Int J Stomatol

Int J Stomatol ›› 2024, Vol. 51 ›› Issue (6): 722-727.doi: 10.7518/gjkq.2024068

• Original Articles • Previous Articles    

Efficacy of speech training in treating marginal velopharyngeal inadequacy: analysis of treatment outcomes and prognostic factors

Qirong Mao(),Heng Yin,Min Wu,Bing Shi,Qian Zheng,Jingtao Li()   

  1. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2023-12-27 Revised:2024-05-05 Online:2024-11-01 Published:2024-11-04
  • Contact: Jingtao Li E-mail:qirong.mao@outlook.com;lijingtao86@163.com
  • Supported by:
    Clinical Research Project of West China Hospital of Stomatology, Sichuan University(LCYJ-2022-YF-2)

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Abstract:

Objective The feasibility and prognostic factors of speech training for patients with marginal velopharyngeal inadequacy (MVPI) were explored. Methods Patients diagnosed with MVPI after primary palatoplasty and received speech training were recruited. Their speech condition before and after treatment was compared to assess the effectiveness of speech training. Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of the treatment outcomes for MVPI after speech training. Results Speech training significantly improved the hypernasality, articulation, and speech clarity of patients with MVPI but failed to ameliorate their nasal emission. Univariant and multivariant logistic regression analyses suggested age at treatment as a factor significantly correlated with the prognosis of speech training. The effective rate of speech training was significantly lower among patients above the age of 8 years (17.6%) than those aged below 8 years (58.3%). Conclusion Speech training is an effective treatment in impro-ving speech clarity in patients with MVPI. Age at treatment and nasal emission may be the prognostic factors of MVPI management.

Key words: velopharyngeal insufficiency, cleft palate, nasal emission, speech training

CLC Number: 

  • R782.2+2

TrendMD: 

Tab 1

Comparison in speech improvement between patients receiving speech training"

观察项目

训练前

（n=58）

训练后

（n=58）

P值
鼻腔共鸣情况<0.001
无高鼻音0/0.0030/51.72
轻度高鼻音48/82.7628/48.28
中度高鼻音10/17.240/0.00
重度高鼻音0/0.000/0.00
鼻漏气0.052
未闻及6/10.3418/31.03
可闻及52/89.6640/68.97
构音<0.001
正常0/0.0038/65.52
省略20/34.486/10.34
代偿22/37.9310/17.24
省略加代偿16/27.594/6.90
语音清晰度<0.001
清晰0/0.0020/34.48
轻度不清晰18/31.0328/48.28
中度不清晰40/68.9710/17.24
重度不清晰0/0.000/0.00

Tab 2

Univariable logistic regression analysis of potential prognostic factors to speech training of MVPI n"

观察项目

有效组

（n=20）

无效组

（n=38）

P值
性别0.493
男1022
女1016
腭裂类型0.567
不完全性腭裂1220
单侧完全性腭裂814
双侧完全性腭裂04
高鼻音0.403
无高鼻音00
轻度高鼻音1434
中度高鼻音64
重度高鼻音00
鼻漏气0.033
未闻及60
可闻及1438
构音0.429
正常00
省略416
代偿1012
省略加代偿610
语音清晰度0.573
清晰00
轻度不清晰810
中度不清晰1228
重度不清晰00
治疗时年龄（均数±标准差）6.29±7.2810.00±7.63<0.001

Tab 3

Multivariable logistic regression testing age at treatment and nasal emission status as prognostic factors to MVPI management"

观察项目B值P值OR（95% CI）
治疗时年龄-0.1450.0310.865（0.759~0.987）
鼻漏气-0.1730.4060.486（-0.579~0.233）

Fig 1

Determination of age cut-off value for speech therapy with receiver operating characteristic curve"

Tab 4

Rate of clear speech intelligibility among patients with MVPI receiving speech training at different age"

