CLEFT PALATE VIDEO SPEECH ANALYSIS & FLEXIBLE NASENDOSCOPY REPORT

Transcription

1 CLEFT PALATE VIDEO SPEECH ANALYSIS & FLEXIBLE NASENDOSCOPY REPORT Name Date of Birth Age Cleft Diagnosis Date of Evaluation Evaluation by Luis Cuadros MD, FACS PART 1: CLEFT PALATE SPEECH EVALUATION Overall Speech Normal Abnormal Intelligibility % Acceptability in Whole Speech Sample and Understandability in Conversational Speech 0 = WNL Speech is normal and always easy to understand 1 = Mild Speech deviates from normal to a mild degree and is occasionally hard to understand 2 = Moderate Speech deviates from normal to a moderate degree and is often hard to understand 3 = Severe Speech deviates from normal to a severe degree and is hard to understand most or all of the time VPI Assessment 0 none 1+ mild 2+ moderate 3+ severe Frequency: Constant Intermittent Stimulable: Yes No Hypernasality 0 - none 1+ mild 2+ moderate 3+ severe 0 = WNL Nasality does not exceed nasality heard in regional speech and there is no perceptual evidence of cleft type speech 1 = Mild Nasality exceeds regional speech nasality; Nasality is perceived as socially acceptable in most circles Patient or parent are satisfied with individuals speech resonance. Speech specialist probably would not recommend physical management after instrumental assessment 2 = Moderate Hypernasality is perceived as pervasive and draws attention to itself and away from the message Speech is socially unacceptable The speech specialist probably would recommend physical management after instrumental assessment 3 = Severe Hypernasality is perceived as pervasive and interferes with speech understandability. Nasality is socially very unacceptable The speech specialist definitely would recommend physical management after instrumental assessment SPEECH TESTS Audible Nasal Emission: absent present not tested Frequency: intermittent/variable frequent/pervasive Mirror Test : negative positive variable not tested Listening tube: negative positive variable not tested Nasal pinch test: negative positive variable not tested Page 1

2 SPEECH FINDINGS Hypernasality Consonant production errors Backing of anterior sounds Hyponasality Compensatory articulation errors Nasalization of oral consonants Cul-de-sac resonance Obligatory articulation errors Weak consonants Substitutions Nasal rustle Misarticulation Omissions Glottal stops Posteriorization Audible nasal emission Facial grimaces OTHER: PHONEMES normal abnormal stimulable note Bilabial plosives: /p/, /b/ Lingual-alveolar plosives: /d/, /t/ Velar plosives: /g/, /k/ Labio-dental fricatives /f/, / v/ Sibilant fricatives /s/, /z/, /sh/, /th/ Affricatives: /ch/, /j/ Voiceless consonants: /y/, /h/, /w/ Nasals: /m/, /n/, /ng/ Alveolar approximate: /r/, /l/ Vowels: /e/, /i/, /a/, /ah/, /u/, /o/ Voice Quality Voice Disorder none present Language Delay: none mild moderate severe SUMMARY: Speech: Overall speech is normal/abnormal with xx% intelligibility. Speech deviates from normal to a mild/moderate/severe degree and is hard to understand some/occasionally/most of the time. Resonance is hypernasal/hyponasal/mixed. Hyponasality is absent/present. Hypernasality is normal/mild/moderate/severe and is perceived as x.x.x.x.x.x. Audible nasal emissions are absent/present and are intermittent/frequent/pervasive. The mirror and listening tube tests are negative/positive. The nasal pinch test is negative/positive. There are/are not compensatory articulation and consonant production errors including glottal stops/substitutions/omissions/nasalizations/weak oral pressures. Phonemes are stimulable/not stimulable. Facial grimaces are/are not present. There is no/mild/moderate/severe language delay. Voice quality is good/soft/hoarse. Velopharyngeal insufficiency is considered to be mild/moderate/severe. Page 2

