) (5)(6)(7)(8)(9)(10) , with the aim of assisting assessment of velopharyngeal function and dysfunction.…”

Fala em indivíduos com fissura labiopalatina após a palatoplastia primária pelas técnicas de Furlow e von Langenbeck

“…A gravação é um recurso que se pode ter sempre à disposição, para ouvir quando e quantas vezes forem necessárias, podendo ainda ser editada e apresentada para o julgamento perceptivo-auditivo por juízes múltiplos, o que permite validar os achados clínicos obtidos durante a avaliação ao vivo. MARINO, 2008;LIPIRA et al, 2011;PANIAGUA et al, 2013), com a videofluoroscopia (SOMMERLAD et al, 2002;KUMMER;BRIGGS;LEE, 2003;BZOCH, 2004;DUDAS et al, 2006;LIPIRA et al, 2011;HENS et al, 2013;PÉRICO, 2013), com a nasometria (DALSTON; WARREN; DALSTON, 1991; SUGUIMOTO, PEGORARO-KROOK, 1995;KEUNING et al, 2002;VAN LIERDE et al, 2002;PEGORARO-KROOK et al, 2006;NARECE, 2007;SILVA, 2007;BASTAZINI, 2008;BRANCAMP;LEWIS, WATTERSON, 2010; BRUNNEGÅRD; LOHMANDER; VAN DOORN, 2012;PADILHA, 2013;LARANGEIRA, 2014) e com a técnica fluxo-pressão (DOTEVALL et al, 2002;GENARO; mostraram um bom nível de concordância entre as impressões clínicas, associadas a esses métodos instrumentais.…”