Juvenile nasopharyngeal angiofibroma| aetiology, diagnosis, treatment

Classification

• Hyponasality (Rhinolalia clausa)
• Hypernasality ( Rhinolalia aperta)
• Mixed nasality

Definitions:

Hyponasality: Is a speech characteristic caused by insufficient resonance of air in the nasal cavity. Associated with all causes of bilateral nasal obstruction e.g. adenoid hypertrophy, allergic rhinitis, deviated septum, sinusitis and turbinate hypertrophy.

Hypernasality: It is a resonance disorder which results from excessive nasal resonance during speech caused by velopharyngeal inadequacy (VPI).

Velopharyngeal insufficiency is a condition where the velum (soft palate) and the pharyngeal muscles, while in function don’t produce the optimal closure between the oro and nasopharynx.

Causes of resonance disorders:

a. Organic:

Structural:

• Congenital: Cleft palate, short palate and deep pharynx.
• Acquired:

        1.Surgery (post tonsillectomy and adenoidectomy).

        2.Trauma and tumor.

Dynamic:

• Upper motor neuron disorder, nuclear, peripheral nerve and end organ disorder.

b. Functional:

• Faulty habits.
• Mental Retardation.
• Hearing impairment. 

Assessment and diagnostic procedures:

• History taking and patient interview. 
• Auditory perceptual assessment.
• Endoscopy. 
• Radiological examination.
• Language and articulation test. 
• Audiological assessment.

Management of Velopharyngeal insufficiency:

• Interdisciplinary team consisting of otorynolaryngologist, pediatrician, phoniatrician, dentist and child psychiatrist.
• Surgical intervention & correction (primary repair and secondary repair).
• Otological and audiological intervention.
• Management of feeding problems and orthodontic intervention.

• Speech therapy.

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