Velopharyngeal Insufficiency Effects on Life Outcome Scores and Decision-Making for Secondary Speech Surgery after Palatoplasty.

Abstract

Twenty to thirty percent of patients develop velopharyngeal insufficiency (VPI) after cleft palate repair, and quality of life (QoL) may outweigh objective parameters in decision for surgery. We evaluated QoL using the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) instrument in post-palatoplasty patients and its impact on decision making for speech surgery. Using cross-sectional methodology, patients ages 3-18 with history of cleft palate repair and their parents were recruited to complete the VELO. Hypernasality, a common manifestation of VPI, was determined by speech pathologist (SLP) documentation. Additional management of hypernasality included nasendoscopy and/or surgery. Clinical and demographic variables were extracted from medical records and summarized using descriptive statistics. Bivariate tests compared VELO scores, decision for additional management, and other variables of interest. Four patients and 66 parents completed the VELO instrument, representing seventy patients (52.9% female, mean age 8.2 years) with a median VELO score of 82.7 (IQR 20.0). Almost half (48.6%) of patients had hypernasality. Clinically evident hypernasality was associated with lower VELO scores (p=0.05). Patients with hypernasality who pursued additional management had lower VELO scores (median=62.5, IQR=13.0) than those with hypernasality who were offered but did not pursue additional management (median=83.7, IQR=11.3) (p=0.02). Patients with hypernasality who were offered but did not pursue additional management had similar VELO scores as those without hypernasality (median=86.5, IQR=18.6) (p=0.75). Patients may not pursue additional management for hypernasality if QoL is unaffected, regardless of clinical assessment. Recurrent administration of the VELO instrument and clinical evaluation together can identify functionally limiting hypernasality that merits surgery.