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The Functional Role of the Tonsils in Speech

The Functional Role of the Tonsils in Speech Abstract Objective: To present illustrative cases showing various tonsillar influences on speech and to present a clinical method for patient evaluation establishing concepts of management and a rational therapeutic approach. Design: The cases were selected from a group of approximately 1000 patients referred to the clinic because of suspected palatal diseases. Complete velopharyngeal assessment was made, including otolaryngologic, speech, and hearing examinations, polysomnography, nasendoscopy, multiview videofluoroscopy, and cephalometry. Results: New observations further elucidate the intimate relation between the tonsils and the velopharyngeal valve. The potential influence of the tonsils on the velopharyngeal valve mechanism, in hindering or assisting speech, is described. Conclusions: In selected cases, the decision to perform tonsillectomy depends on its potential effect on speech. The combination of nasendoscopic and multiview videofluoroscopic studies of the mechanical properties of the tonsils during speech is required for patients who present with velopharyngeal insufficiency in whom tonsillar hypertrophy is found. These studies are also required in patients with palatal anomalies who are candidates for tonsillectomy.(Arch Otolaryngol Head Neck Surg. 1994;120:846-851) References 1. Shprintzen RJ, Sher AE, Croft CB. Hypernasal speech caused by tonsillar hypertrophy . Int J Pediatr Otorhinolaryngol . 1987;14:45-56.Crossref 2. Wallner LJ, Hill BJ, Waldorp W, et al. Voice changes following adenotonsillectomy . Laryngoscope . 1968;78:1410-1418.Crossref 3. Yip ASG, Cleall JF. Cinefluorographic study of velopharyngeal function before and after removal of tonsils and adenoids . Angle Orthod . 1971;41:251-263. 4. Hennigsson G, Isberg A. Influence of tonsils on velopharyngeal movements in children with craniofacial anomalies and hypernasality . Am J Orthod Dentofacial Orthop . 1988;94:253-261.Crossref 5. Vargervick K, Harvold EP. Experiments on the interaction between orofacial function and morphology . Ear Nose Throat J . 1987;60:201-208. 6. MacKenzie-Stepner K, Witzel MA, Stringer DA, Laskin R. Velopharyngeal insufficiency due to hypertrophic tonsils: a report of two cases . Int J Pediatr Otorhinolaryngol . 1987;14:57-63.Crossref 7. Finkelstein Y, Talmi YP, Nahmani A, Hauben D, Zohar Y. Levator veli palatini muscle and eustachian tube function . Plast Reconstr Surg . 1990;85:684-692.Crossref 8. Finkelstein Y, Talmi PY, Hauben JD, et al. Evaluation of the normal and insufficient velopharyngeal valve by the forced sucking test . Laryngoscope . 1991;101:1203-1212.Crossref 9. Finkelstein Y, Talmi YP, Bar Ziv J, Zohar Y. Otitis media with effusion as a presenting symptom of chronic sinusitis . J Laryngol Otol . 1989;103:827-832.Crossref 10. Golding-Kushner KJ, Argamaso RV, Cotton RT, et al. Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an international working group . Cleft Palate Craniofac J . 1990;27:337-348.Crossref 11. Arvystas M, Shprintzen RJ. Craniofacial morphology in the velo-cardio-facial syndrome . J Craniofac Genet Dev Biol . 1984;4:39-45. 12. Finkelstein Y, Lerner MA, Zohar Y, et al. Nasopharyngeal profile and velopharyngeal valve mechanism . Plast Reconstr Surg . 1993;93:603-614.Crossref 13. Calnan J. Submucous cleft palate . Br J Plast Surg . 1954;6:264-272.Crossref 14. Finkelstein Y, Hauben DJ, Talmi PY, Nachmani A, Zohar Y. Occult and overt submucous cleft palate: from peroral examination to nasendoscopy and back again . Int J Pediatr Otorhinolaryngol . 1992;23:25-34.Crossref 15. Croft CB, Shprintzen RJ, Daniller A, Lewin ML. The occult submucous cleft palate and the musculus uvulae . Cleft Palate Craniofac J . 1978;15:150-154. 16. Lewin ML, Croft CB, Shprintzen RJ. Velopharyngeal insufficiency due to hypoplasia of the musculus uvalae and occult submucous cleft palate . Plast Reconstr Surg . 1988;65:585-591.Crossref 17. Shprintzen RJ, Goldberg RB, Lewin ML, et al. A new syndrome involving cleft palate, cardiac anomalies, typical facies, and learning disabilities: velo-cardio-facial syndrome . Cleft Palate Craniofac J . 1978;5:56-62. 18. Iseberg AM. Henningsson GE. Intraindividual change in the occurrence of Passavant's ridge due to change in velopharyngeal sphincter function: a videofluoroscopic study . Cleft Palate Surg . 1990;27:253-255.Crossref 19. Morris HL. The speech pathologist looks at the tonsils and the adenoids . Ann Otol Rhinol Laryngol . 1975;84( (suppl 19) ):63-66. 20. Fritzell B. The velopharyngeal muscles in speech . Acta Otolaryngol (Stockh) . 1969;250( (suppl) ):1-77. 21. Kuehn DP, Folkins JW, Cutting CB. Relationships between muscle activity and velar position . Cleft Palate Craniofac J. 1983;19:25-35. 22. Cosman B, Arlene SF. Pharyngeal flap augmentation . Plast Reconstr Surg . 1975; 55:149-155.Crossref 23. Owsley JQ, Lawson LI, Chierici GJ. The re-do pharyngeal flap . Plast Reconstr Surg. 1976;57:180-185.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

