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BACKGROUND: COVID-19 comprises a respiratory infection resulting from contamination by SARS-CoV-2, with acute respiratory failure being one of its main characteristics, leading to a high frequency of orotracheal intubation (OTI), which in turn increases the risk for dysphagia. Since this can lead to pulmonary impairment, knowing the real occurrence of dysphagia in part of the Brazilian population and its associations allows early and effective clinical management of the multidisciplinary team in relation to patients. OBJECTIVE: To verify the occurrence of dysphagia in COVID-19-positive adult patients in two Brazilian reference hospitals in the care of the pandemic. METHODS: This was a prospective, longitudinal observational study carried out in two private hospitals in Brazil, both references in the care of patients with coronavirus isolation. Data were initially collected by consulting the medical records of each patient. Information was collected regarding sex, age, previous diseases, COVID-19 testing, and the OTI period. After data collection, the clinical speech-language assessment of swallowing for each patient was carried out using the adapted Gugging Swallowing Screen (GUSS), the ASHA NOMS and the Functional Oral Intake Scale (FOIS). RESULTS: A total of 129 participants were evaluated, with a mean age of 72 years. According to the GUSS scale, 9.3% of the patients presented normal/functional swallowing, while 90.7% presented dysphagia, with mild dysphagia in 17.05%, moderate dysphagia in 33.33%, and severe dysphagia in 37.98%. As for the results of the ASHA NOMS, the majority (36.5%) of the patients were at level 1, which represents the patient who is not able to receive his or her food supply orally, having the need to use tube feedings. This is in line with the results observed with the FOIS scale, whereby most patients (42.1%) were classified as Level I, when food intake occurs exclusively through feeding tubes, with no oral supply. Of the 129 participants, 59% of them required OTI. When comparing the time of OTI and the severity of dysphagia, there was a statistically significant difference, with more severe dysphagia, the longer the patient remained intubated. CONCLUSION: There is a high incidence of oropharyngeal dysphagia in patients with COVID-19, with increased severity during longer periods of OTI.

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ABSTRACT Background COVID-19 comprises a respiratory infection resulting from contamination by SARS-CoV-2, with acute respiratory failure being one of its main characteristics, leading to a high frequency of orotracheal intubation (OTI), which in turn increases the risk for dysphagia. Since this can lead to pulmonary impairment, knowing the real occurrence of dysphagia in part of the Brazilian population and its associations allows early and effective clinical management of the multidisciplinary team in relation to patients. Objective To verify the occurrence of dysphagia in COVID-19-positive adult patients in two Brazilian reference hospitals in the care of the pandemic. Methods This was a prospective, longitudinal observational study carried out in two private hospitals in Brazil, both references in the care of patients with coronavirus isolation. Data were initially collected by consulting the medical records of each patient. Information was collected regarding sex, age, previous diseases, COVID-19 testing, and the OTI period. After data collection, the clinical speech-language assessment of swallowing for each patient was carried out using the adapted Gugging Swallowing Screen (GUSS), the ASHA NOMS and the Functional Oral Intake Scale (FOIS). Results A total of 129 participants were evaluated, with a mean age of 72 years. According to the GUSS scale, 9.3% of the patients presented normal/functional swallowing, while 90.7% presented dysphagia, with mild dysphagia in 17.05%, moderate dysphagia in 33.33%, and severe dysphagia in 37.98%. As for the results of the ASHA NOMS, the majority (36.5%) of the patients were at level 1, which represents the patient who is not able to receive his or her food supply orally, having the need to use tube feedings. This is in line with the results observed with the FOIS scale, whereby most patients (42.1%) were classified as Level I, when food intake occurs exclusively through feeding tubes, with no oral supply. Of the 129 participants, 59% of them required OTI. When comparing the time of OTI and the severity of dysphagia, there was a statistically significant difference, with more severe dysphagia, the longer the patient remained intubated. Conclusion: There is a high incidence of oropharyngeal dysphagia in patients with COVID-19, with increased severity during longer periods of OTI.

