TONSILLECTOMY IN CHILDREN WITH OR AT RISK FOR VELOPHARYNGEAL INSUFFICIENCY - EFFECTS ON SPEECH

Recent case reports have challenged the notion that tonsillectomy is c ontraindicated in patients with or at risk for velopharyngeal insuffic iency. The purpose of this study was to quantify the effects of tonsil lectomy (with or without adenoidectomy) on perceptual speech character istics, aerodynamic measures, and endoscopic descriptions of velophary ngeal function in a clinical population. Fifteen children 4 to in year s of age received preoperative and postoperative evaluations. Perceptu al speech characteristics improved or remained the same for most varia bles. There was no statistically significant difference between preope rative and postoperative ratings of hypernasality or frequency and sev erity of nasal emission. However, ratings of voice quality (pitch and breathiness) were significantly improved after surgery. Aerodynamic me asures showed improvement or no change in velopharyngeal function for 12 of 15 children. Endoscopic assessment showed improvement or no chan ge in velopharyngeal closure for 7 of 11 children tested. Cross-method analysis indicated that no single subject showed deterioration in vel opharyngeal function in all three measures. The data from this investi gation do not support the assumption that tonsillectomy is contraindic ated for all children with or at risk for velopharyngeal insufficiency .