Nasendoscopic Evaluation of Stress Velopharyngeal Insufficiency in Wind Musicians: A Pilot Study

2015 ◽  
Vol 30 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Alison Evans ◽  
Tim Driscoll ◽  
Jonathan Livesey ◽  
David Fitzsimons ◽  
Bronwen Ackermann
Keyword(s):  
Soft Palate ◽  
Objective Assessment ◽  
Velopharyngeal Insufficiency ◽  
Air Leak ◽  
Speech Language Pathologist ◽  
Wind Instrument ◽  
Velopharyngeal Closure ◽  
Before And After ◽  
And Function

OBJECTIVE: To investigate the anatomy and function of the velopharyngeal mechanism in musicians who experience symptoms of stress velopharyngeal insufficiency (VPI) compared to musicians who do not. METHODS: The velopharyngeal mechanism of 13 musicians, 8 with reported symptoms of stress VPI and 5 without, were evaluated using video nasendoscopy before and after 30 minutes of playing. All nasendoscopic recordings were rated by an external speech-language pathologist and ear, nose and throat surgeon for maintenance of velopharyngeal closure, type of velopharyngeal closure pattern, and velopharyngeal gap. RESULTS: Six out of 8 cases with stress VPI had nasal air leak during the assessment, 2 of whom had fatigue-related increased symptoms. Three controls had mild nasal air leak without affecting the consistency of soft palate seal nor quality of playing, suggesting that evidence of nasal air leak is not always symptomatic of stress VPI. All cases had unusual anatomical characteristics, such as the soft palate closing against an irregular surface on the posterior nasopharyngeal wall, which may cause insufficient velopharyngeal closure. Typically the soft palate contacted the nasopharyngeal wall higher when playing a wind instrument compared to during speech. CONCLUSION: Specific anatomical features and factors such as fatigue and stress may affect maintenance of velopharyngeal closure in persons with stress VPI. It is important that musicians with stress VPI are evaluated while playing their instrument. Future studies into stress VPI would benefit by including objective assessment components and some degree of quantifiable measurements.

scholarly journals Prosthetic Rehabilitation of Velopharyngeal Insufficiency: Pharyngeal Obturator Prostheses with Different Retention Mechanisms

2010 ◽  
Vol 04 (01) ◽  
pp. 081-087 ◽  
Author(s):  
Suleyman Hakan Tuna ◽  
Gurel Pekkan ◽  
Hasan Onder Gumus ◽  
Alper Aktas
Keyword(s):  
Soft Palate ◽  
Velopharyngeal Insufficiency ◽  
Prosthetic Rehabilitation ◽  
Retention Mechanisms ◽  
Velopharyngeal Closure ◽  
Intelligible Speech

ABSTRACTPharyngeal obturator prostheses restore the congenital or acquired defects of the soft palate and allow adequate closure of palatopharyngeal sphincter. Two patients with soft palate defect and subsequent velopharyngeal insufficiency were rehabilitated using pharyngeal obturator prostheses which had different retention mechanisms. Since it is necessary for swallowing and intelligible speech, the patients were examined in terms of adequate velopharyngeal closure after prosthetic treatment. The results were satisfying for both the patients and physicians. (Eur J Dent 2010;4:81-87)

Comparing the Unaided Visual Exam to Lateral Cinefluorography in Estimating Several Parameters of Velopharyngeal Function

1984 ◽  
Vol 49 (2) ◽  
pp. 136-139 ◽  
Author(s):  
C. R. Eisenbach ◽  
W. N. Williams
Keyword(s):  
Medical Records ◽  
Velopharyngeal Insufficiency ◽  
Poor Agreement ◽  
Connected Speech ◽  
Visual Examination ◽  
Management Decisions ◽  
Form And Function ◽  
Velopharyngeal Closure ◽  
Velopharyngeal Function ◽  
And Function

Retrospectively, the medical records of patients with known velopharyngeal insufficiency (VPI) were reviewed for comments based on an unaided visual examination regarding their velopharyngeal function. These comments were compared to objective findings obtained from the cinefluorographic evaluations performed on each of the patients. A total of 68 recorded comments (47 patients) were identified and fell into four broad categories: (1) velar length, (2) depth of the nasopharynx, (3) velopharyngeal closure, and (4) velar mobility. The results revealed an agreement level of 60% between judgments made from visual examinations and cinefluorographic evaluations. This relatively poor agreement suggests that management decisions concerning VPI must include some method of objectively assessing velopharyngeal form and function during connected speech.

