Correlation of Vocal Intensity with Velopharyngeal Closing Mechanism in Individuals with and without Complaint of Velopharyngeal Dysfunction

Karina Girelli; Sady Selaimen de Costa; Marcus Vinícius Martins Collares; Silvia Dornelles

doi:10.1055/s-0035-1567809

International Archives of Otorhinolaryngology, Table of Contents

Int Arch Otorhinolaryngol 2016; 20(01): 018-024
DOI: 10.1055/s-0035-1567809

Original Research

Thieme Publicações Ltda Rio de Janeiro, Brazil

Correlation of Vocal Intensity with Velopharyngeal Closing Mechanism in Individuals with and without Complaint of Velopharyngeal Dysfunction

Authors

Karina Girelli

¹Master's Degree in Health of Children and Adolescents, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
Sady Selaimen de Costa

²Department of Ophthalmology and Otorhinolaryngology, Universidade Federal do Rio Grade do Sul, Porto Alegre, RS, Brazil
Marcus Vinícius Martins Collares

³Department of Surgery, Universidade Federal do Rio Grade do Sul, Porto Alegre, Rio Grande do Sul, Brazil
Silvia Dornelles

⁴Department of Health and Human Communication, Universidade Federal do Rio Grade do Sul, Porto Alegre, Rio Grande do Sul, Brazil

Abstract

Introduction Velopharyngeal sphincter is a portion of the muscle of the palatopharyngeal arch that is capable of separating the oral cavity from the nasal cavity. It has not been determined yet whether voice intensity has an influence on this capacity. Velopharyngeal sphincter closure is accomplished by elevating and retracting the soft palate at the same time as the nasopharyngeal walls are constricted.

Objective This study aims to correlate voice intensity with velopharyngeal sphincter closure in individuals without velopharyngeal dysfunction and patients with cleft lip and palate.

Methods We conducted a cross-sectional, comparative, and contemporary study. The sample consisted of 16 individuals in the control group and 16 individuals in the study group. Patients underwent instrumental assessment, which we subsequently analyzed using a computer program, and a brief medical history review. The mean age of the control group was 27.6 years, whereas the mean age of the case group was 15.6 years.

Results Cases showed higher voice intensity in regular and weak fricative sentences when compared with controls. There was no agreement on the analysis of the instrumental assessment between the assessors and the computer program. Regardless of voice intensity, the computer program demonstrated a similar closure pattern.

Conclusion The computer program showed similar closure pattern for the three levels of intensity. There was no agreement between the three assessors and the closure pattern determined by the computer program. There was no statistically significant correlation between voice intensity and degree of velopharyngeal sphincter closure.

