A Simple Technique for Determining Velopharyngeal Status during Speech Production

ABSTRACT

Clinical evaluation of velopharyngeal function relies heavily on auditory perceptual judgments that can be supported by instrumental examination of the velopharyngeal valve. Many of the current instrumental techniques are difficult to interpret, expensive, and/or unavailable to clinicians. Proposed in this report is a minimally invasive and inexpensive approach to evaluating velopharyngeal function that has been used successfully in our laboratory for several potentially difficult-to-test clients. The technique is an aeromechanical approach that involves the sensing of nasal ram pressure (N-RamP), a local pressure sensed at the anterior nares, using a two-pronged nasal cannula. By monitoring the N-RamP signal, it is possible to determine the status of the velopharyngeal port (open or closed) during speech production. Four case examples are presented to support its clinical value.

KEYWORDS

Velopharynx - evaluation

REFERENCES

• 1 Bradford L J, Brooks A R, Shelton R L. Clinical judgments of hypernasality in cleft palate children.  Cleft Palate J. 1964;  1 329-335
• 2 Mayo R, Dalston R M, Warren D W. Perceptual assessment of resonance distortion in unoperated clefts of the secondary palate.  Cleft Palate Craniofac J. 1993;  30 (4) 397-400
• 3 Warren D W, Dalston R M, Mayo R. Hypernasality and velopharyngeal impairment.  Cleft Palate Craniofac J. 1994;  31 (4) 257-262
• 4 Watterson T, Emanuel F. Observed effects of velopharyngeal orifice size on vowel identification and vowel nasality.  Cleft Palate J. 1981;  18 (4) 271-278
• 5 Dalston R M, Warren D W, Dalston E T. Use of nasometry as a diagnostic tool for identifying patients with velopharyngeal impairment.  Cleft Palate Craniofac J. 1991;  28 (2) 184-188 discussion 188-189
• 6 Hoit J D, Watson P J, Hixon K E, McMahon P, Johnson C L. Age and velopharyngeal function during speech production.  J Speech Hear Res. 1994;  37 (2) 295-302
• 7 Warren D W, Dubois A B. A pressure-flow technique for measuring velopharyngeal orifice area during continuous speech.  Cleft Palate J. 1964;  16 52-71
• 8 Warren D W. Nasal emission of air and velopharyngeal function.  Cleft Palate J. 1967;  4 (2) 148-155
• 9 Thompson A E, Hixon T J. Nasal air flow during normal speech production.  Cleft Palate J. 1979;  16 (4) 412-420
• 10 Thom S, Hoit J, Hixon T, Smith A. Velopharyngeal development in infants.  Cleft Palate Craniofac J. 2006;  43 539-546
• 11 Buhr R D. The emergence of vowels in an infant.  J Speech Hear Res. 1980;  23 (1) 73-94
• 12 Kent R D, Murray A D. Acoustic features of infant vocalic utterances at 3, 6, and 9 months.  J Acoust Soc Am. 1982;  72 (2) 353-365
• 13 Brigance A. Brigance Diagnostic Inventories: Inventory of Early Development II. North Billareca, MA: Curriculum Associates; 2004
• 14 Fenson L, Dale P, Reznick J et al. MacArthur Communicative Development Inventories: User's Guide and Technical Manual. San Diego, CA: Singular; 1993
• 15 Velleman S. Childhood Apraxia of Speech Resource Guide. Clifton Park, NY: Thomson Delmar Learning; 2003
• 16 American-Speech-language-Hearing Association Panel of Audiologic Assessment .Guidelines for Audiologic Screening. Rockville, MD; 1997
• 17 Semel E, Wiig E H, Secord W A. Clinical Evaluation of Language Fundamentals. 4th ed. Screening Test. San Antonio, TX: Harcourt Assessment; 2004
• 18 Templin M C, Darley F L. Iowa Pressure Articulation Test. 2nd ed. (IPAT). Iowa City, IA: University of Iowa; 1969
• 19 Seaver E J, Dalston R M, Leeper H A, Adams L E. A study of nasometric values for normal nasal resonance.  J Speech Hear Res. 1991;  34 (4) 715-721
• 20 Fairbanks G. Voice and Articulation Drillbook, 2nd ed. New York, NY: Harper and Row; 1960
• 21 Seaver E J, Dalston R M, Leeper H A, Adams L E. A study of nasometric values for normal nasal resonance.  J Speech Hear Res. 1991;  34 (4) 715-721
• 22 Karnell M P, Schultz K, Canady J. Investigations of a pressure-sensitive theory of marginal velopharyngeal inadequacy.  Cleft Palate Craniofac J. 2001;  38 (4) 346-357

1 The rainbow passage has been shown to contain a mixture of oral and nasal consonants equivalent to that found in conversational speech, and normative data are available.[21]

2 The Rainbow passage has been shown to contain a mixture of oral and nasal consonants equivalent to that found in conversational speech and normative data are available.[21]