Nasoendoscopy : Clinical Implications

Abstract

The purpose of this study is to discuss the clinical use of nasoendoscopy examination of the velopharyngeal closure in patients with nasal speech and to describe the clinical implications of this technique. Three difference patients with hypernasal speech, one with cleft palate, one with hearing loss and one mental retardation, were studied velopharyngeal incompetence through direct assessment of the velopharyngeal closure by nasoendoscopy. An Olympus Nasoendoscope model ENFP3 was used and the Siriraj Speech Stimuli Resonation Test (Manochiopinig & Chuangsuwanich 2001) was used as a standard speech sample. After an explanation and informed consent, 10% of xylocaine was sprayed into a nostril for tropical anaesthesia. The first author performed the nasoendoscopy, meanwhile the second author stimulate the speech sample and velopharyngeal function. The same procedure and condition was conducted to each subject in an operation room. Excursion of the soft palate and pharyngeal wall, completeness, asymmetrical, leakage, adequacy, patterns of closure were observed during speech production. Descriptive analysis was used. The results indicate that intelligible speech production depend on a normal velopharyngeal closure mechanism. Abnormal coupling of the oral and nasal cavities of these patients are characterized by hypernasality, nasal emission, imprecise speech production and decrease speech intensity. These typical signs of velopharyngeal insufficiency could be due to either structural defect (cleft palate), physiological dysfunction (hearing loss) or mental status (mental retardation). Nasoendoscopy provides a direct approach to visualize the velopharyngeal closure. This technique helps clinicians to distinguish between those patients with nasal speech who appear to have the physiological potential for satisfactory velopharyngeal closure from those who do not. This distinction is clinically important because of the marked difference in treatment. Furthermore, in patients considered for a pharyngeal flap operation, pre-operative evaluation of the closure is vital. In conclusion, hypernasal speech alone is not a sign of velopharyngeal insufficiency from structural defect. Thus, a diagnosis is suggested to be made by a cranio-maxillo-facial team after complete evaluation. In addition, nasoendoscopy has been valuable in distinguish different groups of patient as well as planning treatment.