SPHINCTER PHARYNGOPLASTY - A PREOPERATIVE AND POSTOPERATIVE ANALYSIS OF PERCEPTUAL SPEECH CHARACTERISTICS AND ENDOSCOPIC STUDIES OF VELOPHARYNGEAL FUNCTION

Perceptual speech and endoscopic evaluations were videotaped preoperat ively and postoperatively for 20 patients who underwent sphincter phar yngoplasty. Randomized videotapes of these evaluations were rated by c linicians experienced in assessment of patients with velopharyngeal dy sfunction. Results of perceptual speech ratings showed that nasal reso nance following sphincter pharyngoplasty improved in 79 percent of pat ients (p = 0.006), frequency of nasal emission decreased in 74 percent (p = 0.018), and severity of emission decreased in 79 percent (p = 0. 006). Rating of the overall change in speech quality was not statistic ally greater than chance (p = 0.41). Thirty percent of patients were j udged to be hyponasal postoperatively, while none had been preoperativ ely. Results of endoscopic evaluations showed that 75 percent of patie nts had a quantitative decrease in orifice size (p = 0.013). Despite i mproved velopharyngeal function, 65 percent of patients were still con sidered candidates for additional surgical management postoperatively. While sphincter pharyngoplasty resulted in improved perceptual speech characteristics and velopharyngeal function, only 18 percent of patie nts showed complete resolution of hypernasality and nasal emission, an d only 35 percent demonstrated complete velopharyngeal closure postope ratively.