Keywords

velopharyngeal sphincter - voice - cleft lip - cleft palate - physiology

Full Text

References

References
1 Altmann EBC. Anatomia e fisiologia do esfíncter velofaríngeo. In: Altmann EBC. Fissuras labiopalatinas. 4 ed. Carapicuíba: Pró-Fono; 1997: 133-156
2 Camargo LOS, Rodrigues CM, Avelar JA. Oclusão velofaríngea em indivíduos submetidos à nasoendoscopia na Clínica de Educação para Saúde (CEPS). Salusvita. 2001; 20 (1) 35-47
3 Souza MCQ. . Características espectrais da nasalidade [Dissertation]. São Paulo: Universidade de São Paulo; 2003
4 Carrara -de Angelis E. Voz nos distúrbios neurológicos. In: Ferreira LP, Befi-Lopes DM, Limongi SCO. Tratado de Fonoaudiologia. São Paulo: Roca; 2005: 75-90
5 Kummer AW. Speech evaluation for patients with cleft palate. Clin Plast Surg 2014; 41 (2) 241-251
6 Zemlin WR. Princípios de Anatomia e Fisiologia em Fonoaudiologia. São Paulo: Artmed; 2002
7 Cheng N, Zhao M, Qi K, Deng H, Fang Z, Song R. A modified procedure for velopharyngeal sphincteroplasty in primary cleft palate repair and secondary velopharyngeal incompetence treatment and its preliminary results. J Plast Reconstr Aesthet Surg 2006; 59 (8) 817-825
8 Silva DP, Dornelles S, Paniagua LM, Da Costa SS, Collares MVM. Aspectos patofisiológicos do esfíncter velofaríngeo nas fissuras palatinas. Int Arch Otorhinolaryngol. 2008; 12 (3) 426-435
9 Trindade IEK, Trindade Junior AS. Avaliação funcional da inadequação velofaríngea. In: Carreirrão S, Lessa S, Zanini AS. Tratamento das fissuras labiopalatinas. 2 ed. Rio de Janeiro: Revinter; 1996
10 Brunner MB, Stellzig-Eisenhauer A, Pröschel U, Verres R, Komposh G. The effect of nasopharngoscopic biofeedback in patients with cleft palate and velopharyngeal dysphunction. Clef Palate – Craniofacial J. 2005: 649-657
11 Araujo Netto BC, Cervantes O. Estudo comparativo entre pacientes fissurados portadores de insuficiência velofaríngea tratados com fonoterapia e faringoplastia. . Rev Bras Cir Plast. 2011; 26 (4) 631-638
12 Palandi BBN, Guedes ZCF. Aspectos of speech of subjects with cleft palate corrected in different ages. Rev CEFAC 2011; 13 (1) 8-16
13 Henningsson G, Kuehn DP, Sell D, Sweeney T, Trost-Cardamone JE, Whitehill TL ; Speech Parameters Group. Universal parameters for reporting speech outcomes in individuals with cleft palate. Cleft Palate Craniofac J 2008; 45 (1) 1-17
14 Trost-Cardamone JE. Coming to terms with VPI: a response to Loney and Bloem. Cleft Palate J 1989; 26 (1) 68-70
15 Trindade IEK, Yamashita RP, Gonçalves CGA. Diagnóstico Instrumental da disfunção velofaríngea. In: Trindade IEK, Silva Filho OG. Fissuras labiopalatinas: uma abordagem interdisciplinar. São Paulo: Editora Santos; 2007: 123-143
16 Pegoraro-Krook MI, Dutka-Souza JCR, Magalhães LCT, Feniman MR. Intervenção fonoaudiológica na fissura palatina. In: Ferreira LP, Befi-Lopes DM, Limongi SCO. Tratado de fonoaudiologia. 2ed. São Paulo: Roca; 2010: 439-455
17 Mituuti CT, Piazentin-Penna SHA, Brandão GR, Bento-Gonçalves CGA. Characterization of the speech of individuals submitted to primary palatoplasty. Rev Soc Bras Fonoaudiol. 2010; 15 (3) 355-361
18 Cassell MD, Elkadi H. Anatomy and Physiology of the palate and Velopharyngeal structures. In: Shprintzen RJ, Bardach J. Cleft Palate Speech Management: A Multidisciplinary Approach. St Louis: Mosby; 1995: 45-58
19 Tabith Junior A. Lesões congênitas de lábio e palato – fissuras labiopalatinas. . In: Tabith Junior A. Foniatria: disfonias, fissuras labiopalatais e paralisia cerebal. 6ª ed. São Paulo: Cortez; 1997
20 Bunton K, Hoit JD, Gallagher K. A simple technique for determining velopharyngeal status during speech production. Semin Speech Lang 2011; 32 (1) 69-80