Double-opposing Z-Plasty Extended with a Pedicled Buccal Fat Pad Flap for Correcting Velopharyngeal Insufficiency after Primary Palatoplasty

2021 ◽  
pp. 105566562110471
Author(s):  
Hojin Park ◽  
Jin Mi Choi ◽  
Tae Suk Oh
Keyword(s):  
Soft Palate ◽  
Surgical Outcomes ◽  
Velopharyngeal Insufficiency ◽  
Moderate Degree ◽  
Fat Pad ◽  
Buccal Fat Pad ◽  
Pharyngeal Wall ◽  
Mucosal Flap ◽  
Velopharyngeal Closure ◽  
Submucous Cleft Palate

Introduction Furlow double-opposing Z-plasty (DOZ) lengthens the soft palate; however, this lengthening is achieved at the expense of increased mucosal flap tension. Thus, its use is limited in patients with severe tension applied on mucosal flap after DOZ. In this study, DOZ was combined with a buccal fat pad (BFP) flap to maximize palatal lengthening and muscle repositioning. Methods This study included patients who underwent surgical correction for velopharyngeal insufficiency between December 2016 and February 2019. Patients with more than moderate degree hypernasality following primary palatoplasty were included in the study. Patients younger than 4 years of age, those with a submucous cleft palate, or syndromic patients were excluded. Speech outcomes were investigated for those who underwent DOZ only (DOZ group, n = 17) and those in whom a BFP was used (BFP group, n = 15) pre- and postoperatively. The velopharyngeal gaps between the uvula and pharyngeal wall were measured before and immediately after surgery to estimate the palatal length. Results Most patients who received a BFP showed improvement in hypernasality. However, the hypernasality of the DOZ group was more severe than that of the BFP group (p = 0.023). The extent of palatal lengthening was 4.4 ± 1.7 mm and 7.5 ± 2.1 mm in the DOZ and BFP groups, respectively (p = 0.001). Conclusions BFPs reduced the tension of the DOZ mucosal flap and maximized palatal lengthening and muscle repositioning. They promoted velopharyngeal closure in patients with moderate and moderate-to-severe velopharyngeal insufficiency. Hence, our method improves the surgical outcomes of patients with velopharyngeal insufficiency after primary palatoplasty.

Unilateral Absence of the Soft Palate: Case Report of Reconstruction with a Mucoperiosteal Island Flap

1993 ◽  
Vol 30 (5) ◽  
pp. 497-499 ◽  
Author(s):  
M. Emin Mavili ◽  
Tacettin Gucer ◽  
Yucel Erk
Keyword(s):  
Case Report ◽  
Cleft Palate ◽  
Soft Palate ◽  
Speech Quality ◽  
Island Flap ◽  
Velopharyngeal Insufficiency ◽  
Congenital Absence

Congenital absence of half of the soft palate Is a rare deformity. There is little in the literature about its definition and management. This article presents a case with velopharyngeal insufficiency caused by unilateral absence of the soft palate. The patient was treated with a modification of the mucoperiosteal Island flap, first designed by Millard, to provide nasal lining during pushback lengthening of a short cleft palate. The speech quality of the patient Improved noticeably after the operation. Although island flap has limited use in primary cleft palate surgery, It may be effective in reconstruction of soft palate defects, when standard pushback procedures are not adequate for solving the problem.

The Effect of Submarine Wastewater Discharge on the Bacterial Quality of Surf Waters

1982 ◽  
Vol 14 (4-5) ◽  
pp. 1-11 ◽  
Author(s):  
D J Livingstone
Keyword(s):  
Escherichia Coli ◽  
South Africa ◽  
Water Quality ◽  
Objective Assessment ◽  
Wastewater Discharge ◽  
Before And After

A system involving enumeration of Escherichia coli I, parasite units, staphylococci and salmonellas, and determination of salinity, was developed for the objective assessment of bacterial water quality in the sea off Durban, South Africa. The system was used to measure the quality of the surf waters before and after the construction of two submarine outfalls. Significant improvement in the quality of the surf along the bathing beaches has been noted since the outfalls became operational.

