FInal Flashcards
Advantages of VP Endoscopy Relative to Fluoroscopy
Nasopharyngoscopy
- Can be performed repeatedly
- Can be performed by SLP
- Can be performed at speech clinic
- Less expensive
- Better clarity
- No radiation
- Less Expensive
Advantages of Fluroscopy
Nasopharyngoscopy
- View attachment of levator at velum
- When the soft palate elevates there is a point of maximum pull (knee of velum) and you do not get a good look at that with endoscopy so sometimes someone might combine fluroscopy and endoscopy
General Symptoms of VPD
- Hypernasality
- Nasal air emission
- Compensatory articulation errors
VPD Etiologies
Nasopharyngoscopy
- CLeft palate/submucous cleft (most common cause)
- Large pharynx/short velum
- some people just inherit a short velum that cannot reach across and complete closure
- neuromotor
- in general it is primarily things like CP or apraxia
- surgery
- post adenoidectomy, surger removal of parts of the soft palate due to disease (cancer)
- developmental
- functional
- functional aphonia (does not have a physcial basis)
- hearing impairment
- because they don’t get auditory feedback, they don’t use articulators as correctly as they should
Quality patient for procedure
Nasopharyngoscopy
- Hypernasality
- Nasal air emisison
- compensatory speech erros
- absence of functioonal O-N fistula
- unresponsive to speech therapy
- anticipating physical management
Quality patient for procedure
Nasopharyngoscopy
- Hypernasality
- Nasal air emisison
- compensatory speech erros
- absence of functioonal O-N fistula
- unresponsive to speech therapy
- anticipating physical management
What do you want to learn?
Nasopharyngosocopy
- Pattern of closure/attempted closure
- Type of patency (opening)
- Approximate degree of patency
- use some type of scale to describe the opening
- Approximate location of patency
Patterns of Closure
Nasopharyngoscopy
- Circular
- Sagital
- Coronal
- the line of closure is on the same plane as the coronal suture of the skull
- the soft palate is doing the majority of the work to achieve closure and is being pulled up and back by the levator muscle and the uvulus muscle - the lateral walls of the pharynx tuck in on either side and close whatever is still open
- as its closing it has a shape of a line
Posterior pharyngeal wall movement
- Usually doesn’t move but it may move forward or medial and it may happen with any of the 3 patterns of closure
- “Passavant’s Ridge”
- where the back wall of the pharynx moves forward during VP closure, but althought it moves it may not be participating
- occurs in “normal” people
Frequency of patterns of closure with VPD
Nasopharyngoscopy
- Coronal* = 60%
- Circular *= 35%
- Sagittal = 5%
most commonly seen *
Type of patency
nasopharyngscopy
I. Normal speech and resonance and normal VP function
II. Consistment VPD
III. Task specific VPD
- VPD but its not there all the time and it depends on what the child is saying, could be any variation of errors
- usually corrected by speech therapy
IV. Irregular VPD
- Neurological disorders
- CP , Apraxia (doesn’t complete closure all the time)
- VCF because of hypertonia
- Tough to correct in treatment
V. Abnormal resonance without VPD (e.g. neuromotor, large tonsils)
Approximate degree of patency
- Not very accurate
Degree of patency relative to normal breathing port
- Normal 0-10%
- Small 11-20%
- Moderate 21-40%
- Larger 41-100%
Typical locations of patency
- Central
- Lateral.. one or both sides
- ## Transverse
