Tonsillectomy in children with or at risk for velopharyngeal insufficiency: Effects on speech

Abstract

Recent case reports have challenged the notion that tonsillectomy is contraindicated in patients with or at risk for velopharyngeal insufficiency. The purpose of this study was to quantify the effects of tonsillectomy (with or without adenoidectomy) on perceptual speech characteristics, aerodynamic measures, and endoscopic descriptions of velopharyngeal function in a clinical population. Fifteen children 4 to 10 years of age received preoperative and postoperative evaluations. Perceptual speech characteristics improved or remained the same for most variables. There was no statistically significant difference between preoperative and postoperative ratings of hypernasality or frequency and severity of nasal emission. However, ratings of voice quality (pitch and breathiness) were significantly improved after surgery. Aerodynamic measures showed improvement or no change in velopharyngeal function for 12 of 15 children. Endoscopic assessment showed improvement or no change in velopharyngeal closure for 7 of 11 children tested. Cross-method analysis indicated that no single subject showed deterioration in velopharyngeal function in all three measures. The data from this investigation do not support the assumption that tonsillectomy is contraindicated for all children with or at risk for velopharyngeal insufficiency. (Otolaryngol Head Neck Surg 1996;115:319-23.)

Get full access to this article

View all access options for this article.

References

1. Subtelny

Koepp-Baker

. The significance of adenoid tissue in velopharyngeal function. Plast Reconstr Surg 1956;17:235–50.

2. Greene

MCL

. Speech of children before and after removal of tonsils and adenoids. J Speech Hear Disord 1957;22:361–70.

3. Gibb

. Hypernasality (rhinolalia aperta) following tonsil and adenoid removal. J Laryngol Otol 1958;433–51.

4. Witzel

Hampton

Margar-Bacal

Cox

. Velopharyngeal insufficiency after adenoidectomy: An 8-year review. Int J Pediatr Otorhinolaryngol 1986;11:15–20.

5. Paradise

Bluestone

. Toward rational indications for tonsil and adenoid surgery. Hosp Pract 1976;February:79–87.

6. Potsic

Schwartz

. T&A today: who, when and why? Patient Care 1988;February:50–74.

7. Blum

Neel

. Current thinking on tonsillectomy and adenoidectomy. Compr Ther 1983;9:48–56.

8. MacKenzie-Stephner

Witzel

Stringer

Laskin

. Velopharyngeal insufficiency due to hypertrophic tonsils: a report of two cases. Int J Pediatr Otorhinolaryngol 1987;14:57–63.

9. Shprintzen

Sher

Croft

. Hypernasal speech caused by tonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 1987; 14:45–56.

10.

10. Kummer

Billmire

Myer

. Hypertrophic tonsils: the effect on resonance and velopharyngeal closure. Plast Reconstr Surg 1993;91:608–11.

11.

11. D'Antonio

Chait

Lotz

Netsell

. Pediatric videonasoendoscopy for speech and voice evaluation. Otolaryngol Head Neck Surg 1986;94:578–83.

12.

12. D'Antonio

Muntz

Marsh

Marty-Grames

Backensto-Marsh

. Practical application of flexible fiberoptic nasopharyngoscopy for evaluating velopharyngeal function. Plast Reconstr Surg 1988;82:611–7.

13.

13. Barlow

Suing

Grossman

Bodmer

Colbert

. A high speed data acquisition and protocol control system for vocal tract physiology. J Voice 1989;3:283–93.

14.

14. Netsell

. Evaluation of velopharyngeal function in dysarthria. J Speech Hear Disord 1969;34:113–22.

15.

15. D'Antonio

Marsh

Muntz

Phillips

. Reliability of flexible fiberoptic nasopharyngoscopy for evaluation of velopharyngeal function in a clinical population. Cleft Palate J 1989; 26: 217–25.