Functional anatomy of the soft palate applied to wind playing

2010 ◽  
Vol 25 (4) ◽  
pp. 183-189 ◽  
Author(s):  
Alison Evans ◽  
Bronwen Ackermann ◽  
Tim Driscoll
Keyword(s):  
Soft Palate ◽  
High Pressures ◽  
Prolonged Exposure ◽  
Functional Anatomy ◽  
Velopharyngeal Insufficiency ◽  
Related Disorder ◽  
Velopharyngeal Closure ◽  
Teachers And Students ◽  
Wind Players ◽  
Air Passage

Wind players must be able to sustain high intraoral pressures in order to play their instruments. Prolonged exposure to these high pressures may lead to the performance-related disorder velopharyngeal insufficiency (VPI). This disorder occurs when the soft palate fails to completely close the air passage between the oral and nasal cavities in the upper respiratory cavity during blowing tasks, this closure being necessary for optimum performance on a wind instrument. VPI is potentially career threatening. Improving music teachers' and students' knowledge of the mechanism of velopharyngeal closure may assist in avoiding potentially catastrophic performance-related disorders arising from dysfunction of the soft palate. In the functional anatomy of the soft palate as applied to wind playing, seven muscles of the soft palate involved in the velopharyngeal closure mechanism are reviewed. These are the tensor veli palatini, levator veli palatini, palatopharyngeus, palatoglossus, musculus uvulae, superior pharyngeal constrictor, and salpingopharyngeus. These muscles contribute to either a palatal or a pharyngeal component of velopharyngeal closure. This information should guide further research into targeted methods of assessment, management, and treatment of VPI in wind musicians.

Comparing Quality of Life and Perceptual Speech Ratings in Children With Cleft Palate

2020 ◽  
pp. 105566562094943
Author(s):  
Hailey M. Pedersen ◽  
Paige A. Goodie ◽  
Maia N. Braden ◽  
Susan L. Thibeault
Keyword(s):  
Quality Of Life ◽  
Cleft Palate ◽  
Population Based ◽  
Velopharyngeal Insufficiency ◽  
Average Score ◽  
Life Outcomes ◽  
Speech Language Pathologist ◽  
Perceptual Characteristics ◽  
Velopharyngeal Function

Objective: To delineate the relationship between patient and parent-reported quality of life (QOL) ratings and perceptual characteristics of speech assigned by a speech-language pathologist (SLP) in children with repaired cleft palate. Design: Prospective. Setting: Academic Children’s Hospital. Participants: This population-based sample included children, aged 3 to 18 with a history of repaired cleft palate, and their parents. Intervention: Participants completed the Velopharyngeal Insufficiency Effects on Life Outcomes Questionnaire (VELO). Children’s speech was judged perceptually by an expert SLP using the Pittsburgh Weighted Speech Scale (PWSS). Main Outcome Measure(s): Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire assessed participant and parent perceptions of impact of velopharyngeal function on QOL. Pittsburgh Weighted Speech Scale assessed nasal emissions, facial grimacing, nasality, quality of phonation, and articulation. Results: Enrollment included 48 participant parent dyads. Overall, participants reported high QOL scores within the 95% CI with children reporting slightly better yet not significantly different QOL (86.27 ± 8.96) compared to their parents (81.81 ± 15.2). Children received an average score of 1.38 ± 1.96 on the PWSS corresponding to borderline velopharyngeal competence. A significant moderate negative correlation was found between PWSS total score and parent VELO total score (r = −0.51103, P = .0002). Mild–moderate significant negative correlations were measured between PWSS total and the 5 subscales of the VELO. No significant correlations were measured between PWSS and child VELO total responses or between total scores and subscales. Conclusions: Results suggest that as perceptual analysis of speech improves, overall QOL improves moderately.

scholarly journals Assessment of Kinesio Taping Versus Phonophoresis for the Treatment of Painful Hallux Valgus: A Pilot Study

2021 ◽  
Vol 10 ◽  
pp. 1888
Author(s):  
Parisa Taheri ◽  
Razieh Maghroori ◽  
Aidin Heidari
Keyword(s):  
Hallux Valgus ◽  
Score Function ◽  
P Value ◽  
Foot Kinematics ◽  
Intermetatarsal Angle ◽  
Valgus Angle ◽  
Before And After ◽  
Insignificant Difference ◽  
And Function

