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The role of auditory perceptual analysis of speech in predicting velopharyngeal gap size in children with velopharyngeal insufficiency




Assessment of velopharyngeal (VP) function starts with careful perceptual speech analysis, because it is the degree of speech impairment that dictates the need for intervention.


The aim of this study was to evaluate the role of auditory perceptual analysis of speech in predicting VP gap size in children with VP insufficiency.

Design and setting

This was a prospective correlation study conducted in a hospital-based setting.

Materials and methods

Referred sample of 38 participants with VP insufficiency and age ranging from 4 to 16 years were included in the study. The subjective evaluation of patients’ speech was carried out using four-point severity scales. This included degree of hypernasality, audible nasal emission of air, the compensatory articulations (glottal and pharyngeal articulation), and the overall intelligibility of speech. Nasalance scores for oral and nasal sentences were measured. A combination of nasopharyngoscopy and multiview videofluoroscopy was used to measure VP gap size, which was rated using the scale proposed by Golding-Kushner and colleagues. The studied patients were classified into three groups on the basis of the estimated gap size (small, moderate, and large VP gap groups).

Statistical analysis

Statistical analysis was carried out using analysis of variance and post-hoc tests.


There was a positive correlation between all studied auditory perceptual analysis variables and VP gap size. The degree of hypernasality and overall speech intelligibility had the strongest predictive values, followed by glottal articulation, nasal emission, pharyngeal articulation, and oral sentence nasalance score.


The study finding suggests that the size of the VP opening can be predicted on the basis of perceptual assessment of speech, which helps to anticipate the appropriate line of intervention without the need for invasive procedures.


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Corresponding author

Correspondence to Gamal Youssef MSc, MD.

Additional information

Conflicts of interest

There are no conflicts of interest.

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Youssef, G., Alkhaja, A. The role of auditory perceptual analysis of speech in predicting velopharyngeal gap size in children with velopharyngeal insufficiency. Egypt J Otolaryngol 31, 122–127 (2015).

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  • auditory perceptual analysis
  • cleft palate speech
  • hypernasality
  • velopharyngeal gap size
  • velopharyngeal insufficiency