Differences in velopharyngeal pressures during speech sound production in patients with unilateral cleft lip and palate (UCLP) and healthy individuals.

Background: During articulation the velopharynx needs to be opened and closed rapidly and a tight closure is needed. Based on the hypothesis that patients with cleft lip and palate (CLP) produce lower pressures in the velopharynx than healthy individuals, this study compared pressure profiles of the velopharyngeal closure during articulation of different sounds between healthy participants and patients with surgically closed unilateral CLP (UCLP) using high resolution manometry (HRM). Materials and methods: Ten healthy adult volunteers (group 1: 20-25.5 years) and ten patients with a non-syndromic surgically reconstructed UCLP (group 2: 19.1-26.9 years) were included in this study. Pressure profiles during the articulation of four sounds (/i:/, /s/, /ʃ/ and /n/) were measured by HRM. Maximum, minimum and average pressures, time intervals as well as detection of a previously described 3-phase-model were compared. Results: Both groups presented with similar pressure curves for each phoneme with regards to the phases described and pressure peaks, but differed in total pressures. An exception was noted for the sound /i:/, where a 3-phase-model could not be seen for most patients with UCLP. Differences in velopharynx pressures of 50% and more were found between the two groups. Maximum and average pressures in the production of the alveolar fricative reached statistical significance. Conclusions: It can be concluded that velopharyngeal pressures of patients with UCLP are not sufficient to eliminate nasal resonance or turbulence during articulation, especially for more complex sounds. These results support a general understanding of hypernasality during speech implying a (relative) velopharyngeal insufficiency.

Deglutition in Patients With Hypernasality Associated With Unilateral Cleft Lip and Palate Evaluated With High-Resolution Manometry.

OBJECTIVE: To evaluate pharyngeal pressure profiles during swallowing in patients with unilateral cleft lip and palate (UCLP) and identify compensation mechanisms. DESIGN: Prospective experimental study. SETTING: University Hospital and Medical School. PARTICIPANTS: Ten volunteers and 10 patients with nonsyndromic repaired UCLP with hypernasality (age: 19-27 years, 5 females and 5 males per group) were included. INTERVENTIONS: All participants swallowed 2 and 10 mL of water and underwent high-resolution manometry (HRM). MAIN OUTCOME MEASURES: Pharyngeal and upper esophageal sphincter (UES) parameters were measured using HRM. Student t test was used for statistical intergroup comparisons. Additionally, the Sydney Swallowing Questionnaire (SSQ) was used as a subjective measure. RESULTS: Patients exhibited reduced velopharyngeal closing pressure and velopharyngeal and tongue base (TB) region contraction times, compared to volunteers (P < .05). The UES opening and closing functions did not change. The SSQ revealed nasal regurgitation in some patients. CONCLUSIONS: In patients with UCLP, velopharyngeal region alterations are caused by impaired muscle force and function. The reduced TB contraction time may be a compensation mechanism allowing bolus transportation without nasal regurgitation. However, deglutition is not completely altered since UES function remains normal. Future studies will need to reveal at which point a decrease in velopharyngeal closing pressure will result in velopharyngeal insufficiency.

[Effect of Bolus Volume on Pharyngeal Swallowing Dynamics Evaluated with Small High-Resolution Manometry Catheters]. / Einfluss des Schluckvolumens auf die Pharynxdynamik, evaluiert mit dünnen Hochauflösungsmanometriesonden.

The bolus volume has a modulating effect on the swallowing dynamics, but previously reported adaptations of the pharyngeal function have been inconsistent. Therefore, the aim of this study was to comprehensively evaluate changes of pressure and time parameters in the pharynx and upper esophageal sphincter (UES) in relation to the swallowed bolus volume with high-resolution manometry (HRM). To examine the normal swallowing physiology, particularly thin HRM probes were used, which were expected to influence the investigated structures only minimally.10 healthy volunteers accomplished 10 swallows with 2 and 10 ml water respectively in an upright position, while an HRM-examination was performed. Pressure and time parameters of the velopharynx, the tongue base region and the UES were determined and analyzed for statistical differences with respect to the bolus volume.Swallowing larger bolus volumes resulted in both, a longer closure of the velopharynx and in a longer opening of the UES. Volume dependent pressure changes in the pharyngeal swallowing sequence were not detectable.Under the chosen test conditions, bolus volume had an impact on the time parameters of the pharyngeal phase, thus, temporal adaptations of the automated swallowing dynamics were detected. Changes in pharyngeal pressure parameters as shown in other studies cannot be confirmed. They may be due to HRM probes with a larger diameter, which take an effect on the pharyngeal structures themselves. With regard to diagnostic aspects, HRM studies should always be conducted with different bolus volumes in order to investigate the swallowing process completely.