口蓋裂音声二次修正法としての SPEECH AID と咽頭弁手術の比較に関する研究

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Four dimentional clinical studies, chiefly by hearing test of nasality, articulation, and intelligibility, were presented in order to compare and discuss the efficacy of speech aid appliance and pharyngeal flap operation. Analysis by soundspectrograph and respiratory leak value by manometer were observed as the objective evaluations of hearing test. And the muscle stimulation of speech aid appliance was investigated by radiocephalometric measurements. These studies employed 26 subjects who had been treated by speech aid appliance, and 26 subjects who had been treated by pharyngeal flap operation. 15 subjects in these were operated after the speech aid application for a period of time. The observational period was 1 week to 5 months after speech aid application, and 1 week to 3 months after pharyngeal flap operation. The long term follow up observation was made of 15 subjects for 6 to 12 months after pharyngeal flap operation. The results were as follows ; 1. The pharyngeal flap operation was more effective than speech aid appliance in comparison of hearing test, of analysis by soundspectrograph, and of respiratory leak values by manometer. Nasality and nasal emission persisted in more than half of the subjects with speech aid appliance, while in the majority of the subjects who had pharyngeal flap operation, nasality and nasal emission were eliminated in 1 week to 12 months after the operation. 2. The improvements were most remarkable in 1 week to 1 month after speech aid application or pharyngeal flap operation. Thereafter, the improvements by speech aid appliance were unstable for deterioration after amelioration. However, the improvements by pharyngeal flap operation were stable or further improved. 3. Normal speech without nasality or articulatory error could not be achieved by speech aid application. On the other hand, 8 subjects with pharyngeal flap operation acquired normal speech. 4. Analysis by soundspectrograph confirmed the above results and showed better ameliorated pattern by pharyngeal flap operation than by speech aid application. 5. Nasality reduction was related to age and function of velopharyngeal muscle. The subjects, who were younger than 15 or able to move the muscle during phonation, were improved sufficiently by speech aid application or pharyngeal flap operation. Especially, the function of lateral pharyngeal wall is most related to nasality reduction. In all subjects who had the mobility of lateral wall during phonation, nasality disappeared after pharyngeal flap operation. The other subjects did not acquired desirable amelioration by speech aid appliance, but some of these were ameliorated by pharyngeal flap operation. 6. The efficacy of speech aid appliance was mainly related to its pharyngeal section and factors involving the subjects, and the efficacy of pharyngeal flap operation was thought to be ralated chiefly to operator's technique. Therefore, proper selection of subjects is thought the most important factor for speech aid application. Pharyngeal flap operation does not require any criteria for subjects, except for the problem of general contraindication for surgical operation. 7. Muscle stimulation of speech aid appliance was observed by radiocephalometric measurements in several subjects whom the speech aid appliance was applied over 2 months. On the bases of these results and training for articulatory correction and removability feature of the speech aid appliance, it is thought that the temporary use of speech aid appliance before pharyngeal flap operation is better procedure to ameliorate the efficacy after operation. When this procedure is employed, the selection of subjects is an important factor for its success.
九州歯科学会の論文
1973-11-30

口蓋裂音声二次修正法としての SPEECH AID と咽頭弁手術の比較に関する研究

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