Pharyngeal flap outcomes for velopharyngeal insufficiency: Evaluation of speech, obstructive sleep apnea, and velopharyngeal anatomy.

The purpose of this study was to evaluate the speech outcomes, reveal postoperative rates of obstructive sleep apnea, and characterize changes in the pharyngeal flap and velopharyngeal anatomy following pharyngeal flap surgery for velopharyngeal insufficiency. A retrospective chart was reviewed for patients with clefts who underwent pharyngeal flap surgery between November 2020 and November 2021. The data collected included age, gender, cleft palate type, age at pharyngeal flap surgery, postoperative complications, age and type of primary palatoplasty, preoperative and postoperative speech assessments, magnetic resonance imaging findings, and obstructive sleep apnea outcomes. The authors included 72 nonsyndromic patients who underwent pharyngeal flap surgery following cleft palate repair. The mean age at pharyngeal flap surgery was 10.6 ± 6.2 years. There was a significant improvement in the Pittsburgh Weighted Speech Score Hypernasality Component and the nasalance scores of oral syllables (p < 0.001). The obstructive sleep apnea rate after pharyngeal flap surgery was 6.9%. Compared to preoperatively, the velar angle was more acute (p < 0.001), the velar length was longer (p < 0.001), the distance of the velum tip to the posterior pharyngeal wall was shorter (p < 0.001), the size of velopharyngeal gap was narrower (p < 0.001), and the pharyngeal flap atrophied (p < 0.001) at 6 months postoperatively. The pharyngeal flap improved speech outcomes in patients with velopharyngeal insufficiency with a relatively low incidence of obstructive sleep apnea (6.9%). The velum is positioned more superiorly and posteriorly, and the size of the velopharyngeal gap is substantially reduced after pharyngeal flap surgery. In addition, the pharyngeal flap partially atrophied over time.

Comprehensive evaluation of velopharyngeal function in myasthenia gravis patients.

PURPOSE: Hypernasality, which is a symptom of dysarthria, may be seen in patients with Myasthenia Gravis with bulbar symptoms. However, there is not enough evidence to show that these patients may have velopharyngeal dysfunction. This study investigates the features of velopharyngeal function in myasthenia gravis patients using objective and subjective measurement tools. METHODS: Ten adult myasthenia gravis patients with bulbar symptoms and ten adult myasthenia gravis patients without bulbar symptoms were recruited for this study. Ten healthy subjects were also included as the control group. The nasalance scores of the participants were determined using a nasometer. The degree and pattern of velopharyngeal closure were scored using flexible nasoendoscopy during speech, blowing, dry swallowing, and food swallowing. Perceptual hypernasality was assessed. RESULTS: Velopharyngeal dysfunction was detected in 50% of the myasthenia gravis patients with bulbar symptoms. Velopharyngeal dysfunction was not seen in myasthenia gravis patients without bulbar symptoms. The degree of velopharyngeal closure in patients with bulbar symptoms differed depending on the tasks being performed. No significant difference in velopharyngeal closure patterns was observed between the groups (p < 0.05). CONCLUSION: Myasthenia gravis patients with bulbar involvement may have velopharyngeal dysfunction. It is important to conduct a comprehensive evaluation to assess all aspects of the velopharyngeal function.

Perceptions Regarding the Academic and Cognitive Performance of Individuals With Cleft Lip and/or Palate.

INTRODUCTION: Factors such as teachers' appropriate support and social interactions have an impact on the academic performance of children with cleft lip and/or palate (CL/P). This study was designed to investigate the perceptions of the teachers and the general public about the academic and cognitive performance of individuals with CL/P. METHODS: This study was included 360 (male/female = 102/258) teachers and 640 (male/female = 259/381) participants that represent the general public. Anonymized web-based and paper-and-pencil self-administered questionnaire that included multiple-choice and yes/no questions were administered. Within-group differences and intergroup differences were analyzed in terms of academic and cognitive performance. RESULTS: Most of the teachers and the general public indicated that the academic and cognitive performance of individuals with CL/P is the same as their unaffected peers. A significantly higher proportion of the teachers indicated that the academic performance of children with CL/P is the same as their unaffected peers than the general public. CONCLUSION: Considering that the general public's attitudes and appropriate teacher support are crucial to prevent adverse impacts on the lives of individuals with CL/P, it is important to support teachers with the appropriate information and to encourage the public to recognize that everybody with a facial difference should be treated as an individual rather than a disability.

Evaluation of the voice onset time in Turkish-Speaking schoolchildren.

