title: Relationship between velopharyngeal closure, hypernasality, nasal air emission and nasal rustle in subjects with repaired cleft palate.
abstract: OBJECTIVE
  To investigate the correlation among velopharyngeal closure, hypernasality, audible nasal air emission (NAE) and nasal rustle (NR), in individuals with repaired cleft palate.
  
  
  METHODS
  One hundred patients with repaired cleft palate and lip, submitted to pressure-flow study for measurement of velopharyngeal orifice area (velopharyngeal area) and speech sample recordings. Velopharyngeal area was estimated during the production of the sound /p/ inserted in a sentence, and the velopharyngeal closure was classified as adequate, borderline or inadequate. Hypernasality was rated using a 4-point scale, NAE and NR were rated as absent or present, by three speech language pathologists, using recorded speech samples. Inter and intra-judge agreements were established. Statistical analysis was performed using the Spearman correlation coefficient considering p<0.05. An ordinal logistic regression model was developed to investigate whether the characteristics of speech can predict velopharyngeal closure. For this, the speech samples included in this analysis were those that obtained 100% agreement among raters as to the degree of hypernasality (43 out of 100).
  
  
  RESULTS
  Significant correlation was found between hypernasality and velopharyngeal area; audible NAE and velopharyngeal area. A negative correlation was observed between the NR and velopharyngeal area. The regression analysis showed that the perceptual speech characteristics contributed significantly to predict the velopharyngeal closure.
  
  
  CONCLUSIONS
  There is significant correlation between velopharyngeal closure and hypernasality, NAE and NR. It suggests that the perceptual speech characteristics can predict velopharyngeal closure, favoring the diagnosis and the definition of treatment conduct of velopharyngeal dysfunction.
authors.affiliation: Hospital for the Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo, Bauru, SP, Brazil.
authors.forename: Rafaeli Higa
authors.initials: RH
authors.lastname: Scarmagnani
authors.affiliation: Support and Rehabilitation Center of Patients with Cleft Palate, Londrina, PR, Brazil.
authors.forename: Daniela Aparecida
authors.initials: DA
authors.lastname: Barbosa
authors.affiliation: Hospital for the Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo, Bauru, SP, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Fukushiro
authors.affiliation: Universidade Estadual Paulista Júlio de Mesquita Filho, Bauru, SP, Brazil.
authors.forename: Manoel Henrique
authors.initials: MH
authors.lastname: Salgado
authors.affiliation: Hospital for the Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo, Bauru, SP, Brazil.
authors.forename: Inge Elly Kiemle
authors.initials: IE
authors.lastname: Trindade
authors.affiliation: Hospital for the Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo, Bauru, SP, Brazil.
authors.forename: Renata Paciello
authors.initials: RP
authors.lastname: Yamashita
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002971:Cleft Lip / Q000503:physiopathology* / Q000601:surgery; D002972:Cleft Palate / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology*; D025363:Rhinomanometry; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis* / Q000503:physiopathology; D014832:Voice Disorders / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult