Pinborough-Zimmerman J, Canady C, Yamashiro D K, Morales L
Child Development Clinic, Utah Department of Health, Department of Communication Disorders, University of Utah, Salt Lake City 84114-4640, USA.
Cleft Palate Craniofac J. 1998 Jan;35(1):81-7. doi: 10.1597/1545-1569_1998_035_0081_aancrf_2.3.co_2.
The purpose of the study was to determine differences in articulation and nasality with obturation over time in children with a palatal fistula.
Articulation and nasality were measured with the fistula open, immediately after obturation, and 4 to 7 weeks postobturation. SETTING, PATIENTS, PARTICIPANTS: Subjects were 15 patients with a palatal fistula secondary to a repaired cleft palate who were seen through the Orofacial Program, Utah Department of Health, ranging in age from 4 years 6 months to 13 years 1 month.
Acrylic palatal obturators were designed to provide coverage specific to the unique shape and location of each child's fistula. Obturators were cemented to molar teeth using wire clasps for control of usage.
Measurements consisted of listener judgments of hypernasality, hyponasality, and nasal emissions; instrumental ratings of nasalance using the Nasometer 6200-2; and performance on a standardized articulation test.
Significant improvement occurred only on nasal emission measures from the preobturation condition to immediate postobturation. However, significant improvement was found in articulation, listener judgments of hypernasality, nasal emissions, and Nasometric Nasal Sentence mean scores from the preobturation condition to 4 to 7 weeks postobturation and from the immediate postobturation condition to 4 to 7 weeks postobturation. No significant differences were found between conditions for listener judgments of hyponasality and Nasometric Zoo and Rainbow Passage scores. Obturation of the palatal fistula over a 4- to 7-week period resulted in no adverse effect on articulation ability, perceptual ratings of nasality, or instrumental ratings of nasalance.
Clinical management of patients with a palatal fistula can be enhanced with treatment using obturation over time. For subjects who continue to exhibit hypernasality immediately postobturation, sustained obturation is advocated prior to consideration of surgical intervention for treatment of a palatal fistula and/or velopharyngeal dysfunction.
本研究旨在确定腭裂患儿在腭瘘阻塞治疗过程中，随着时间推移其发音和鼻音的差异。
在瘘口开放时、阻塞后即刻以及阻塞后4至7周测量发音和鼻音。地点、患者、参与者：研究对象为15例继发于腭裂修复术后的腭瘘患者，通过犹他州卫生部口腔颌面项目就诊，年龄范围为4岁6个月至13岁1个月。
定制丙烯酸腭阻塞器，以覆盖每个患儿瘘口独特的形状和位置。使用钢丝卡环将阻塞器固定在磨牙上，以控制其使用。
测量内容包括听众对高鼻音、低鼻音和鼻漏气的判断；使用鼻声计6200 - 2进行鼻共鸣的仪器评分；以及标准化发音测试的表现。
仅在从阻塞前状态到阻塞后即刻的鼻漏气测量方面有显著改善。然而，从阻塞前状态到阻塞后4至7周以及从阻塞后即刻到阻塞后4至7周，在发音、听众对高鼻音的判断、鼻漏气以及鼻声计鼻语句平均得分方面均有显著改善。在听众对低鼻音的判断以及鼻声计动物园和彩虹通道得分方面，各状态之间未发现显著差异。在4至7周内对腭瘘进行阻塞治疗，对发音能力、鼻音的感知评分或鼻共鸣的仪器评分均无不良影响。
随着时间推移，使用阻塞治疗可加强对腭瘘患者的临床管理。对于阻塞后即刻仍持续表现出高鼻音的患者，在考虑对腭瘘和/或腭咽功能障碍进行手术干预之前，提倡持续进行阻塞治疗。
