Return to: Cleft Lip and Palate Protocols

Note: below is of historical perspective

Diagnosis and documentation of hypernasal speech and velopharyngeal function for speech involves both perceptual and objective measures. The protocol used for these evaluations by the speech-language pathologist may include either videoendoscopy or videofluoroscopy as well as perceived judgments of speech adequacy and acoustic nasometric measures. The data-entry form for this protocol is provided in Figure IC-8 (PDF). The following is a description of the various components of this protocol. A sample clinical report derived from the data recorded is provided in Figure IC-9 (PDF).

1. PATIENT HISTORY
   • After the patient's identifying information (name, birth date, etc) are recorded, the motivation for the evaluation is coded along with the patient's presenting disorder (eg, cleft palate, cancer, muscular function disorder). Additional notes regarding patient history may be typed in by the clinician for completeness.
2. SPEECH QUALITY
   • The speech-language pathologist records ratings of nasality, densality, audible nasal emission of air, and presence of oral speech distortions as a concise indicator of perceived speech adequacy. These ratings are based on composite observations of speech performance including counting, repeating sentences (Zoo Passage, Low Pressure Sentences, and Nasal Sentences), and conversation.
3. PROCEDURE
   • Detailed description of the procedure is then coded including type of evaluation, use of anesthesia or barium contrast, type of scope used (for endoscopic studies) or videofluorographic views recorded, and ratings of patient compliance.
4. FINDINGS
   • Standard observations of various components of velopharyngeal observations are coded including velopharyngeal status for speech, consistency of velopharyngeal closure, ratings of velar, lateral wall, and posterior wall movements, and details of residual abnormal velopharyngeal opening observed. Additional description notes may be included to provide adequate detail.
5. NASOMETRY
   • Acoustic nasometric measures are obtained as the patient produces standardized utterances that include the Zoo Passage, Low Pressure Sentences, and Nasal Sentences (Figure IC-10, PDF). Mean and standard deviations of the nasalance measures obtained for each utterance set are recorded.
6. RECOMMENDATIONS
   • The findings are reviewed with the attending physician and parents prior to recording a final recommendation. Recommendations may include physical management, behavioral management, or a combination of the two. When the findings warrant no management or a follow-up examination, that is recorded as well. Additional notes about recommendations may be included to provide adequate detail.
7. REPORT
   • The report generated from the evaluation includes a written description of each of the observations coded in the data-entry form described above, as well as a photograph containing select images from the videoendoscopic or videofluoroscopic evaluation. The report is formatted as a memo from the speech-language pathologist to the referring attending physician.