Study of the normal and insufficient velopharyngeal valve by the "Forced Sucking Test"

The functional role of the adenoids in speech

Illustrative cases are presented showing a variety of interrelationships between the adenoids and the activity of the velopharyngeal valve in speech. The cases presented were selected from a group of 1000 patients referred because of suspected velopharyngeal diseases. When appropriate, complete velopharyngeal assessment was made including otolaryngological speech and hearing examination, polysomnography, nasendoscopy, multiview videofluoroscopy and cephalometry. New observations are described which further elucidate the mechanism by which the adenoids may change the mechanism of velopharyngeal valving and consequently speech patterns. In conclusion, procedures involving the adenoids and tonsils and surgical correction of velopharyngeal valve abnormalities to improve respiratory function must be performed in a manner which ensures preservation of normal speech activity. Similarly, surgical correction of velopharyngeal valve abnormalities to improve speech activity must preserve its respiratory function. The velopharyngeal valve and the adeno-tonsils must be considered together whenever diagnosis and a therapeutic intervention of either of them is considered. A clinical method for patient evaluation, patient management and the development of a rational therapeutic approach is presented.

Peritonsillar abscess as a cause of transient velopharyngeal insufficiency

"Hot potato voice" is a characteristic sign of peritonsillar abscess and peritonsillitis. Our findings show that the hot potato voice is the result of an underlying transient velopharyngeal insufficiency combined with muffled oral resonance. The hot potato voice should be distinguished from the muffled oral voice which can be occasionally encountered in cases of severe tonsillitis. The velopharyngeal insufficiency is the result of transient dysfunction of the palatal muscles on the affected side. Transient negative middle-ear pressure indicating eustachian tube dysfunction was found in few of the patients in whom concomitant sinusitis was also present. The clinical, nasendoscopic, and radiologic findings are analyzed and discussed. We believe that this phenomenon is valuable as a research tool for the investigation of the anatomy and physiology of the velopharyngeal valve.