Background: Hallux valgus (HV) is a deformity that affects the quality of life and function in a negative manner causing disturbed balance and walking and even alters the foot kinematics. Conservative treatments are the choice for mild to moderate HV, but the question about the best method has not been responded yet. In the current study, it is aimed to assess and compare the efficacy of kinesiotaping (KT) versus phonophoresis (PH) for the treatment of painful HV. Materials and Methods: This randomized clinical trial has been conducted on a total number of 37 toes (37 toes of a total number of 24 patients) randomly divided into two subgroups of either KT or PH with 1% hydrocortisone among which the total numbers of 31 toes from 20 patients fulfilled the study protocol. The variables including pain (using VAS score), function (using Manchester-Oxford Foot questionnaire)(MOXFD), hallux valgus angle (HVA), and intermetatarsal angle (IMA) were assessed and compared between two groups before and after two months following the interventions. Results: The pain score decreased significantly within the time in both groups (P-value<0.001), while the comparison of KT with PH revealed insignificant difference (P-value=0.08). MOXFD assessments showed significantly improved status within two months for both interventions (P-value<0.001) with no remarkable difference between the groups (P-value=0.55). The IMA and HVA altered following both of the techniques. KT was superior to PH for the correction of HVA, but not for IMA (P-value>0.05). Conclusion: We found both of the KT and PH techniques could successfully rehabilitate the patients’ pain and improve function, however the KT was slightly better than PH due to HVA reduction. [GMJ.2021;10:e1888]

scholarly journals Quality of life in patients with laryngeal cancer before and after surgery

2019 ◽  
Vol 147 (11-12) ◽  
pp. 713-717
Author(s):  
Tomasz Zatoński ◽  
Mateusz Kolator
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Laryngeal Cancer ◽  
Objective Assessment ◽  
Neck Surgery ◽  
Treatment Results ◽  
Before And After ◽  
Eortc Qlq ◽  
Surgery Department

Introduction/Objective. Assessment of the Quality-of-life questionnaires was filled out before and after surgery by patients with laryngeal cancer hospitalized in the Otolaryngology, Head and Neck Surgery Department, qualified for surgical treatment. Methods. Fifty-four patients with laryngeal cancer in T3 and T4 stages who were qualified for total laryngectomy were asked to fill out the EORTC QLQ-30 and H&N30 modules before and a few years after surgical treatment. Results. The quality of life of the hospitalized patients increased after surgery. The level of pain after surgery decreased and was statistically significant (p = 0.025). In the study group, 90.6% of patients survived five years after surgery. Conclusion. The quality of life in patients with laryngeal cancer improved in the domain of pain. Further research should be conducted on a larger group of patients. Future results could provide useful material for analysis regarding the benefits for the patient that may be relevant to a decision to consent to the proposed treatment and the choice of its type.

Fiberoptic Endoscopic Evaluation of Swallowing in Infants and Children: Protocol, Safety, and Clinical Efficacy: 25 Years of Experience

2019 ◽  
Vol 129 (5) ◽  
pp. 469-481 ◽  
Author(s):  
Claire Kane Miller ◽  
Jay Paul Willging
Keyword(s):  
Team Approach ◽  
Sensory Threshold ◽  
Safe Procedure ◽  
Airway Protection ◽  
Endoscopic Evaluation ◽  
Swallowing Function ◽  
Speech Language Pathologist ◽  
Before And After ◽  
Pharyngeal Swallowing ◽  
And Function

Background: The application of fiberoptic endoscopic evaluation of swallowing (FEES) in the pediatric dysphagia protocol requires specialized knowledge of pediatric conditions that result in dysphagia, recognition of normal and abnormal laryngopharyngeal anatomy and function across ages, and the ability to identify maturational changes in anatomy and function of the aerodigestive tract that pertain to airway protection and swallowing function. Methods: Over the past 25 years, we have performed over 7,000 collaborative Otolaryngology and Speech-Language Pathology FEES examinations in patients ranging from 2 days of age to young adults. During this time period, we have monitored the safety of the procedure, explored the feasibility and utility of FEES across conditions, compared and contrasted FEES to the videofluoroscopic evaluation of swallowing (VFSS), and developed specific pediatric FEES protocols with operational definitions for identification and interpretation of swallowing parameters. Results: FEES has proved to be a safe procedure in patients across ages. There have been no significant adverse events. FEES is comparable to the VFSS in the assessment of events before and after the swallow. It provides unique information regarding laryngopharyngeal anatomy and function, airway protection integrity, sensory threshold, and secretion management ability, as well as pharyngeal swallowing dynamics and the efficacy of compensatory swallowing strategies. Conclusions: There are specific indications and contraindications for pediatric FEES, and unique components that characterize the pediatric FEES protocols across ages and conditions. FEES procedures performed jointly by an Otolaryngologist and Speech-Language pathologist offer a team approach to interpretation and management recommendations.

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