THE FUNCTIONAL-ROLE OF THE TONSILS IN SPEECH

Objective: To present illustrative cases showing various tonsillar inf luences on speech and to present a clinical method for patient evaluat ion establishing concepts of management and a rational therapeutic app roach. Design: The cases were selected from a group of approximately 1 000 patients referred to the clinic because of suspected palatal disea ses. Complete velopharyngeal assessment was made, including otolaryngo logic, speech, and hearing examinations, polysomnography, nasendoscopy , multiview videofluoroscopy, and cephalometry. Results: New observati ons further elucidate the intimate relation between the tonsils and th e velopharyngeal valve. The potential influence of the tonsils on the velopharyngeal valve mechanism, in hindering or assisting speech, is d escribed. Conclusions: In selected cases, the decision to perform tons illectomy depends on its potential effect on speech. The combination o f nasendoscopic and multiview videofluoroscopic studies of the mechani cal properties of the tonsils during speech is required for patients w ho present with velopharyngeal insufficiency in whom tonsillar hypertr ophy is found. These studies are also required in patients with palata l anomalies who are candidates for tonsillectomy.