21 Monlleó IL, Fontes MIB, Ribeiro EM, De Souza J, Leal GF, Félix TM, Fett-Conte AC, Bueno BH, Magna LA, Mossey PA, Gil-da Silva-Lopes V. Implementing the Brazilian Database on Orofacial Clefts. Plastic Surgery International 2013; 2013: 1-10
22 Souza J, Raskin S. Clinical and epidemiological study of orofacial clefts. J Pediatr (Rio J) 2013; 89 (2) 137-144
23 Martelli DR, Machado RA, Swerts MSO, Rodrigues LAMR, Aquino SN, Martelli Júnior H. Non syndromic cleft lip and palate: relationship between sex and clinical extension. Braz J Otorhinolaryngol 2012; 78 (5) 116-120
24 Nóbrega ESS. Fissuras Palatais. In: Mélega JM. Cirurgia Plástica – Fundamentos e Arte– Cirurgia reparadora da cabeça e pescoço. Rio de Janeiro Medsi 2002; 110-125
25 Mourão D, Souza GS, Torres LV, Vaz RN, Prado SG. Estudo sobre desenvolvimento fonológico em fissurados: implicações na fala e na linguagem. Estudos 2006; 33 (5/6) 425-441
26 Penido FA, Noronha RM, Caetano KI, Jesus MS, Di Ninno CQ, Britto AT. Correlação entre os achados do teste de emissão de ar nasal e da nasofaringoscopia em pacientes com fissura labiopalatina operada. Rev Soc Bras Fonoaudiol 2007; 12 (2) 126-134
27 Hoit JD, Watson PJ, Hixon KE, McMahon P, Johnson CL. Age and velopharyngeal function during speech production. J Speech Hear Res 1994; 37 (2) 295-302
28 Zajac DJ. Velopharyngeal function in young and older adult speakers: evidence from aerodynamic studies. J Acoust Soc Am 1997; 102 (3) 1846-1852
29 Eckelmann D, Baldridge P. Speech training for a child with cleft palate. J Speech Disord 1945; 10: 137-149
30 Trost JE. Articulatory additions to the classical description of the speech of persons with cleft palate. Cleft Palate J 1981; 18 (3) 193-203
31 Koishi HU, Tsuji DH, Imamura R, Sennes LU. Variação da intensidade vocal: estudo da vibração das pregas vocais em seres humanos com videoquimografia. Rev Bras Otorrinolaringol (Engl Ed) 2003; 69 (4) 464-470
32 Bradford LJ, Brooks AR, Shelton Jr RL. Clinical judgments of hypernasality in cleft palate children. Cleft Palate J 1964; 35: 329-335
33 Mayo R, Dalston RM, Warren DW. Perceptual assessment of resonance distortion in unoperated clefts of the secondary palate. Cleft Palate Craniofac J 1993; 30 (4) 397-400
34 Warren DW, Dalston RM, Mayo R. Hypernasality and velopharyngeal impairment. Cleft Palate Craniofac J 1994; 31 (4) 257-262
35 Watterson T, Emanuel F. Observed effects of velopharyngeal orifice size on vowel identification and vowel nasality. Cleft Palate J 1981; 18 (4) 271-278
36 Young LH, Zajac DJ, Mayo R, Hooper CR. Effects of vowel height and vocal intensity on anticipatory nasal airflow in individuals with normal speech. J Speech Lang Hear Res 2001; 44 (1) 52-60
37 Yamashita RP, Oliva TRT, Fukushiro AP, Brustello CMB, Trindade IEK. Efeito da velopastia intravelar sobre o fechamento velofaríngeo avaliado por meio da técnica fluxo-pressão. Rev Soc Bras Fonoaudiol. 2010; 15 (3) 362-368
38 Skolnick ML, McCALL GN, Barnes M. The sphincteric mechanism of velopharyngeal closure. Cleft Palate J 1973; 10: 286-305
39 Shprintzen RJ. An invited commentary on the preceding article by Ibuki, Karnell and Morris. Cleft Palate J 1983; 20: 105-107
40 Pigott RW, Makepeace AP. Some characteristics of endoscopic and radiological systems used in elaboration of the diagnosis of velopharyngeal incompetence. Br J Plast Surg 1982; 35 (1) 19-32
41 Croft CB, Shprintzen RJ, Rakoff SJ. Patterns of velopharyngeal valving in normal and cleft palate subjects: a multi-view videofluoroscopic and nasendoscopic study. Laryngoscope 1981; 91 (2) 265-271
42 Havstam C, Lohmander A, Persson C, Dotevall H, Lith A, Lilja J. Evaluation of VPI-assessment with videofluoroscopy and nasoendoscopy. Br J Plast Surg 2005; 58 (7) 922-931