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Semin Speech Lang 2011; 32(2): 159-167
DOI: 10.1055/s-0031-1277718
© Thieme Medical Publishers

Perceptual Assessment of Resonance and Velopharyngeal Function

Ann W. Kummer1
  • 1Senior Director, Division of Speech Pathology, Cincinnati Children's Hospital Medical Center, Professor of Clinical Pediatrics and Professor of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
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Publication History

Publication Date:
26 September 2011 (online)

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ABSTRACT

Cleft lip is an anomaly that primarily affects aesthetics, whereas cleft palate is an anomaly that primarily affects function, particularly speech. In fact, the main reason for repairing the palate is to provide adequate structure and function for normal speech production. Despite undergoing palatoplasty surgery, 20 to 30% of children with repaired cleft palate will demonstrate some degree of velopharyngeal dysfunction, resulting in abnormal speech. Velopharyngeal dysfunction is also seen in individuals without a history of cleft palate for various reasons. Because the symptoms of velopharyngeal dysfunction have a variety of causes, a comprehensive evaluation is very important to make the appropriate recommendations for treatment. The purpose of this article is to discuss the clinical assessment of velopharyngeal function for speech, using low-tech and “no-tech” procedures.

KEYWORDS

Velopharyngeal insufficiency - velopharyngeal incompetence - velopharyngeal dysfunction - hypernasality - assessment