3 PART 2: OROFACIAL/INTRAORAL EXAMINATION ORAL CAVITY Palate: Normal Abnormal Palate Mobility: Good Fair Limited Poor Palate Length: Good Fair Short Dehisced Oropharyngeal space: Small Medium Cavernous Other Palate Fistula: None Small Medium Large Fistula Location: Anterior mid Posterior Uvula: Present Absent Abnormal Pharyngeal Flap: Absent Present Lateral Wall Motion: Good Fair Limited Poor Passavant s Ridge Absent Present Not Tested Tonsils: Normal Enlarged Removed Adenoids: Normal Enlarged Removed Dentition: Normal Abnormal Not Tested Notes / Other: NASAL AIRWAY Septum Congestion Turbinates Obstruction SUMMARY: Orofacial / Intraoral Exam: The palate is normal/abnormal with good/fair/limited/poor mobility. The length is full/fair/short/dehisced. The oropharyngeal space is small/medium/cavernous. A palatal fistula is seen/not seen. It is small/medium/large and located anterior/mid-palatal. The uvula is present/not present with an intact/dehisced posterior soft palate. A pharyngeal flap is present/not present. Lateral wall motion is good/fair/limited/poor. Passavant s ridge can/can not be seen. The tonsils are normal/enlarged/have been removed. The adenoids are normal/enlarged/not seen. Dentition is normal/abnormal. Page 3

4 PART 3: FLEXIBLE VIDEO NASENDOSCOPY REPORT Technical Preparation Instrumentation Side and Site Recording Benadryl 12.5mg oral, Afrin decongestant, 2% viscous lidocaine Olympus 2.2mm flexible scope Right Left nares, along floor of nose and below inferior turbinate Video sample JVC Camcorder;, nasendoscopy Medicapture; Digital voice field recorder. Quality of evaluation: Cooperation: NASENDOSCOPIC EVALUATION OF PALATO-PHARYNGEAL MOTION Resting gap: Small Moderate Large Palatal surface: Bulge (Normal-convex) Flat Groove (Abnormal-concave) Palate motion: Not Seen Poor Fair Good Adenoid pad Small Medium Large Velar contact: Not Seen Fair Good Pattern of closure: Sagittal (Vertical) Coronal (Horizontal) Circular Other: Type of closing gap: Symmetric Asymmetric Size of closing gap: None Small Moderate Large % closure: 0% = No Closure >>>> 100% = Complete Closure % residual closing gap: 0% = Full Closure >>>> 100%= No Closure grade of closure: Grade I - Full Closure Grade Ii <25% Grade Iii <50% Grade Iv < 75% Bubble through phenomenon: Absent Present Lateral pharyngeal wall motion: None Present Limited Not Visualized Other: SUMMARY: Nasendoscopy: The resting gap is small/moderate/large with a normal/concave/vshaped palatal surface. Palatal motion is poor/fair/good with a sagittal(vertical)/coronal(horizontal)/circular pattern of closure. Closure is symmetric/asymmetric. There is a grade I/II/III/IV closure with xx% residual gap. The adenoid pad is small/medium/large. A bubble through phenomenon is seen/not seen. Lateral pharyngeal motion is not seen/present/limited. Other findings include Page 4

5 CLEFT PALATE VIDEO SPEECH ANALYSIS & FLEXIBLE NASENDOSCOPY REPORT SUMMARY Name Date of Birth Age Cleft Diagnosis Date of Evaluation Evaluation by Luis Cuadros MD, FACS Summary: Speech: Orofacial Exam: Nasendoscopy: Recommendations: References: Henningsoon, et al. Universal Parameter for Reporting Speech Outcome in Individuals with Cleft Palate. Cleft Palate - Craniofacial Journal, January 2008, Vol. 45, No. 1, p Golding-Kushner, et al., Standards for the Reporting of Nasopharngoscopy and Multiview Videofluoroscopy: A report From an International Working Group. Cleft Palate Journal, October 1990, Vol 27, No 4, Report Prepared by: Luis Cuadros, M.D., F.A.C.S, member American Cleft Palate Association, American College of Surgeons, American Society of Plastic Surgeons NEW MEXICO CLEFT PALATE STUDY CENTER 8232 Louisiana NE, Suite A Albuquerque, New Mexico tel fax info@cuadrosmd.com Page 5

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