• 대한구순구개열학회지
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• 제8권1호
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• pp.45-52
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• 2005

Velopharyngeal Insufficiency(VPI); the failure of velum, the lateral wall and the posterior pharyngeal wall to separate the nasal cavity from pharyngeal cavity during speech, can be caused by congenital conditions include cleft palate, submucous cleft palate and congenital palatal insufficiency. Speech problems of VPI are characterized by hypernasality, nasal air emission, increased nasal air flow and decreased intelligibility. These speech problems of VPI can be treated with the surgical procedure, the application of temporary prosthesis and speech therapy. Biofeedback technique with Nasometer is a speech treatment method of VPI that commonly used as one component of a comprehensive procedure for improvement of speech in patients with VPI. In this article describes a case of VPI treated by biofeedback technique with Nasometer; which showed satisfactory result in nasalance and formant analysis after the speech therapy during 9 months.

• 대한후두음성언어의학회지
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• 제16권2호
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• pp.118-122
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• 2005

Background and Objectives The compensatory articulation not only influences general speech intelligibility, but also prevents precise assessment of the velopharyngeal function. This study was performed to investigate frequently affected phonemes, prevalence and the characteristics of compensatory articulation in the patients with cleft palate having velopharyngeal insufficiency. Material and Method An archival review was taken on 103 cleft palate subjects. Their age ranged from 2.6 to 63 years (mean age of 9.8 years). They were grouped into two : preschool group (n=71) and older patient group (n=32). The prevalence and patterns of compensatory articulation were examined on oral high pressure consonants such as plosives, fricatives and affricates. Results : Compensatory errors were observed in $49.5\%$ of the subjects and were mostly glottal stops with the exception of 4cases who had pharyngeal fricatives in addition to glottal stops. The most frequently substituted phonemes were velar plosives and tense sound. There was no significant difference of prevalence in both groups. However, errors for bilabial and alveolar plosives were more frequently observed in preschool group. Conclusion High prevalence of compensatory articulation observed in both preschool and older age group indicates that their articulation errors tend to remain unless appropriate speech therapy is provided. To improve speech intelligibility of the patients with cleft palate having velopharyngeal insufficiency, it is advisable to address and correct the compensatory articulation errors in their earlier ages.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.175-177
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• 2010

Ppupose: Velopharyngeal insufficiency (VPI) during articulation development period can cause compensatory articulation like glottal stop, which can maintain VPI symptoms such as hypernasality and nasal emission despite of recovered velopharyngeal function. Methods: A girl visited our department with speech problems such as hypernasality, compensatory articulation patterns, and nasal air emission. She had history of postpalatoplasty fistula which was repaired after 1 year follow-up. Results: After treated with speech therapy without surgery, her hypernasal speech problem was corrected. From this, we could assume that the fistula during articulation development period induced VPI, which leads to glottal substitution and this compensatory articulation maintained VPI though the fistula was repaired. Conclusion: In this report, we could observe that palatal fistula in articulation development period can have detrimental effect on articulation, and also we could confirm that evaluation of soft palate mechanism with using speech sample without compensatory articulations prevent the patient from unnecessary operation.

• 대한후두음성언어의학회지
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• 제8권2호
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• pp.210-216
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• 1997

Many tools have been used to evaluate the voice abnormalities of velopharyngeal insufficiency(VPI). The aim of study was to obtain the objective evaluation method of VPI by comparing the acoustic and nasalance data of experimentally induced VPI group and those of normal control group. Ten healthy young men were included in this study Mild and severe VPI were experimentally induced by retracting velopharyngeal movement. Using the nasometer, we obtained the nasalance score of the sustained oral vowels and those of three types of nasometer passages and the slope scores of nasogram of nasal words. And we analysed the change of formant frequencies for the sustained oral vowels and the changes of various parameters of hyper-tnasality by the computerized speech analysis system. The nasalance score of sustained /a/ was increased significantly in VPI conditions. There was no changes in the slope score of nasogram. On the acoustic speech analysis, the second formant frequencies of vowel /e/ and /i/ were decreased significantly in VPI conditions. This results suggested that the measurement of nasalance score and formant frequency might be useful in the evaluation of VPI.

• 대한음성언어의학회:학술대회논문집
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• 대한음성언어의학회 1996년도 제6회 학술대회 심포지움
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• pp.96-96
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• 1996

구개인두부전증(velopharyngeal insufficiency, VPI)에 의한 발음이상을 평가하는 방법에는 여러 가지 방법이 개발되어 왔으나 비강측정기(nasometry)에 의한 비성수치(naslance score)의 측정과 spectrography에 의한 음향분석이 최근 널리 사용되고 있다. 본 연구에서는 실험적으로 유발한 VPI군의 음향학적 결과와 비강측정기의 결과를 정상군과 비교함으로써 VPI환자의 보다 정확하고 객관적인 평가의 방법과 지표를 얻고자 하였다. (중략)

