Assessment of mouth breathing by Speech-Language Pathologists: an international Delphi consensus

Abstract

Purpose mouth breathing (MB) has detrimental effects on children’s growth. Diagnosis of MB is possible through a multidisciplinary approach including Speech-Language Pathologist’s (SLP) assessment; however, SLPs currently have little to no defined selection criteria to determine the awake and habitual breathing pattern. This study aims at identifying relevant criteria for the assessment of the habitual and awake breathing pattern of preschool children, and developing a grid that would help SLPs diagnose MB in their clinical practice. Methods A three-rounded online international Delphi process was conducted to achieve a consensus on the relevant items and their interpretation. Agreement was established through a Content Validity Ratio calculation. Based on the agreed items, we developed a grid through a scoring function. Results Observing the child at rest (i.e., time spent with an open/closed mouth and position of the tongue/lips) was considered the most important criterion. The experts also considered that observing the breathing pattern while chewing (open/closed mouth) and after swallowing (i.e., air intake and open/ closed mouth just after swallowing) should provide relevant but secondary information in decision-making. We were able to establish a clinical grid based on those criteria. Conclusion The Delphi procedure provided content-valid criteria and conditions of observation for the myofunctional SLP assessment of the awake and habitual breathing pattern in preschoolers. A clinical validation of the developed prototype grid should be conducted in preschool children to explore its effectiveness in the diagnosis of MB.

Towards a better diagnosis of mouth breathing: validity and reliability of a protocol for assessing the awake breathing pattern in preschool children

“…This classification method, which also takes into account the parental questionnaire, allowed us to classify breathing into two distinct patterns: NB versus MB. This goes against the international consensus established by the previous study ( 11 ) and supported by some authors ( 5 , 18 , 22 ) . This consensus was based on expert’s opinion and therefore remained subjective.…”

“…We designed a parental questionnaire based on items proved to be discriminating and relevant for the diagnosis of mouth breathing in four studies ( 14 , 19 - 21 ) . Items were selected if they met the conditions for a functional observation of the child’s habitual and awake breathing pattern as previously described ( 11 ) . We designed a five-point Likert scale ranging from 1 = “never” to 5 = “always” in order to be as comprehensive as possible for the classification of the habitual awake breathing pattern.…”

“…Two steps were needed before assessing psychometrics properties of the ABPA. First, we needed to test the hypothesis that awake breathing is best described by three groups (NB, OB and MB), as suggested by the consensus of experts who participated in developing the clinical grid ( 11 ) . Second, as the continuous variable of CO 2 percentage was selected as the reference measurement for the psychometric assessment of the ABPA, we needed to discretize it into categories in order to make it suitable for the categorical nature of the grid’s data.…”

“…Most of these tools are not reliable for the preschool population because the administration is complicated or impossible. Moreover, they all base the identification of MB on nasal airflow resistance/obstruction rather than on the habitual and preferred breathing pattern in everyday life ( 11 , 12 ) . While it is imperative to assess and remove the obstruction to rehabilitate nasal breathing, nasal resistance/obstruction is not associated with the breathing pattern ( 12 ) and MB does not always result from obstruction.…”

“…Most recently, a clinical grid for the Awake Breathing Pattern Assessment (ABPA) was created to address the lack of tools that Speech and Language Pathologists can use to categorize the awake and habitual breathing pattern in the myofunctional assessment ( 11 ) . Orofacial functions are definitely part of the SLP’s scope of practice ( 13 , 14 ) , but the categorization of the breathing pattern still too often relies on the clinical expertise in orofacial myology/myofunctional pathology and the experience with MB patients.…”