Shapiro R S
Int J Pediatr Otorhinolaryngol. 1980 Sep;2(3):255-60. doi: 10.1016/0165-5876(80)90051-8.
At the Cleft Palate Unit of The Montreal Children's Hospital a number of patients are seen each year who developed velopharyngeal insufficiency after adenoidectomy. Each time one of these patients is seen, the question is asked: "What would have happened to the speech if adenoidectomy had not been done, and the adenoid had been allowed to undergo the normal process of atrophy at puberty?" We had not seen a patient develop velopharyngeal insufficiency at puberty without adenoidectomy until recently, when an 11.5-year-old boy presented with a history of hypernasality for 1.5 years. Physical examination revealed the soft palate to be slightly short but with good mobility. The voice was mildly hypernasal but there was no nasal escape. Radiologic investigation revealed a very deep nasopharynx with virtual absence of adenoid tissue and a slight shortness of the palate. The child had been on speech therapy and the recommendation was that the therapy be stopped. When the child was seen 2.5 months after cessation of speech therapy, the hypernasality had cleared completely. Speech Pathologists at other Cleft Palate Units were contacted and no similar cases were known. The literature also did not reveal any similar cases of velopharyngeal insufficiency developing after puberty in the absence of adenoidectomy and without a cleft palate.
在蒙特利尔儿童医院的腭裂治疗中心，每年都会接待一些在腺样体切除术后出现腭咽闭合不全的患者。每次见到这样的患者，都会有人提出这样的问题：“如果没有进行腺样体切除术，让腺样体在青春期自然萎缩，患者的 speech 会怎样？”直到最近，我们才见到一名没有接受腺样体切除术却在青春期出现腭咽闭合不全的患者。那是一名 11.5 岁的男孩，有 1.5 年的鼻音过重病史。体格检查发现软腭稍短，但活动良好。声音有轻度鼻音，但没有鼻腔漏气。影像学检查显示鼻咽部非常深，几乎没有腺样体组织，软腭稍有缩短。该患儿一直在接受言语治疗，建议停止治疗。在停止言语治疗 2.5 个月后复诊时，鼻音过重的情况已完全消失。我们联系了其他腭裂治疗中心的言语病理学家，他们均表示没有听说过类似病例。文献中也未发现任何在没有腭裂且未进行腺样体切除术的情况下青春期后出现腭咽闭合不全的类似病例。
