THE FUNCTIONAL-ROLE OF THE ADENOIDS IN SPEECH

Illustrative cases are presented showing a variety of interrelationshi ps between the adenoids and the activity of the velopharyngeal valve i n speech. The cases presented were selected from a group of 1000 patie nts referred because of suspected velopharyngeal diseases. When approp riate, complete velopharyngeal assessment was made including otolaryng ological speech and hearing examination, polysomnography, nasendoscopy , multiview videofluoroscopy and cephalometry. New observations are de scribed which further elucidate the mechanism by which the adenoids ma p change the mechanism of velopharyngeal valving and consequently spee ch patterns. In conclusion, procedures involving the adenoids and tons ils and surgical correction of velopharyngeal valve abnormalities to i mprove respiratory function must be performed in a manner which ensure s preservation of normal speech activity. Similarly, surgical correcti on of velopharyngeal valve abnormalities to improve speech activity mu st preserve its respiratory function. The velopharyngeal valve and the adeno-tonsils must be considered together whenever diagnosis and a th erapeutic intervention of either of them is considered. A clinical met hod for patient evaluation, patient management and the development of a rational therapeutic approach is presented.