Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, U.S.A.
Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
Laryngoscope. 2021 Jun;131(6):E2046-E2052. doi: 10.1002/lary.29189. Epub 2020 Oct 26.
OBJECTIVES/HYPOTHESIS: To investigate perceptual speech outcomes following sphincter pharyngoplasty (SP) and to identify patient characteristics associated with velopharyngeal insufficiency (VPI) resolution or improvement.
Retrospective review of prospectively collected data was performed of consecutive patients that underwent SP for management of VPI between 1994 and 2016 at a single tertiary care pediatric hospital. Demographic data, nasendoscopic findings, and speech characteristics were recorded using a standardized protocol. Pre- and post-operative VPI was graded on a five-point Likert scale. Frequency of post-operative VPI resolution and improvement was assessed and associations with patient characteristics were analyzed. The association between odds of VPI resolution or improvement and five patient characteristics identified a priori was performed controlling for confounding factors.
Two-hundred ninety-six subjects were included. All patients had at least minimal VPI pre-operatively; 72% were graded moderate or severe. Sixty-four percent experienced resolution and 83% improved at least one point on the VPI-severity scale. Of the five patient characteristics, only history of cleft palate repair was significantly associated with decreased odds of VPI improvement but not resolution when controlling for other variables.
Sphincter pharyngoplasty resulted in resolution of VPI in 64% and improvement in 83% of subjects. Children with a history of cleft palate had significantly decreased odds of VPI improvement compared to those without a history of cleft palate. Neither syndrome diagnosis nor 22q11 deletion had a significant association with speech outcomes after sphincter pharyngoplasty.
4 Laryngoscope, 131:E2046-E2052, 2021.
目的/假设：研究环咽肌成形术后的语音感知结果，并确定与腭咽闭合不全（VPI）解决或改善相关的患者特征。
对 1994 年至 2016 年期间在一家三级儿科医院接受 SP 治疗 VPI 的连续患者进行前瞻性收集数据的回顾性分析。使用标准化方案记录人口统计学数据、鼻内镜检查结果和语音特征。术前和术后 VPI 采用五点 Likert 量表分级。评估术后 VPI 解决和改善的频率，并分析与患者特征的关联。通过控制混杂因素，对五个预先确定的患者特征与 VPI 解决或改善的关联进行分析。
共纳入 296 例患者。所有患者术前均有至少轻度 VPI，72%为中度或重度。64%的患者 VPI 得到解决，83%的患者 VPI 严重程度评分至少提高了一个等级。在五个患者特征中，只有腭裂修复史与 VPI 改善的可能性降低显著相关，但在控制其他变量时，与 VPI 解决的可能性无关。
环咽肌成形术使 64%的 VPI 得到解决，83%的患者得到改善。与无腭裂史的患者相比，有腭裂史的患儿 VPI 改善的可能性显著降低。综合征诊断和 22q11 缺失与环咽肌成形术后的语音结果均无显著关联。
4 级《喉镜》，131：E2046-E2052，2021 年。
