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Speech therapy for persistent hypernasality/nasal air escape after velopharyngeal surgery
Author(s) -
SELL DEBBIE,
MA L
Publication year - 1995
Publication title -
international journal of language and communication disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.101
H-Index - 67
eISSN - 1460-6984
pISSN - 1368-2822
DOI - 10.1111/j.1460-6984.1995.tb01683.x
Subject(s) - velopharyngeal insufficiency , medicine , speech therapy , speech language pathology , etiology , audiology , speech therapist , communication disorder , surgery , language disorder , physical therapy , cognition , psychiatry
The treatment of speech symptoms associated with velopharyngeal inadquacy is frequently surgery. Unfortunately, about 20–30% of cases have persistent hypernasality/nasal air escape after velopharyngeal surgery and, in effect, present as surgical failures. It is the usual practice of surgical colleagues to recommend six months' post‐operative speech therapy in this situation. Very often this can lead to a negative unsuccessful experience for both the patient and the speech and language therapist. The use of nasopharyngoscopy as a pre‐operative investigation in the assessment of velopharyngeal dysfunction has been well established. Some authorities advocate the use of this technique for the objective assessment of post‐operative velopharyngeal closure, but this is rarely an established standard of care in the National Health Service (NHS). At Great Ormond Street the speech and language therapist is responsible for coordinating the service for velopharyngeal inadequacy and is trained in endoscopy. The model of practice includes a speech tape recording and assessment, and nasopharyngoscopy, at three months post‐operatively. Since 1990, more than 200 consecutive patients have been referred with suspected disorders of velopharyngeal function and entered on the database. To date there have been 63 surgical procedures. Through the use of video presentations, different examples of post‐operative findings will be presented. Evidence is provided to show that the aetiology of postoperative hypernasality and nasal air escape is variable. For example, the aetiology may be inappropriate surgical procedures, poor surgical technique, habitual factors or variability related to consonant production. Speech therapy is not always appropriate and should be recommended when the therapist and the surgeon have observed post‐operative velopharyngeal function through nasopharyngoscopy. Sometimes it may be advised for a shorter period than the routine recommendation of six months. Post‐operative nasopharyngoscopy will provide guidelines for appropriate referral, thereby increasing the cost‐effectiveness of speech therapy treatment. In addition, it will reduce the frequent sense of failure and frustration often associated with this treatment — not only for the patient but also for the therapist. It is suggested that the routine post‐operative recommendation of six months' therapy should be discarded in favour of specific recommendations based on the nasopharyngoscopy and speech assessment findings.