观察项目治疗时年龄P值
<8岁（n=24）≥8岁（n=34）
有效14/58.36/17.60.027
1 Ruda JM, Krakovitz P, Rose AS. A review of the evaluation and management of velopharyngeal insufficiency in children[J]. Otolaryngol Clin North Am, 2012, 45(3): 653-669.
2 Johns DF, Rohrich RJ, Awada M. Velopharyngeal incompetence: a guide for clinical evaluation[J]. Plast Reconstr Surg, 2003, 112(7): 1890-1898, 1982.
3 Lindeborg MM, Shakya P, Rai SM, et al. Optimi-zing speech outcomes for cleft palate[J]. Curr Opin Otolaryngol Head Neck Surg, 2020, 28(4): 206-211.
4 Harding A, Grunwell P. Active versus passive cleft-type speech characteristics[J]. Int J Lang Commun Disord, 1998, 33(3): 329-352.
5 Smith B, Guyette TW. Evaluation of cleft palate speech[J]. Clin Plast Surg, 2004, 31(2): 251-260.
6 Henningsson G, Kuehn DP, Sell D, et al. Universal parameters for reporting speech outcomes in indivi-duals with cleft palate[J]. Cleft Palate Craniofac J, 2008, 45(1): 1-17.
7 Hu HM, Xi X, Wong LLN, et al. Construction and evaluation of the Mandarin Chinese matrix (CMNmatrix) sentence test for the assessment of speech recognition in noise[J]. Int J Audiol, 2018, 57(11): 838-850.
8 马平川, 毛渤淳, 郭春丽, 等. 汉语普通话腭裂语音数据库的搭建与应用[J]. 华西口腔医学杂志, 2020, 38(2): 149-154.
Ma PC, Mao BC, Guo CL, et al. Establishment and application of mandarin cleft palate speech database[J]. West China J Stomatol, 2020, 38(2): 149-154.
9 Zhang B, Guo CL, Yin H, et al. The correlation between consonant articulation and velopharyngeal function in patients with unoperated submucous cleft palate[J]. J Craniofac Surg, 2020, 31(4): 1070-1073.
10 Zhang B, Yang C, Yin H, et al. Preoperative velopharyngeal closure ratio correlates with Furlow palatoplasty outcome among patients with nonsyndro-mic submucous cleft palate[J]. J Craniomaxillofac Surg, 2020, 48(10): 962-968.
11 Cheng X, Bo ZY, Yin H, et al. Age and preoperative velar closure ratio are significantly associated with surgical outcome of furlow double-opposing Z-plasty in palatal re-repair[J]. J Oral Maxillofac Surg, 2020, 78(3): 431-439.
12 尹恒, 郭春丽, 石冰, 等. 黏膜下腭裂的形态分类与腭咽功能分析[J]. 华西口腔医学杂志, 2016, 34(5): 488-492.
Yin H, Guo CL, Shi B, et al. Morphological classification and velopharyngeal function analysis of submucous cleft palate patients[J]. West China J Stomatol, 2016, 34(5): 488-492.
13 马思维, 任战平, 文抑西, 等. 65例腭裂术后MVPI患者构音特点及治疗策略探讨[J]. 实用口腔医学杂志, 2013, 29(6): 844-847.
Ma SW, Ren ZP, Wen YX, et al. Articulation of 65 patients with MVPI and the speech therapy approach after repair of cleft palate[J]. J Pract Stomatol, 2013, 29(6): 844-847.
14 毛奇蓉, 尹恒, 李精韬. 边缘性腭咽闭合不全临床诊疗研究进展[J]. 国际口腔医学杂志, 2024, 51(1): 116-123.
Mao QR, Yin H, Li JT. Progress in the management of marginal velopharyngeal incompetence[J]. Int J Stomatol, 2024, 51(1): 116-123.
15 Krause CJ, Tharp RF, Morris HL. A comparative study of results of the von Langenbeck and the V-Y pushback palatoplasties[J]. Cleft Palate J, 1976, 13: 11-19.
16 Neely BJ, Bradley DP. A rating scale for evaluation of video tape recorded X-ray studies[J]. Cleft Palate J, 1964, 16: 88-94.
17 Laine T, Warren DW, Dalston RM, et al. Screening of velopharyngeal closure based on nasal airflow rate measurements[J]. Cleft Palate J, 1988, 25(3): 220-225.
18 Warren DW, Dalston RM, Mayo R. Hypernasality and velopharyngeal impairment[J]. Cleft Palate Craniofac J, 1994, 31(4): 257-262.
19 Morris HL, Smith JK. A multiple approach for eva-luating velopharyngeal competency[J]. J Speech Hear Disord, 1962, 27: 218-226.
20 Smith BE, Guyette TW. Pressure-flow differences in performance during production of the CV syllables /pi/ and /pa/[J]. Cleft Palate Craniofac J, 1996, 33(1): 74-76.
21 Warren DW, Dalston RM, Mayo R. Hypernasality in the presence of “adequate” velopharyngeal closure[J]. Cleft Palate Craniofac J, 1993, 30(2): 150-154.
22 Jones DL, Morris HL, Van Demark DR. A comparison of oral-nasal balance patterns in speakers who are categorized as “almost but not quite” and “sometimes but not always”[J]. Cleft Palate Craniofac J, 2004, 41(5): 526-534.
23 Murthy J, Sendhilnathan S, Hussain SA. Speech outcome following late primary palate repair[J]. Cleft Palate Craniofac J, 2010, 47(2): 156-161.
24 Pamplona C, Ysunza A, Patiño C, et al. Speech summer camp for treating articulation disorders in cleft palate patients[J]. Int J Pediatr Otorhinolaryngol, 2005, 69(3): 351-359.
25 Derakhshandeh F, Nikmaram M, Hosseinabad HH, et al. Speech characteristics after articulation therapy in children with cleft palate and velopharyngeal dysfunction-a single case experimental design[J]. Int J Pediatr Otorhinolaryngol, 2016, 86: 104-113.
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