- What is Passavant’s pad?
a. A passavants pad, or ridge, is a bulge in the posterior pharyngeal wall that is seen in some people during velopharyngeal closure, possibly due to constriction of the superior constrictor muscles. It typically does not assist in VP closure.
- What are the general symptoms of VPD?
a. Nasal air emission
b. Hypernasality
c. Compensatory articulation errors
- How is VP function for speech production related to VP function for non-speech
activities?
- Happen differently, they are not related. In non-speech activities, the velum is typically higher and the seal is tighter. The ability to do non-speech velar seal is not related to the ability to create a seal during speech.
- What is nasalance?
a. A physical measure of nasality that is measured using a device called a nasometer.
- What is the difference between nasalance and NAE?
a. Nasal air emission refers to just the air coming out of the nasal cavity. Nasalance uses a formula that compares the air coming out of the nasal cavity with the combined air coming out of the nasal and oral cavity. Seems more similar to how listeners hear it.
- How is nasalance influenced by phonemes?
The types of phonemes can change the nasalence score, so this should be considered. Ex: higher vowels tend to have the highest scores.
- How is nasalance related to normal nasality and HYN?
Lower nasalance scores are associated with normal nasality, whereas higher are associated with hypernasality. More specific: 10-30%=normal/borderline personality. 31-35%=mild hypernasality. 36-45%=moderate hypernasality. >45%=severe hypernasality
- Do the adenoids assist in VP closure?
Sometimes the adenoids can assist in closure in children. In these children, when the adenoids naturally leave the body as the child ages, they sometimes have to adjust their method of velopharyngeal closure. Children who have adenoidectomies sometimes have resulting hypernasality due to no longer having the ability to use the adenoids to assist in closure and having less time to adjust than children who lose their adenoids naturally.
- Do the palatine tonsils assist in VP closure?
a. NO
- What are the advantages of speech appliance over pharyngoplasty?
a. There is no physical risk
b. It can be used as earlier management before the surgery is done (commonly around 5 or 6)
c. It can easily be modified if structure changes
d. It might stimulate VP movement, get the muscles functioning
e. It can help permit better facial growth.
- What are the advantages of pharyngoplasty over speech appliance?
a. Pharyngoplasty better if: Noncompliant patients/parents (may not follow up), preference, geographic difficulty (ex: need multiple visits for speech appliance, may be difficulty if live far from services). Older children.
- How does sphincter pharyngoplasy differ from midline pharyngoplasty?
Sphincter pharyngoplastic is used when children have VPI due to leakage on the lateral borders of the closure (either unilateral or bilateral). A midline pharyngoplasty is used when the VPI is due to a gap/air leakage in the midline of the VP port
- Describe the three types of sphincter pharyngoplasty? (idk, just describing the types of pharyngoplasty)
a. Furlow z plasty
b. Pharyngeal wall augmentation
c. Sphincter pharyngoplasty
d. Pharyngeal flap
- What are some possible complications associated with pharyngoplasty?
a. Post op bleeding, airway obstruction, sleep anea, mouth breathing, nasal secretions, mortality (very small, 0.5%)
- What circumstances favor speech appliance over pharyngoplasty.
a. Younger children
b. Unknown etiology
c. Severe paralysis—if can stimulate movement of muscles with speech paralysis and make opening smaller, is a good prognostic indicator later for pharyngoplasty.
d. Severe articulation disorder—may not hear much difference with surgery even if hypernasality is fixed if have severe artic disorder. Focus on improving artic first.
e. Mild hypernasality
f. Not a candidate for surgery
- What is speech bulb reduction therapy.
a. The size of the speech bulb is gradually reduced with hope it will help stimulate the muscles of the VP port to begin initiating more closure on their own?
- Generally, discuss pre-surgical stimulation of speech/language in a toddler.
a. Encourage parents to use a large variety of words. ⚫ Parent’s should imitate child’s vocalizations ⚫ Encourage repetition of phonemes child can produce
- Describe a therapy program to:
Decrease HYN
- Auditory discrimination ⚫ Visual Feedback: Nasometer, Listening tube ⚫ Tactile Feedback: Palpate nares ⚫ Lower back of the tongue: ⚫ Increase oral activity and volume: Louder speech with more effort. Wider mouth opening
- VCV’s: Each vowel in combination with each consonant. e.g., /aba,aebae/. Proceed to other voice obstruents and higher vowels 2. Short words: VCV, CVC, VC, CV, e.g., easy, baby, is, see 3. 10 short phrases loaded with Obstruents or sonorants, e.g., “Suzy is great” 4. Reading 5. Structured conversation
- Describe a therapy program to: Decrease NAE
• Feedback: Listening tube, See Scape, Mirror, Pressure-flow equipment to monitor NAE 1. Produce sustained fricatives without NAE. May need visual confirmation of closure. 2. Add vowels to the fricatives (CV & CVC). First with /i/ and /u/ and then add other vowels. 3. Introduce other pressure consonants. 4. Remove supplementary feedback for patient and enforce monitoring by unaided auditory feedback. 5. Phrases: With and then without aided feedback. 6. Criterion for all steps: 95% without NAE
CPAP
Continuous positive airway pressure. A machine that is used sometimes w/ sleep apnea, is also possible treatment for VPI. Application of air pressure into the nasal cavity is thought to strengthen to musculature of velopharyngeal closure. It may help treat mild hypernasality in the short term, but it is unknown if there are improvements long term
Hypertelorism
abnormally increased distance between the eyes
Pharyngoplasty
a surgical intervention to correct velopharyngeal insufficiency
Cul-de-sac resonance
See Scape
a device used for visual feedback about nasality. Is placed in the nose, and the “styrophome?” rises when air goes in. The child can be told to try to produce the sounds/words without the styrophome rising inside of the see scape.
Palatoplasty
a cleft palate surgical repair
