Efficacy of continuous positive airway pressure for treatment of hypernasality.
OBJECTIVE
To determine whether speech hypernasality in subjects born with cleft palate can be reduced by graded velopharyngeal resistance training against continuous positive airway pressure (CPAP).


METHODS
Pretreatment versus immediate posttreatment comparison study.


METHODS
Eight university and hospital speech clinics.


METHODS
Forty-three subjects born with cleft palate, aged 3 years 10 months to 23 years 8 months, diagnosed with speech hypernasality.


METHODS
Eight weeks of 6 days per week in-home speech exercise sessions, increasing from 10 to 24 minutes, speaking against transnasal CPAP increasing from 4 to 8.5 cm H(2)0. MAIN OUTCOME MEASURES Pretreatment to immediate posttherapy change in perceptual nasality score based on blinded comparisons of subjects' speech samples to standard reference samples by six expert clinician-investigators.


RESULTS
Participating clinical centers treated from two to nine eligible subjects, and results differed significantly across centers (interaction p =.004). Overall, there was statistically significant reduction in mean nasality score after 8 weeks of CPAP therapy, whether weighted equally across patients (mean reduction = 0.20 units on a scale of 1.0 to 7.0, p =.016) or across clinical centers (mean = 0.19, p =.046). This change was about one-sixth the maximum possible reduction from pretreatment. Nine patients showed reductions of at least half the maximum possible, but hypernasality of eight patients increased at least 30% above pretreatment level. Most improvement was seen during the second month when therapy was more intense (p =.045 for nonlinearity). No interactions with age or sex were detected.


CONCLUSIONS
Patients receiving 8 weeks of velopharyngeal CPAP resistance training showed a net overall reduction in speech hypernasality, although response was quite variable across patients and clinical centers. The net reduction in hypernasality is not readily explainable by random variability, subject maturation, placebo effect, or regression to the mean. CPAP appears capable of substantially reducing speech hypernasality for some subjects with cleft palate.
Kuehn
David P
DP
Department of Speech and Hearing Science, University of Illinois, Urbana-Champaign 61820, USA. d-kuehn@uiuc.edu
Imrey
Peter B
PB
Tomes
Lucrezia
L
Jones
David L
DL
O'Gara
Mary M
MM
Seaver
Earl J
EJ
Smith
Bonnie E
BE
Van Demark
D R
DR
Wachtel
Jayne M
JM
D000293:Adolescent; D000328:Adult; D000403:Airway Resistance / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016013:Likelihood Functions; D016014:Linear Models; D008297:Male; D010160:Palate, Soft / Q000503:physiopathology; D010349:Patient Compliance; D010614:Pharynx / Q000503:physiopathology; D010700:Phonetics; D011175:Positive-Pressure Respiration; D016037:Single-Blind Method; D013064:Speech Disorders / Q000628:therapy*; D013067:Speech Perception; D013070:Speech Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome