Abstract
Statement of problem
Prosthetic intervention with a speech aid prosthesis (SAP) along with speech therapy
has been reported to improve speech outcomes in patients with persisting velopharyngeal
insufficiency (VPI). However, little is known regarding the impact of this treatment
on different speech parameters over time in adult patients with VPI.
Purpose
The purpose of this retrospective study was to evaluate the change in speech parameters
after rehabilitation with an SAP and speech therapy in adult patients with VPI using
subjective and objective tests.
Material and methods
Patients above 16 years of age who had received prosthetic treatment for VPI and had
complete speech assessment records between 2017 and 2020 were included in the analysis.
After completion of the prosthetic treatment, speech therapy comprising 2 sessions
per week of 45 minutes was provided by a speech pathologist. Speech evaluation was
performed using tests that included speech intelligibility calculation, nasal pinch
test, audible nasal air emissions, acoustic analysis, and the nasalance check. Assessments
were done at 4 time intervals: T0: without an SAP; T1: 1 week with an SAP; T2: 1 month
with an SAP; and T3: 3 months with an SAP. A descriptive analysis was followed by
a comparison between groups using the Friedman test for subjective assessments and
repeated measures ANOVA for objective tests (α=.05).
Results
Of 10 individuals who had received an SAP, 5 participants, 2 men and 3 women with
a mean age of 38 years were included in the analysis. Statistically significant improvement
in mean scores was observed from T0 to T3 concerning speech intelligibility (P<.001), hypernasality (P<.001), audible nasal air emission (P<.001), mean fundamental frequency (P=.034), shimmer percentage (P=.004), and nasalance (P=.004). Improvement in jitter percentage was not statistically significant (P=.218).
Conclusions
An SAP along with speech therapy should be considered as a conservative and effective
treatment option for addressing speech issues in adult patients with VPI.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Prosthetic DentistryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Anatomy and physiology of velopharyngeal closure and insufficiency.Adv Otorhinolaryngol. 2015; 76: 1-6
- Intensive speech therapy programme combined with a speech bulb prosthesis in the prosthodontic rehabilitation of velopharyngeal dysfunction.Cureus. 2020; 12: 6951
- Velopharyngeal insufficiency in patients without a cleft palate: important considerations for the ENT surgeon.J Laryngol Otol. 2020; 134: 252-255
- What’s new in cleft palate and velopharyngeal dysfunction management?.Plast Reconstr Surg. 2017; 139: 1343-1355
- Diagnosis and management of velopharyngeal dysfunction.Oral Maxillofac Surg Clin North Am. 2016; 28: 181-188
- Treatment of velopharyngeal dysfunction: a clinical report.J Prosthet Dent. 2020; 123: 888-891
- Association of velopharyngeal insufficiency with quality of life and patient-reported outcomes after speech surgery.JAMA Facial Plast Surg. 2017; 19: 406-412
- Quality of life in children with velopharyngeal insufficiency.Arch Otolaryngol Head Neck Surg. 2007; 133: 224-229
- Communication disorders in individuals with cleft lip and palate: an overview.Indian J Plast Surg. 2009; 42: 137-143
- The effect of age at surgery and compensatory articulation on speech outcome in submucous cleft palate patients treated with double-opposing Z-plasty: a 10-year experience.J Plast Reconstr Aesthet Surg. 2017; 70: 646-652
- Treatment of velopharyngeal insufficiency in a patient with a submucous cleft palate using a speech aid: the more treatment options, the better the treatment results.Maxillofac Plast Reconstr Surg. 2019; 41: 1-6
- Nasalance and nasality at experimental velopharyngeal openings in palatal prosthesis: a case study.J Appl Oral Sci. 2011; 19: 616-622
- The outcome of long-term follow-up after palatoplasty.Plast Reconstr Surg. 2000; 105: 12-17
- A clinical study of palatal lift for treatment of velopharyngeal incompetency.J Korean Assoc Oral Maxillofac Surg. 2001; 27: 92-96
- The effect of timing of surgery for velopharyngeal dysfunction on speech.J Craniofac Surg. 2004; 15: 804-809
- Prosthetic rehabilitation of velopharyngeal insufficiency: pharyngeal obturator prostheses with different retention mechanisms.Eur J Dent. 2010; 4: 81-87
- Speech intelligibility of patients with cleft lip and palate after placement of speech prosthesis.Cleft Palate Craniofac J. 2007; 44: 635-641
- Laryngeal airway resistance in children with cleft palate and adequate velopharyngeal function.Cleft Palate Craniofac J. 1995; 32: 138-144
- Prosthetic rehabilitation of a congenital soft palate defect.J Indian Prosthodont Soc. 2014; 14: 181-186
- Alleviating speech and deglutition: role of a prosthodontist in multidisciplinary management of velopharyngeal insufficiency.J Indian Prosthodont Soc. 2015; 15: 281
- Successful and rapid response of speech bulb reduction program combined with speech therapy in velopharyngeal dysfunction: a case report.Maxillofac Plast Reconstr Surg. 2015; 37: 1-4
- Speech-aid prosthesis in velopharyngeal incompetency patient with cleft palate: can speech aids be applicable for adult patient?.Maxillofac Plast Reconstr Surg. 2021; 43: 1-7
- The use of a temporary oral prosthesis to treat speech in velopharyngeal incompetence.Facial Plast Surg. 1993; 9: 206-212
- Effect of a palatal lift prosthesis in individuals with velopharyngeal incompetence.Int J Prosthodont. 2009; 22: 579-585
- Speech intelligibility and communication-related quality of life in tracheoesophageal speakers.Int J phonosurg laryngol. 2020; 10: 33-39
- Preliminary study of acoustic analysis for evaluating speech-aid oral prostheses: characteristic dips in octave spectrum for comparison of nasality.J Formos Med Assoc. 2015; 114: 950-958
- Changes in the quality of life and acoustic speech parameters of patients in various stages of prosthetic rehabilitation with an obturator after maxillectomy.J Prosthet Dent. 2020; 123: 355-363
- Acoustic analysis of voice in children with cleft palate and velopharyngeal insufficiency.Int J Pediatr Otorhinolaryngol. 2015; 79: 1073-1076
- Acoustic analysis of voice in children with cleft lip and palate following vocal rehabilitation: preliminary report.Int J Pediatr Otorhinolaryngol. 2019; 126: 109618
- Vocal acoustic analysis–jitter, shimmer and hnr parameters.Proc Technol. 2013; 9: 1112-1122
- Nasalance scores as a function of skeletal malocclusion of english-speaking adults in the north indian population.Folia Phoniatr Logop. 2022; 74: 78-88
- Objective assessment of hypernasality in patients with cleft lip and palate with the nasalview system: a clinical validation study.Int J Otolaryngol. 2012; 2012: 321319
- Velopharyngeal function and cleft palate prosthesis.J Prosthet Dent. 1959; 9: 149-158
- Efficacy of speech aid prostheses for acquired defects of the soft palate and velopharyngeal inadequacy—clinical assessments and cephalometric analysis: a memorial sloan-kettering study.Head Neck. 2005; 27: 195-207
- A comparative of perceptual and objective measures of speech intelligibility in children with hearing impairment.Int J Sci Eng Dev Res. 2020; 5: 71-75
- An appliance based approach to the management of palatopharyngeal incompetency: a clinical pilot project.J Prosthet Dent. 1993; 69: 186-195
Article info
Publication history
Published online: January 05, 2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 by the Editorial Council for the Journal of Prosthetic Dentistry.
