The Effect of Loudness Variation on Velopharyngeal Function in Children with 22q11.2 Deletion Syndrome: A Pilot Study

Abstract

Objective: Children with 22q11.2 deletion syndrome (22qDS) often require surgical intervention to treat velopharyngeal dysfunction (VPD). Although some studies have documented improved velopharyngeal (VP) closure under increased speaking effort, currently no studies have examined the effect of similar behavioral speech modifications on VP closure in children with 22qDS. The purpose of this pilot study was to explore the effect of loudness on VP closure during speech in children with 22qDS and persisting VPD. Patients and Methods: Four children with 22qDS, posterior pharyngeal flap, and persisting mild VPD underwent pressure-flow testing while repeating words at habitual and increased loudness levels. Using a single-subject A-B design, descriptive statistics and graphical measures were used to examine differences in VP orifice area (VPA) and timing of closure in the habitual versus loud condition. Results: Results were mixed. Median VPA decreased during some stimuli for 3 participants, but increased for 1 subject when speaking louder. Median duration of nasal airflow decreased for 3 participants in the loud condition. Conclusion: This study presents preliminary aerodynamic data regarding the plasticity of VP physiology in the 22qDS group. Further research is needed to determine how loudness impacts VP function in children with 22qDS.

Effects of Surgical Intervention and Continuous Positive Airway Pressure Therapy on Velopharyngeal Structure and Function: A Case Report

“…A poorer postsurgical resonance rating observed in this report is likely related to the large increase in velopharyngeal orifice area (+80 mm 2 ); however, studies have suggested that other factors such as temporal variability and loudness may affect perceptual ratings of hypernasality and velopharyngeal orifice area (Warren et al, 1985; Warren et al, 1993; Warren et al, 1994; Cummings et al, 2015). The relationship between perceived severity of hypernasality and velopharyngeal gap size is nonlinear and studies have failed to demonstrate a strong correlation (Dalston and Seaver, 1990; Witt and D’Antonio, 1993; Baken and Orlikoff, 2000).…”

Aerodynamic Study of Velopharyngeal Insufficiency in 22q11.2 Deletion Syndrome

“…In this regard, it must be emphasized that more nuanced structural anomalies underlie occult submucous clefts compared to classic “open” submucosal forms with Calnan triad (uvula bifida, soft palate muscle diastasis, palpable notch in hard palate). Therefore, occult submucous cleft anomalies can be exclusively identifiable through intra-operative surgical dissection and, as such, can only be presumed (position and insertion anomalies of the levator palati and/or uvula muscle; minimal alterations to the palatal bone posterior border) in non-operated cases after conventional clinical and instrumental examination [ 6 , 16 , 17 , 18 ].…”

“…The speech sample was recorded using the Voice Analysis module of the Daisy 3.6 program [ 13 ] (Biomedica Amplifon, Ripamonti, 133, 20141, Milano, Italy). Three experienced speech pathologists assessed and perceptually graded rhinolalia, rhinophony and nasal air escape, and repeated the same assessment after 15 days, according to the classification by Massari [ 17 ]. Each expert listened to the speech sample recordings of the 31 recruited individuals in a randomized order, for as long as necessary, for the purpose of perceptual evaluation.…”

Nasalization Amplitude-Timing Characteristics of Speakers With and Without Cleft Palate

“…In contrast, the minimal effect of vocal loudness on nasalance was reported in children with cleft palate and varying degrees of hypernasality (Van Lierde et al, 2011). Despite the inconclusive acoustic findings, aerodynamic studies (McHenry, 1997; Cummings et al, 2015) suggest that increased loudness facilitates velopharyngeal closure overall in terms of reducing velopharyngeal orifice size in some patients with velopharyngeal dysfunction. Cummings et al (2015) further showed that increased vocal loudness decreased nasal airflow durations, suggesting that temporal gestures of velopharyngeal opening and closing may be altered by vocal loudness.…”

“…Despite the inconclusive acoustic findings, aerodynamic studies (McHenry, 1997; Cummings et al, 2015) suggest that increased loudness facilitates velopharyngeal closure overall in terms of reducing velopharyngeal orifice size in some patients with velopharyngeal dysfunction. Cummings et al (2015) further showed that increased vocal loudness decreased nasal airflow durations, suggesting that temporal gestures of velopharyngeal opening and closing may be altered by vocal loudness. It is reasonable to hypothesize that vocal loudness changes may also affect the temporal domain of acoustic nasalization, which still needs to be investigated.…”