Adenoidal Atrophy, Velopharyngeal Incompetence and Sucking Exercises: A Two Year Follow-Up Case Report

Abstract

In this study a patient was referred to Medical Speech Pathology when he was 18 years of age with the diagnosis of being hypernasal. He had been followed by the second author for approximately the last ten years from an orthodontic standpoint. The patient was attending college and had an interest in music and played the bassoon and saxophone. During the initial evaluation he indicated that approximately a year and a half ago around the age of 16 years he began to experience some difficulty when he played the bassoon and saxophone because of a more than usual amount of air pressure coming from his nose. Being musically inclined he wanted to continue to play the saxophone and bassoon, but was perplexed by the unusual amount of nasal air pressure while playing these instruments. In a conference with the second author we noted that in a review of a lateral radiogram that had been taken when the patient was ten years of age that marked hypertrophy of adenoid tissue appeared to be present (Figure 1). In reviewing another radiogram taken at the age of 18 years the large adenoidal mass once present appeared to have shown a substantial decrease (Figure 2). Adenoidal atrophy has been discussed by Sub-telny (6), Westlake and Rutherford ('7), and Massengill (2) in regard to velopharyngeal closure or lack of velOpharyngeal closure. The patient was referred for an ENT examination and the otolaryn-gologist reported that the nasopharynx could be visualized quite well. There was a minimal amount of adenoid tissue and essentially a normal ENT examination. The next step was a cinefluorography study to determine the presence or absence of velopharyngeal closure. The results of the cinefluorography study indicated the patient was obtaining only touch velopharyngeal closure (this is where the palate barely touches the pharyngeal wall as compared to complete velopharyngeal closure where there is a large velo-pharyngeal seal), during sustained phonation of the vowel /i/.