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Velopharyngeal area and nasal air emission in the conditions with and without a palatal prosthesis

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Author(s):
Cristianne Chiquto Netto
Total Authors: 1
Document type: Master's Dissertation
Press: Bauru.
Institution: Universidade de São Paulo (USP). Faculdade de Odontologia de Bauru (FOB/SDB)
Defense date:
Examining board members:
Maria Ines Pegoraro Krook; Ana Paula Fukushiro; Viviane Cristina de Castro Marino
Advisor: Maria Ines Pegoraro Krook
Abstract

Introduction: Although perceptual judgement is recognized to be the gold standard for clinical speech evaluation of cleft palate and/or velopharyngeal dysfunction (VPD) patients, it can be influenced by a number of factors due to its subjectivity. Instrumental assessment such as pressure-flow technique can provide additional information related to speech and velopharyngeal dysfunction findings in individuals adapted to palatal speech device with obturator pharyngeal bulb for treatment of VPD Objectives: Describe and compare the results of velopharyngeal area measurements by using pressure-flow technique and the judgment of the occurrence of air nasal emission (NAE) during repetition of words containing the p consonant and utterance of the word papai in the Test of Nasal Air Emission (TNAE), in conditions with and without palatal speech device as well as to analyze the relation between NAE and velopharyngeal dysfunction ratings in conditions with and without palatal speech device.Method: A retrospective study of samples including 94 patients with diagnosis of velopharyngeal insufficiency wearing palatal prostheses with pharyngeal bulb was performed. Velopharyngeal function was rated (adequate, marginal-adequate, marginal-inadequate and inadequate) in according to velopharyngeal measurements obtained from aerodynamic evaluation during the production of p consonant in the segment pa. The results of NAE occurrence judgement (present/absent) during the repetition of words with p and utterance of papai in the TNAE were collected from the patients´s recordings, in the conditions with and without prosthesis. Results: Velopharyngeal area measurements and NAE occurrence judgement were significantly lower in the with-prosthesis condition. However, speech prosthesis was able to eliminate NAE in 63.9% of the patients, when considering utterances of words with p in articulatory evaluation as comparison, and managed to eliminate it by 50% of them with regard to the word papai in the TEAN. With the speech device, 56.4% of patients demonstrated adequate velopharyngeal function and 43.6% showed velopharyngeal ratings different of the adequate one (marginal adequate = 5.3%, marginal inadequate = 5.3% and inadequate = 33%).Conclusions: The measures of velopharyngeal area obtained byusing pressure-flow technique decreased significantly when the patient uses prosthesis (condition with prosthesis), revealing that the prosthetic device can improve velopharyngeal function for the speech. Although the occurrence of nasal air flow (EAN) in the production of the consonant p presents to be lower with prosthesis, either in the hearing judgement as in the visual one, the latter seems to be more sensible to identify the occurrence of flow. Nasal air flow (EAN) demonstrated to have a direct relation with the velopharyngeal function for it was absent in an adequate velopharyngeal function (condition with prosthesis) and present in an inadequate velopharyngeal function (condition without prosthesis). Nevertheless, this relation may be susceptible to the interference of many factors that may positively or negatively influence the occurrence of EAN in the velopharyngeal function. (AU)

FAPESP's process: 13/13424-3 - Velopharyngeal area with and without palatal prosthesis assessed by flow-pressure technique
Grantee:Cristianne Chiquito Netto
Support Opportunities: Scholarships in Brazil - Master