• 음성과학
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• 제3권
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• pp.57-69
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• 1998

Velopharyngeal function refers to the combined activity of the soft palate and pharynx in closing and opening the velopharyngeal port to the required degree. In normal speech, during the production of oral consonant sounds elevation of the soft palate, along with the superior constrictor muscle, occludes the oropharynx from the nasopharynx. Inadequate velopharyngeal function caused by congenital or acquired insufficiency or incompetency may result in abnormal speech characterized by hypernasality, nasal emission and decreased intelligibility of speech due to weak consonant production. The speech aid is often helpful in improving the speech of individuals with velopharyngeal incompetency. In this article, the pathogenesis and treatment of velopharyngeal incompetence are discussed and a speech aid appliance that was constructed for the patient is described.

• 대한두개안면성형외과학회지
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• 제11권2호
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• pp.73-76
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• 2010

Purpose: There are several surgical methods for correcting a velopharyngeal insufficiency (VPI) but in some cases, it is not possible to achieve complete recovery of the velopharyngeal function. This paper introduces a new therapy for treating hypernasality without further surgery using continuous positive airway pressure (CPAP). Methods: CPAP therapy was applied to seven VPI patients for eight weeks from April of 2007 to September of 2009. All patients underwent palatoplasty for the cleft palate and six patients underwent palatal lengthening for VPI before CPAP therapy. A speech pathologist performed an auditory perceptual evaluation to evaluate the improvement in hypernasality after 8-week CPAP therapy. Results: Six patients showed an improvement in hypernasality after CPAP therapy according to the auditory perceptual evaluation. One patient with severe hypernasality responded to the early part of therapy but the hypernasality did not improve after therapy. Conclusion: CPAP therapy might be effective in reducing the hypernasality in patients with VPI by providing resistance training to strengthen the velopharyngeal closure muscles. In particular, CPAP therapy could be more effective for patients who show mild to moderate hypernasality after surgery.

• Archives of Plastic Surgery
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• 제40권2호
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• pp.97-103
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• 2013

Background Velopharyngeal insufficiency (VPI) may persist after primary repair of the cleft palate, and surgical correction is necessary in many cases. The purpose of this study is to evaluate the effect of double opposing Z-plasty (DOZ) in cleft palate patients suffering from VPI after primary two-flap palatoplasty. Methods Between March 1999 and August 2005, we identified 82 patients who underwent two-flap palatoplasty for cleft palate repair. After excluding the patients with congenital syndrome and mental retardation, 13 patients were included in the final study group. The average age of the patients who underwent DOZ at was 5 years and 1 month. Resonance, nasal emission, and articulation were evaluated by a speech pathologist. The velopharyngeal gaps were measured before and after surgery. Results Six patients attained normal speech capabilities after DOZ. The hypernasality grade was significantly improved after surgery in all of the patients (P=0.0015). Whereas nasal emission disappeared in 8 patients (61.5%), it was diminished but still persisted in the remaining 5 patients. Articulation was improved in all of the cases. In two cases, the velopharyngeal gap was measured using a ruler. The gap decreased from 11.5 to 7 mm in one case, and from 12.5 to 8 mm in the second case. Conclusions The use of DOZ as a surgical option to correct VPI has many advantages compared with other procedures. These include short surgery time, few troublesome complications, and no harmful effects on the dynamic physiological functioning of the pharynx. This study shows that DOZ can be another option for surgical treatment of patients with VPI after two-flap palatoplasty.

• 대한구순구개열학회지
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• 제15권2호
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• pp.97-108
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• 2012

Velopharyngeal insufficiency (VPI) is improper closure of velopharynx during the phonation and swallowing due to various causes, especially appeared in cleft palate patients. The several surgical techniques and speech therapy can be considered in treatment of VPI. The surgical techniques such as Furlow's double opposing Z-plasty, pharyngeal flap, push-back palatoplasty, etc. have been widely used when the speech therapy is not so much effective. However, there is considerable variability in the methods for evaluation and in success criteria making difficult to compare among surgical techniques. This article reviewed the recent articles about comparing the surgical techniques in treatment of VPI. Although there is no significant difference in speech assessment by speech pathologist, Furlow's double opposing Z-plasty is a useful technique especially diminishing hypernasality and nasal emission.

• 대한후두음성언어의학회지
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• 제33권3호
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• pp.188-192
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• 2022

Velopharyngeal insufficiency (VPI) is a phenomenon that can occur due to anatomical or neurological causes of the soft palate. VPI can make the patient difficult to articulate through hypernasality and nasal emission. There has been needed the customized treatment, as VPI can occur for many causes. We present the case of 21-year-old male who took palate plastic surgery 20 years ago for congenital submucosal cleft palate. As he had poor contraction of both lateral side of velopharynx, he was diagnosed with coronal type VPI. Through sphincter pharyngoplasty, he can obtain improvement of articulation accuracy. We would like to share this challenged case.