REFERENCES

  • 1 Hirschberg J, Van Demark D R. A proposal for standardization of speech and hearing evaluations to assess velopharyngeal function.  Folia Phoniatr Logop. 1997;  49 (3-4) 158-167
    CrossrefPubMedGoogle Scholar
  • 2 Scherer N J, D'Antonio L L. Parent questionnaire for screening early language development in children with cleft palate.  Cleft Palate Craniofac J. 1995;  32 (1) 7-13
    CrossrefPubMedGoogle Scholar
  • 3 Smith B E, Kuehn D P. Speech evaluation of velopharyngeal dysfunction.  J Craniofac Surg. 2007;  18 (2) 251-261
    CrossrefPubMedGoogle Scholar
  • 4 Kummer A. Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance. Clifton Park, NY: Cengage Delmar Learning; 2008
    Google Scholar
  • 5 Templin M C, Darley F L. Templin-Darley Tests of Articulation. Iowa City, IA: The University of Iowa; 1969
    Google Scholar
  • 6 Bzoch K. Bzoch Error Patterns Diagnostic Articulation Test. Iowa City, IA: The University of Iowa; 1979
    Google Scholar
  • 7 Peterson-Falzone S J, Hardin-Jones M A, Karnell M P. Cleft Palate Speech. 4th ed. St. Louis, MO: Elsevier; 2010
    Google Scholar
  • 8 Kummer A. Assessment of Velopharyngeal Function. In: Losee J, Kirschner R, eds. Comprehensive Cleft Care. New York, NY: McGraw Hill; 2009: 589-605
    Google Scholar
  • 9 Kummer A. Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance. Clifton Park, NY: Thomson Delmar Learning; 2001
    Google Scholar
  • 10 Grunwell P, Brondsted K, Henningsson G et al. A six-centre international study of the outcome of treatment in patients with clefts of the lip and palate: the results of a cross-linguistic investigation of cleft palate speech.  Scand J Plast Reconstr Surg Hand Surg. 2000;  34 (3) 219-229
    CrossrefPubMedGoogle Scholar
  • 11 Henningsson G, Kuehn D P, Sell D, Sweeney T, Trost-Cardamone J E, Whitehill T L. Speech Parameters Group . Universal parameters for reporting speech outcomes in individuals with cleft palate.  Cleft Palate Craniofac J. 2008;  45 (1) 1-17
    CrossrefPubMedGoogle Scholar
  • 12 Sell D, John A, Harding-Bell A, Sweeney T, Hegarty F, Freeman J. Cleft audit protocol for speech (CAPS-A): a comprehensive training package for speech analysis.  Int J Lang Commun Disord. 2009;  44 (4) 529-548
    CrossrefPubMedGoogle Scholar
  • 13 Sell D, Harding A, Grunwell P. GOS.SP.ASS.'98: an assessment for speech disorders associated with cleft palate and/or velopharyngeal dysfunction (revised).  Int J Lang Commun Disord. 1999;  34 (1) 17-33
    CrossrefPubMedGoogle Scholar
  • 14 Breuls M, Sell D, Manders E, Boulet E, Vander Poorten V. SISL (ScreeningsInstrument Schisis Leuven): assessment of cleft palate speech, resonance and myofunction.  B-ENT. 2006;  2 (Suppl 4) 71-84
    PubMedGoogle Scholar
  • 15 Lohmander A, Olsson M. Methodology for perceptual assessment of speech in patients with cleft palate: a critical review of the literature.  Cleft Palate Craniofac J. 2004;  41 (1) 64-70
    CrossrefPubMedGoogle Scholar
  • 16 Sell D, Harding A, Grunwell P. A screening assessment of cleft palate speech (Great Ormond Street Speech Assessment).  Eur J Disord Commun. 1994;  29 (1) 1-15
    CrossrefPubMedGoogle Scholar
  • 17 Lohmander-Agerskov A, Havstam C, Söderpalm E et al. Assessment of speech in children after repair of isolated cleft palate.  Scand J Plast Reconstr Surg Hand Surg. 1993;  27 (4) 307-310
    PubMedGoogle Scholar
  • 18 Schneider E, Shprintzen R J. A survey of speech pathologists: current trends in the diagnosis and management of velopharyngeal insufficiency.  Cleft Palate J. 1980;  17 (3) 249-253
    PubMedGoogle Scholar
  • 19 Sell D. Issues in perceptual speech analysis in cleft palate and related disorders: a review.  Int J Lang Commun Disord. 2005;  40 (2) 103-121
    CrossrefPubMedGoogle Scholar
  • 20 Peterson-Falzone S J, Hardin-Jones M A, Karnell M P, McWilliams B J. Cleft Palate Speech. 3rd ed. St. Louis, MO: Mosby; 2001
    Google Scholar
  • 21 Zraick R I, Liss J M, Dorman M F, Case J L, LaPointe L L, Beals S P. Multidimensional scaling of nasal voice quality.  J Speech Lang Hear Res. 2000;  43 (4) 989-996
    PubMedGoogle Scholar
  • 22 Zraick R I, Liss J M. A comparison of equal-appearing interval scaling and direct magnitude estimation of nasal voice quality.  J Speech Lang Hear Res. 2000;  43 (4) 979-988
    PubMedGoogle Scholar
  • 23 Whitehill T L. Assessing intelligibility in speakers with cleft palate: a critical review of the literature.  Cleft Palate Craniofac J. 2002;  39 (1) 50-58t
    CrossrefPubMedGoogle Scholar
  • 24 Kummer A W, Curtis C, Wiggs M, Lee L, Strife J L. Comparison of velopharyngeal gap size in patients with hypernasality, hypernasality and nasal emission, or nasal turbulence (rustle) as the primary speech characteristic.  Cleft Palate Craniofac J. 1992;  29 (2) 152-156
    CrossrefPubMedGoogle Scholar
  • 25 Kummer A W, Briggs M, Lee L. The relationship between the characteristics of speech and velopharyngeal gap size.  Cleft Palate Craniofac J. 2003;  40 (6) 590-596
    CrossrefPubMedGoogle Scholar
  • 26 Wang N M, Yeung K W, Chen T A, Chen Y R. Voice disorders in children with velopharyngeal valving problems.  Changgeng Yi Xue Za Zhi. 1990;  13 (1) 48-53
    PubMedGoogle Scholar
  • 27 Lewis J R, Andreassen M L, Leeper H A, Macrae D L, Thomas J. Vocal characteristics of children with cleft lip/palate and associated velopharyngeal incompetence.  J Otolaryngol. 1993;  22 (2) 113-117
    PubMedGoogle Scholar
  • 28 D'Antonio L L, Muntz H R, Province M A, Marsh J L. Laryngeal/voice findings in patients with velopharyngeal dysfunction.  Laryngoscope. 1988;  98 (4) 432-438t
    PubMedGoogle Scholar
  • 29 Kummer A, Marsh J. Pediatric voice and resonance disorders. In: Johnson A, Jacobson B, eds. Medical Speech-Language Pathology: A Practitioner's Guide. New York, NY: Thieme; 1998
    Google Scholar
  • 30 Paal S, Reulbach U, Strobel-Schwarthoff K, Nkenke E, Schuster M. Evaluation of speech disorders in children with cleft lip and palate.  J Orofac Orthop. 2005;  66 (4) 270-278
    CrossrefPubMedGoogle Scholar
  • 31 Bzoch K. Clinical assessment, evaluation and management of 11 categorical aspects of cleft palate speech. In: Bzoch K, ed. Communicative Disorders Related to Cleft Lip and Palate. Austin, TX: Pro-Ed; 1997: 261-311
    Google Scholar
  • 32 Haapanen M L. A simple clinical method of evaluating perceived hypernasality.  Folia Phoniatr (Basel). 1991;  43 (3) 122-132
    CrossrefPubMedGoogle Scholar
  • 33 Johns D F, Rohrich R J, Awada M. Velopharyngeal incompetence: a guide for clinical evaluation.  Plast Reconstr Surg. 2003;  112 (7) 1890-1897
    CrossrefPubMedGoogle Scholar
  • 34 Rudnick E F, Sie K C. Velopharyngeal insufficiency: current concepts in diagnosis and management.  Curr Opin Otolaryngol Head Neck Surg. 2008;  16 (6) 530-535
    CrossrefPubMedGoogle Scholar
  • 35 Sweeney T, Sell D. Relationship between perceptual ratings of nasality and nasometry in children/adolescents with cleft palate and/or velopharyngeal dysfunction.  Int J Lang Commun Disord. 2008;  43 (3) 265-282
    CrossrefPubMedGoogle Scholar

Ann W KummerPh.D. CCC-SLP ASHA-F 

Division of Speech Pathology, MLC 4011, Cincinnati Children's Hospital Medical Center

3333 Burnet Avenue, Cincinnati, OH 45229-3039

Email: ann.kummer@cchmc.org

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