Development of Therapeutic Procedure to Stimulate Velopharyngeal Function using Newly Designed Speech Appliance.

本研究的目的是建立一个策略，以刺激咽功能，使用语音球减少。为了确定球的适当减小体积，当允许呼吸空气通过在语音器具的球的垂直中心中钻出的开口进入鼻腔时，监测与鼻空气流速和口腔空气压力的变化相关的提上睑肌活动。开口面积从0（闭塞条件）到38.5 mm ^2到12.6 mm ^2不等。多元回归分析显示，上睑提肌活动度与鼻气流率和口腔气压相关，鼻气流率对上睑提肌活动度的影响大于口腔气压。在此基础上，设计了一种治疗方案，并应用于5例常规配戴语音矫治器的腭裂修复患者。也就是说，进行了球缩小，使得球体积的减少可以等于水平投影中12.6 mm^2至38.5 mm^2范围内的圆形面积。每月进行一次，持续3个月。每次复位后一个月进行鼻咽纤维镜检查和感觉评估。结果显示，5名受试者中有4名在阻塞性语言期间显示了完全的咽部闭合和无鼻分泌物，并且在每次评估中观察到了改善的腭咽功能。然而，另一例受试者在第一次和第二次评价中显示完全闭合，而第三次评价未显示任何改善。结果表明，这种灯泡减少策略的原型可能是有效的改善咽喉功能，而改善咽喉功能的过程可能是可变的受试者。减少效应的维持保证了未来的研究。

The purpose of this study is to establish a strategy to stimulate velopharyngeal function using speech bulb reduction. To determine an adequate reduction volume of the bulb, levator muscle activity associated with changes in nasal air flow rate and oral air pressure was monitored when respiratory air was allowed into the nasal cavity through the opening drilled in the vertical center of the bulb of a speech appliance. The opening area was varied from 0 (occluded condition) to 38.5mm^2 through 12.6mm^2. Multiple regression analyzes showed that levator muscle activity correlated with nasal air flow rate and oral air pressure, while nasal air flow rate contributed to the changes in levator muscle activity more significantly than oral air pressure did. Based on the results, prototype strategy of bulb reduction therapy was designed and applied to 5 repaired cleft palate patients who were routinely wearing a speech appliance. That is, bulb reduction was performed so that decrease in the bulb volume could be equal to the circular area ranged from 12.6mm^2 to 38.5mm^2 in horizontal projection. The reduction was carried out monthly for 3 months. Nasopharyngeal fiberscopic and perceptual evaluations were carried out onemonth after each reduction. As results, four out of five subjects showed complete closure of the velopharynx and no nasal emission during obstruent speech, and the improved veloharyngeal function was observed in each evaluation. However, another subject showed complete closure in first and second evaluation, while third evaluation did not show any improvement. The results suggested that this prototype of bulb reduction strategy might be effective for the improvement of velopharyngeal function, while the process towards improved velopharyngeal function might be variable across subjects. A maintenance of the reduction effect warrants future study.