咽擦音的鉴别诊断及利用磁共振成像对腭咽功能进行治疗监测
Differential Diagnosis of a Pharyngeal Fricative and Therapeutic Monitoring of Velopharyngeal Function Using Magnetic Resonance Imaging.
作者信息
Mason Kazlin N, Botz Ellie, Gampper Thomas
机构信息
Department of Human Services, University of Virginia, Charlottesville.
Division of Plastic Surgery, University of Virginia Health System, Charlottesville.
出版信息
Am J Speech Lang Pathol. 2025 Jan 7;34(1):1-11. doi: 10.1044/2024_AJSLP-24-00292. Epub 2024 Dec 5.
PURPOSE
Speech disorders associated with velopharyngeal dysfunction (VPD) are common. Some require surgical management, while others are responsive to speech therapy. This is related to whether the speech error is obligatory (passive) or compensatory (active). Accurate identification of speech errors is necessary to facilitate timely and appropriate intervention. Recent studies have supported the role of magnetic resonance imaging (MRI) in the assessment process for VPD. The purpose of this study was to utilize MRI to support differential diagnosis and treatment planning in a child presenting with inconsistent nasal air escape, mild hypernasality, and compensatory speech errors.
METHOD
A nonsedated, fully awake, velopharyngeal (VP) MRI protocol was implemented to acquire anatomic data at rest and during phonation. Segmentations and visualization of the tongue, palate, adenoids, and nasopharyngeal airway were completed. Anatomic linear measurements were obtained for VP variables to assess VP function, establish a baseline, and monitor change over time.
RESULTS
VP anatomy was successfully visualized on MRI in multiple imaging planes. All anatomic measurements fell within normative expectations. Elevation and retraction of the soft palate occurred against the adenoid pad. A pharyngeal fricative was documented, resulting a small VP gap during speech. In contrast, adequate VP closure was obtained for vowels and other oral consonant sounds.
CONCLUSIONS
Quantitative assessment and visualization of the anatomy demonstrated adequate VP closure capabilities and a pharyngeal fricative substitution that had not been adequately perceived during routine clinical assessments. This study suggests a promising additive role for VP MRI for enhanced differential diagnosis and therapeutic monitoring in children with VPD and concomitant speech disorders.
SUPPLEMENTAL MATERIAL
目的
与腭咽功能障碍（VPD）相关的言语障碍很常见。有些需要手术治疗，而另一些则对言语治疗有反应。这与言语错误是强制性的（被动的）还是代偿性的（主动的）有关。准确识别言语错误对于促进及时和适当的干预很有必要。最近的研究支持了磁共振成像（MRI）在VPD评估过程中的作用。本研究的目的是利用MRI辅助对一名存在鼻腔异常漏气、轻度鼻音过重和代偿性言语错误的儿童进行鉴别诊断和治疗规划。
方法
实施了一项非镇静、完全清醒的腭咽（VP）MRI方案，以获取静息和发声时的解剖数据。完成了舌头、腭、腺样体和鼻咽气道的分割与可视化。获取了VP变量的解剖学线性测量值，以评估VP功能、建立基线并监测随时间的变化。
结果
在多个成像平面上成功通过MRI可视化了VP解剖结构。所有解剖测量值均在正常范围内。软腭向腺样体垫上方抬起并后缩。记录到一个咽擦音，导致言语时出现较小的VP间隙。相比之下，元音和其他口腔辅音发音时VP关闭正常。
结论
对解剖结构的定量评估和可视化显示出VP具有足够的关闭能力以及存在一个在常规临床评估中未被充分察觉的咽擦音替代。本研究表明，VP MRI在增强对患有VPD及伴发言语障碍儿童的鉴别诊断和治疗监测方面具有有前景的辅助作用。
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