OBJECTIVES: To determine the voice onset time (VOT) values of Turkish speaking schoolchildren and to evaluate the effect of gender, age and vowel height on VOT values in this age group. METHODS: One hundred and twenty native Turkish children between the ages of 7-11 years were included in the study. All children were divided into 4 age groups: Group I 7.0 to 7 years, 11 months; Group II 8.0 to 8 years, 11 months; Group III 9.0 to 9 years, 11 months; and Group IV 10.0 to 10 years, 11 months. The six Turkish plosive sounds (/p/,/b/,/t/,/d/,/k/,/g/) and the eight Turkish vowel sounds (/a/,/e/,/ɯ/,/i/,/o/,/oe/,/u/,/y/) were compiled into 48 different syllables, such as/pa/,/be/,/ti/, and/ko/. The syllables were repeated three times and were recorded by Behringer C-1 studio condenser microphone. Records were analysed by Praat software. The VOT values was established by measuring the time between temporary plosion of the pause and the onset of vocal fold vibration. RESULTS: The mean voice onset time values of the voiced and voiceless plosive sounds of the groups were analysed with One Way ANOVA test. There was no statistically significant difference between the groups (p > 0.05). The VOT values of voiceless plosive sounds in all groups were established as positive, and VOT values of voiced plosive sounds were found to be negative. Mean VOT values according to gender was analysed by Independent Samples t-test. A significant difference was found between genders in voiced (/b/,/d/,/g/) plosive sounds and in the/t/sound among the voiceless plosive sounds (p < 0.05). The difference between the heights of vowels and VOT were analysed by one-way ANOVA test. A significant difference was observed between the height of the following vowel and the voiceless plosives/p/,/t/,/k/and voiced plosive/b/(p < 0.05). CONCLUSIONS: The VOT values of voiceless plosive sounds in Turkishspeaking schoolchildren were positive and the VOT values of their voiced plosive sounds were found negative. It was established that the height of the following vowel increases the VOT values of voiceless plosive sounds and has a variable effect on voiced plosive sounds.

Does contribution of extended vomer flap to palatoplasty affects speech results.

Development of normal speech is the primary goal of successful palatoplasty. The purpose of this study was to determine the importance of the contribution of vomer flap to palatoplasty procedure for speech function. Eighty-one children who underwent 2 flap palatoplasty procedures for cleft palate repair between 2002 and 2010 were retrospectively reviewed in 3 groups. Group 1 underwent palatoplasty without contribution of vomer flap. Group 2 underwent palatoplasty with standard dissection of vomer flap, whereas group 3 underwent palatoplasty with extended dissection of vomer flap. Speech function of the patients was evaluated using objective assessment tools such as nasopharyngoscopy and nasometer. Eighty-one children who underwent 2 flap palatoplasty were included in this study. The mean age at palatoplasty was 10.17 months, and mean length of follow-up was 72.33 months. For most syllables, patients repaired using extended vomer flap demonstrated lower nasalance scores. Nasopharyngoscopic examination revealed velopharyngeal motility in 24 patients (80%) in group 1 and in 20 (83.3%) and 23 (85.2%) patients in groups 2 and 3, respectively (P = 0.930). In velopharyngeal closure, there were only 5 patients (18.5%) in group 3, whereas there were 6 patients (25.0%) for group 2 and 10 patients (33.3%) for group 1 with no closure (P = 0.311). Although most optimum results were observed in the group with extended dissection of the vomer flap, contribution of the extended vomer flap to the repair of the soft palate did not lead to significantly better speech results.

Nasality evaluation of Turkish phonemes in vowel-consonant combinations.

OBJECTIVES: The purpose of this study is to find average nasalance values of Turkish syllables with the nasometer. METHODS: This study is done at Hacettepe University Department of Otolaryngology Audiology and Speech Pathology Unit with 50 participating children. RESULTS: The normative nasalance values of Turkish phonemes are determined. It is found that nasalance scores of syllables that is combined with/i/phoneme is statistically have higher nasalance scores than/a/and/e/phonemes (p<0.05). There is no difference find statistically between age and nasalance value (p>0.05). Statistical difference between age and nasalance score is found in "iki, se, ese, isi, aç, eç, çi, içi, iç, al, yi, iy, iyi, yiy, ana, ne" syllables (p<0.05). These phonemes have positive relation with the age. There is no statistical difference between sex and nasalance scores (p<0.05). Statistical difference is only found in "tat- te- li- lil- aya" syllables (p<0.05). On these phonemes it is found that girls have higher nasalance score than boys. CONCLUSION: As a result, it is thought that gathered nasalance values of Turkish phonemes will be useful for resonance disorder diagnosis and follow ups on treatment.