Flashcards in 3.4 Causes of Velopharyngeal Dysfunction Deck (23)
What are the organic causes of hypernasality/NAE?
- Congenital Palatal Insufficiency (Deep pharynx)
- Neuromuscular Disorders
- Cleft palate
- Ablative surgery
- Radiation to Nasopharynx
What are the non-organic causes of hypernasality/NAE?
- functional/ sound specific
What are the causes of hyponasality?
- Nasal Obstruction
- Pharyngeal Obstruction
What are the signs of a submucous cleft?
- Absent or broad posterior nasal spine
- No color change
- Anterior attachment of the levators
- Zona Pellucida
- Bifid Uvula
A high arched palate will not typically cause what?
What are the signs of congenital palatal Insufficiency: deep Nasopharynx?
- Hypernasality is the primary presenting factor
- Palate appears normal
- Nasal regurgitation as newborn may be first sign
- Occurs rarely following maxillary advancement
What occurs after an adenoidectomy when you have a congenital palatal insufficiency?
Deep nasopharynx is unmasked (velopharyngeal mechanism seems able to adjust to slow involution but not the sudden increase with adenoidectomy
What are the signs of a lower motor lesion?
- Usually unilateral, but may be bilateral
What are the signs of an upper motor lesion?
Both larynx and velum should be assessed (one may be paralyzed)
When can neuromuscular insufficiency occur?
- Congenitally (Moebius or velocardiofacial syndrome)
- Tumors (congenital or acquired)
- Surgically or via a trauma
How is the velum for functional/sound specific VPI?
Velum is neurologically and anatomically capable of closure at time of evaluation
What is the most likely cause of functional/sound specific VPI?
Most likely cause is early Conductive Hearing Loss
In regards to functional/sound specific VPI, what happens after post T&A with tubes?
improved hearing increases speech output and unmasks the "posterior nasal fricative"
Functional/sound specific will not respond to what?
Surgery or Prosthetic management
What does functional/sound specific require?
Functional/sound specific is truly a misarticulation using what?
posterior nasal fricative
What is apraxia of speech?
Motor speech disorder causing difficulty combining and sequencing motor movements
What subsystems of speech does apraxia of speech affect?
- Velopharyngeal function
Apraxia of speech has poor ______________, ____________, and _____________ of VP closure.
coordination, timing, and duration
Apraxia of speech causes what?
inconsistent hypernasality/ hyponasality
What happens during apraxia of speech?
velum elevates inappropriately for nasal sounds and remains open for oral sounds
What are the nasal airway obstruction?
- Nasal cleft deformities
- Allergic Rhinitis
- Vasomotor rhinitis
- Bacterial URL
- Choanal atresia
- Nasal cavity mass
- Septal deviation
- Turbinate enlargement
- Nasal hygiene
- Maxillary retrusion (seen in down, apert, crouzon syndromes)