Andressa Sharllene Carneiro da Silva

Comparative analysis of velopharyngeal activity assessed by acoustic rhinometry and rhinomanometry

PURPOSE To analyze the velopharyngeal (VP) activity of subjects with velopharyngeal dysfunction (VPD) by acoustic rhinometry, as compared to rhinomanometry. METHODS This was a prospective clinical study conducted in 41 adults, both genders, with repaired cleft palate, with or without a previously repaired cleft lip, and residual VPD on clinical assessment, without compensatory articulations for [p], [t], and [k]. The outcome measures were as follows: (1) on acoustic rhinometry, nasopharyngeal volumetric change (ΔV) during [p], [t], and [k], relatively to rest condition (decreases by <3 cm3 considered as absence of VP activity); (2) on modified anterior rhinomanometry, VP orifice area (areas ≥0.05 cm2 considered as inadequate closure). The plosive [p] was used when comparing the techniques (n=24). RESULTS (1) A mean ΔV decrease of 18% was observed during [k], which was significantly lower (p<0.05) than the decrease reported for individuals without VPD (30%). ΔV values suggesting VPD were observed in 59% subjects. Similar results were obtained for [p] and [t], which shall be used as stimulus, given that they do not involve the use of the tongue to lift the velum during VP closure, differently from the velar plosive [k]. (2) Inadequate closure was seen in 85% subjects. No correlation was observed between ∆V and VP orifice area. Agreement between techniques was observed in 51% cases. CONCLUSION Acoustic rhinometry had low accuracy as a diagnostic method of VPD when compared to the gold standard method. Nevertheless, the technique shows potential as a method for monitoring the outcomes of clinical and surgical treatment of VPD aimed at increasing velar and pharyngeal activity.Purpose: To analyze the velopharyngeal (VP) activity of subjects with velopharyngeal dysfunction (VPD) by acoustic rhinometry, as compared to rhinomanometry. Methods: This was a prospective clinical study conducted in 41 adults, both genders, with repaired cleft palate, with or without a previously repaired cleft lip, and residual VPD on clinical assessment, without compensatory articulations for [p], [t], and [k]. The outcome measures were as follows: (1) on acoustic rhinometry, nasopharyngeal volumetric change (ΔV) during [p], [t], and [k], relatively to rest condition (decreases by <3 cm3 considered as absence of VP activity); (2) on modified anterior rhinomanometry, VP orifice area (areas ≥0.05 cm2 considered as inadequate closure). The plosive [p] was used when comparing the techniques (n=24). Results: (1) A mean ΔV decrease of 18% was observed during [k], which was significantly lower (p<0.05) than the decrease reported for individuals without VPD (30%). ΔV values suggesting VPD were observed in 59% subjects. Similar results were obtained for [p] and [t], which shall be used as stimulus, given that they do not involve the use of the tongue to lift the velum during VP closure, differently from the velar plosive [k]. (2) Inadequate closure was seen in 85% subjects. No correlation was observed between ∆V and VP orifice area. Agreement between techniques was observed in 51% cases. Conclusion: Acoustic rhinometry had low accuracy as a diagnostic method of VPD when compared to the gold standard method. Nevertheless, the technique shows potential as a method for monitoring the outcomes of clinical and surgical treatment of VPD aimed at increasing velar and pharyngeal activity.

Velar activity in individuals with velopharyngeal insufficiency assessed by acoustic rhinometry

Acoustic rhinometry is routinely used for the evaluation of nasal patency. Objective To investigate whether the technique is able to identify the impairment of velopharyngeal (VP) activity in individuals with clinical diagnosis of velopharyngeal insufficiency (VPI). Methods Twenty subjects with repaired cleft palate and inadequate velopharyngeal function (IVF) and 18 non-cleft controls with adequate velopharyngeal function (AVF), adults, of both genders, were evaluated. Area-distance curves were obtained during VP rest and speech activity, using an Eccovision Acoustic Rhinometry system. Volume was determined by integrating the area under the curve at the segment corresponding to the nasopharynx. VP activity (∆V) was estimated by the absolute and relative differences between nasopharyngeal volume at rest (Vr) and during an unreleased /k/ production (Vk). The efficiency of the technique to discriminate IVF and AVF was assessed by a ROC curve. Results Mean Vk and Vr values (±SD) obtained were: 23.2±3.6 cm3 and 15.9±3.8 cm3 (AVF group), and 22.7±7.9 cm3 and 20.7±7.4 cm3 (IVF group), corresponding to a mean ∆V decay of 7.3 cm3 (31%) for the AVF group and a significantly smaller ∆V decay of 2.0 cm3 (9%) for the IVF group (p<0.05). Seventy percent of the IVF individuals showed a ∆V suggesting impaired VP function (below the cutoff score of 3.0 cm3 which maximized both sensitivity and specificity of the test), confirming clinical diagnosis. Conclusion Acoustic rhinometry was able to identify, with a good discriminatory power, the impairment of VP activity which characterizes VPI.

Dimensões nasofaríngeas em indivíduos sem anomalias craniofaciais: dados normativos

OBJECTIVE To establish normative values of minimum cross-sectional nasopharyngeal area in individuals without craniofacial anomalies at different age ranges. MATERIAL AND METHOD Ninety-six individuals of both genders, without craniofacial anomalies, and with normal body mass index and neck circumference were evaluated. Participants were divided into 4 age groups: children, aged 6 to 10 years (G1); adolescents, aged 11 to 17 years (G2); young adults, 18 to 39 years (G3), and middle-aged adults, 40 to 59 years (G4). Minimum cross-sectional nasopharyngeal area (nasopharyngeal area - NPA) was assessed by means of modified anterior rhinomanometry (pressure-flow technique) using a PERCI-SARS system (version 3.50 - Microtronics Corp.). RESULTS Mean±SD values of NPA were 1.025±0.054cm2, 1.055±0.081cm2, 1.050±0.083cm2, and 1.054±0.081cm2, respectively for groups G1, G2, G3, and G4, showing that there were no differences between the four age groups. CONCLUSION Normative data of NPA were established for individuals without craniofacial anomalies from different age ranges, and they may be used as reference values in the clinical routine and for future studies regarding nasopharyngeal obstruction diagnosis, particularly in cases of craniofacial anomalies.

Análise perceptiva e nasométrica da hipernasalidade após a veloplastia intravelar para correção da insuficiência velofaríngea: efeitos a longo prazo

Objetivo investigar o efeito, a longo prazo, da veloplastia intravelar realizada para a correcao cirurgica da insuficiencia velofaringea (IVF) residual, sobre a hipernasalidade de individuos com fissura de palato reparada. Metodos foram avaliados 60 pacientes com fissura de palato±labio operada e IVF residual, de ambos os sexos, com idade entre 4 e 52 anos, os quais foram submetidos a palatoplastia secundaria com veloplastia intravelar. A avaliacao perceptivo-auditiva da fala foi realizada para classificacao da hipernasalidade, durante a conversacao espontânea e a repeticao de vocabulos e frases, utilizando-se escala de 6 pontos, onde 1=ausencia e 6=hipernasalidade grave. A nasometria foi utilizada para determinacao do escore de nasalância (correlato acustico da nasalidade), durante a leitura de 5 sentencas contendo sons exclusivamente orais, utilizando-se como limite de normalidade o escore de 27%. As avaliacoes foram realizadas 4 dias antes e 16 meses, em media, apos a cirurgia e o sucesso cirurgico foi analisado com base na proporcao de reducao e eliminacao/normalizacao da hipernasalidade e da nasalância. Resultados verificou-se, apos a cirurgia, reducao da hipernasalidade e da nasalância em 75% e 52% dos pacientes, respectivamente. Proporcoes menores foram identificadas quando utilizado o criterio mais rigoroso de analise (eliminacao/normalizacao), ou seja, 32% de eliminacao da hipernasalidade e 38% de normalizacao da nasalância, respectivamente. Conclusao aveloplastia intravelarmostrou ser um procedimento efetivo, a longo prazo, na reducao do sintoma mais significante da IVF residual e deve ser considerada como uma primeira opcao no tratamento cirurgico da IVF residual.