Academic journal article Journal of Medical Speech - Language Pathology

Endoscopic and Perceptual Evaluation of Velopharyngeal Insufficiency (VPI) and Hypernasality. (Tutorial)

Academic journal article Journal of Medical Speech - Language Pathology

Endoscopic and Perceptual Evaluation of Velopharyngeal Insufficiency (VPI) and Hypernasality. (Tutorial)

Article excerpt

The evaluation of velopharyngeal insufficiency and its associated effects on speech represent a complex interaction of both listener judgments of nasality and visualization of the velopharyngeal mechanism using either endoscopy or radiographic analyses. Although the parameters of hypernasality and velopharyngeal insufficiency are dependent on each other, the differences between the parameters are far from trivial. The purpose of this paper is to provide a comprehensive clinical protocol that integrates perceptual judgments of nasality with visual inspection of velopharyngeal insufficiency using nasal endoscopy. This clinical protocol is based on relevant clinical research obtained over the past forty years and refined by the authors through extensive clinical experience. The protocol provides clear, concise descriptions of terminology and rationales for clinical procedures. Furthermore, the clinical protocol integrates acoustic, perceptual, physiological, and practical information. It is the aim of this paper , therefore, to provide a comprehensive clinical guide to the evaluation of hypernasality and velopharyngeal insufficiency enhancing the ability of the clinician to perform the diagnostic procedures, understand the elements of the procedures, and appropriately interpret the findings.

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The evaluation of velopharyngeal insufficiency and its associated effects on speech represent a complex interaction of both listener judgments of nasality and visual observation of the velopharyngeal mechanism. Although the parameters of hypernasality and velopharyngeal insufficiency are dependent on each other, the differences between the parameters are far from trivial. Hypernasality is a perceptual parameter that requires listener judgments of speech production and the determination that nasal resonance is notably higher than normal. Although trained judgments of hypernasal speech are the most frequent index leading to the clinical decision to treat or not to treat, the clinician must also determine what kind of treatment would provide the best results, especially if surgical repair is being considered. This requires an accurate assessment of velopharyngeal insufficiency. Velopharyngeal insufficiency (VPI) refers to the inability or reduced ability to achieve closure of the velopharyngeal port when necessa ry. Assessment of velopharyngeal insufficiency requires visualization of the velopharyngeal mechanism using endoscopy or radiographic analysis to evaluate the ability to achieve closure of the velopharyngeal port using the movements of the velum, lateral pharyngeal walls, and posterior pharyngeal wall. The purpose of this article is to provide a comprehensive diagnostic procedure that integrates perceptual judgments of nasality with visual judgments of velopharyngeal insufficiency using endoscopy.

HYPERNASALITY

Clinically, it is convenient to consider the percept of nasality to include three main areas of focus. First, the percept is associated with the notion of oralnasal resonance imbalance. Resonance is the phenomenon whereby one body (or cavity of air) is set into vibration by the vibration of another body. Thus, the primary vibrating body is represented by the vocal folds, and the cavities set into resonance by those vibrations are the oral and nasal chambers. When the ratio of nasal to oral resonance increases, it is expected that the listener's percept of nasality would increase. Because this resonance phenomenon occurs primarily for voiced phonemes, vowels and voiced consonants make ideal listening judgment stimuli. Second, the percept is associated with the notion of audible nasal emission of air accompanying VPI. While this aerodynamic phenomenon can be associated with voiced consonants, it is more likely to be perceived on voiceless consonants requiring higher intraoral pressure. Therefore, voiceless fric atives, plosives, and affricates become ideal listening judgment stimuli for audible nasal emissions. …

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