The Functional Role of the Tonsils in Speech

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References (27)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1994.01880320048011
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Abstract

Abstract Objective: To present illustrative cases showing various tonsillar influences on speech and to present a clinical method for patient evaluation establishing concepts of management and a rational therapeutic approach. Design: The cases were selected from a group of approximately 1000 patients referred to the clinic because of suspected palatal diseases. Complete velopharyngeal assessment was made, including otolaryngologic, speech, and hearing examinations, polysomnography, nasendoscopy, multiview videofluoroscopy, and cephalometry. Results: New observations further elucidate the intimate relation between the tonsils and the velopharyngeal valve. The potential influence of the tonsils on the velopharyngeal valve mechanism, in hindering or assisting speech, is described. Conclusions: In selected cases, the decision to perform tonsillectomy depends on its potential effect on speech. The combination of nasendoscopic and multiview videofluoroscopic studies of the mechanical properties of the tonsils during speech is required for patients who present with velopharyngeal insufficiency in whom tonsillar hypertrophy is found. These studies are also required in patients with palatal anomalies who are candidates for tonsillectomy.(Arch Otolaryngol Head Neck Surg. 1994;120:846-851) References 1. Shprintzen RJ, Sher AE, Croft CB. Hypernasal speech caused by tonsillar hypertrophy . Int J Pediatr Otorhinolaryngol . 1987;14:45-56.Crossref 2. Wallner LJ, Hill BJ, Waldorp W, et al. Voice changes following adenotonsillectomy . Laryngoscope . 1968;78:1410-1418.Crossref 3. Yip ASG, Cleall JF. Cinefluorographic study of velopharyngeal function before and after removal of tonsils and adenoids . Angle Orthod . 1971;41:251-263. 4. Hennigsson G, Isberg A. Influence of tonsils on velopharyngeal movements in children with craniofacial anomalies and hypernasality . Am J Orthod Dentofacial Orthop . 1988;94:253-261.Crossref 5. Vargervick K, Harvold EP. Experiments on the interaction between orofacial function and morphology . Ear Nose Throat J . 1987;60:201-208. 6. MacKenzie-Stepner K, Witzel MA, Stringer DA, Laskin R. Velopharyngeal insufficiency due to hypertrophic tonsils: a report of two cases . Int J Pediatr Otorhinolaryngol . 1987;14:57-63.Crossref 7. Finkelstein Y, Talmi YP, Nahmani A, Hauben D, Zohar Y. Levator veli palatini muscle and eustachian tube function . Plast Reconstr Surg . 1990;85:684-692.Crossref 8. Finkelstein Y, Talmi PY, Hauben JD, et al. Evaluation of the normal and insufficient velopharyngeal valve by the forced sucking test . Laryngoscope . 1991;101:1203-1212.Crossref 9. Finkelstein Y, Talmi YP, Bar Ziv J, Zohar Y. Otitis media with effusion as a presenting symptom of chronic sinusitis . J Laryngol Otol . 1989;103:827-832.Crossref 10. Golding-Kushner KJ, Argamaso RV, Cotton RT, et al. Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an international working group . Cleft Palate Craniofac J . 1990;27:337-348.Crossref 11. Arvystas M, Shprintzen RJ. Craniofacial morphology in the velo-cardio-facial syndrome . J Craniofac Genet Dev Biol . 1984;4:39-45. 12. Finkelstein Y, Lerner MA, Zohar Y, et al. Nasopharyngeal profile and velopharyngeal valve mechanism . Plast Reconstr Surg . 1993;93:603-614.Crossref 13. Calnan J. Submucous cleft palate . Br J Plast Surg . 1954;6:264-272.Crossref 14. Finkelstein Y, Hauben DJ, Talmi PY, Nachmani A, Zohar Y. Occult and overt submucous cleft palate: from peroral examination to nasendoscopy and back again . Int J Pediatr Otorhinolaryngol . 1992;23:25-34.Crossref 15. Croft CB, Shprintzen RJ, Daniller A, Lewin ML. The occult submucous cleft palate and the musculus uvulae . Cleft Palate Craniofac J . 1978;15:150-154. 16. Lewin ML, Croft CB, Shprintzen RJ. Velopharyngeal insufficiency due to hypoplasia of the musculus uvalae and occult submucous cleft palate . Plast Reconstr Surg . 1988;65:585-591.Crossref 17. Shprintzen RJ, Goldberg RB, Lewin ML, et al. A new syndrome involving cleft palate, cardiac anomalies, typical facies, and learning disabilities: velo-cardio-facial syndrome . Cleft Palate Craniofac J . 1978;5:56-62. 18. Iseberg AM. Henningsson GE. Intraindividual change in the occurrence of Passavant's ridge due to change in velopharyngeal sphincter function: a videofluoroscopic study . Cleft Palate Surg . 1990;27:253-255.Crossref 19. Morris HL. The speech pathologist looks at the tonsils and the adenoids . Ann Otol Rhinol Laryngol . 1975;84( (suppl 19) ):63-66. 20. Fritzell B. The velopharyngeal muscles in speech . Acta Otolaryngol (Stockh) . 1969;250( (suppl) ):1-77. 21. Kuehn DP, Folkins JW, Cutting CB. Relationships between muscle activity and velar position . Cleft Palate Craniofac J. 1983;19:25-35. 22. Cosman B, Arlene SF. Pharyngeal flap augmentation . Plast Reconstr Surg . 1975; 55:149-155.Crossref 23. Owsley JQ, Lawson LI, Chierici GJ. The re-do pharyngeal flap . Plast Reconstr Surg. 1976;57:180-185.Crossref

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Aug 1, 1994

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