RESUMO Contexto A COVID-19 compreende uma infecção respiratória decorrente da contaminação pelo vírus SARS-CoV-2, sendo a insuficiência respiratória aguda uma de suas principais características, levando a uma alta frequência de intubação orotraqueal (IOT), que por sua vez aumenta o risco para a disfagia. Uma vez que esta pode levar ao comprometimento pulmonar, conhecer a real ocorrência de disfagia em parte da população brasileira e suas associações permite o manejo clínico precoce e eficaz da equipe multidisciplinar em relação aos pacientes. Objetivo: Verificar a ocorrência de disfagia em pacientes adultos positivos para COVID-19 em dois hospitais brasileiros, referências no atendimento à pandemia. Métodos: Trata-se de um estudo prospectivo, observacional longitudinal, realizado em dois hospitais privados no Brasil, ambos referências no atendimento de pacientes com isolamento por coronavírus. Inicialmente os dados foram levantados por meio de consulta aos prontuários de cada paciente. Foram também coletadas informações sobre sexo, idade, doenças anteriores, teste de COVID-19 e período de IOT. Após a coleta de dados, foi realizada a avaliação fonoaudiológica clínica da deglutição de cada paciente por meio do Gugging Swallowing Screen (GUSS) adaptado, do ASHA NOMS e da Functional Oral Intake Scale (FOIS). Resultados Foram avaliados 129 participantes, com média de idade de 72 anos. De acordo com a escala GUSS, 9,3% dos pacientes apresentaram deglutição normal/funcional, enquanto 90,7% apresentaram disfagia, sendo esta de grau leve em 17,05%, moderado em 33,33% e grave em 37,98%. Quanto aos resultados do ASHA NOMS, a maioria (36,5%) dos pacientes encontrava-se no nível 1, que representa o paciente que não consegue receber alimentação por via oral, tendo a necessidade do uso de alimentação por sonda. Esse dado está de acordo com os resultados observados com a escala FOIS, em que a maioria dos pacientes (42,1%) foi classificada como nível I, quando a ingestão de alimentos ocorre exclusivamente por sondas, sem oferta por via oral. Dos 129 participantes, 59% deles necessitaram de IOT. Ao comparar o tempo de IOT e a gravidade da disfagia, encontrou-se diferença estatisticamente significante, sendo que quanto mais grave a disfagia, maior o tempo que o paciente permaneceu intubado. Conclusão Existe alta incidência de disfagia orofaríngea em pacientes com COVID-19, com maior gravidade durante períodos mais longos de IOT.

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RESUMO Objetivo verificar os desfechos de deglutição e alimentação de pacientes pediátricos submetidos à intubação orotraqueal (IOT) prolongada, considerando aqueles que evoluíram para traqueostomia após. Métodos estudo de coorte retrospectivo, realizado por meio da análise de prontuários de pacientes admitidos em Unidade de Terapia Intensiva Pediátrica e acompanhados até a alta hospitalar, entre março de 2017 e dezembro de 2018. Resultados dos 51 pacientes incluídos, 64,7% eram do gênero masculino e a mediana de idade foi de 6,7 meses. Pacientes submetidos à IOT por mediana de sete dias apresentaram disfagia orofaríngea (DOF) leve e, quando submetidos a mais de 14 dias, apresentaram DOF moderada/grave, distúrbio alimentar pediátrico (DAP) com características de recusa alimentar e contraindicação de alimentação por via oral na alta hospitalar. Dentre os pacientes, 74,5% foram submetidos apenas à IOT e 25,5% evoluíram para traqueostomia, após. Pacientes traqueostomizados apresentaram maior ocorrência de alta hospitalar com DOF moderada/grave, DAP com características de recusa alimentar e uso de via alternativa de alimentação, em comparação a pacientes sem traqueostomia (p=0,001). Comparado ao diagnóstico inicial, pacientes não traqueostomizados tiveram diagnóstico final com graus mais leves de disfagia (p<0,001). Conclusão o tempo de IOT e a presença de traqueostomia são fatores associados ao diagnóstico fonoaudiológico de DOF moderada/grave, à presença de sinais de DAP com características de recusa alimentar e à necessidade de via alternativa de alimentação, persistentes até a alta hospitalar, sendo achados fonoaudiológicos frequentes entre os desfechos de deglutição/alimentação em pediatria.

ABSTRACT Purpose To verify the swallowing and feeding outcomes of pediatric patients undergoing prolonged OTI, considering those who progressed to tracheostomy afterward. Methods Retrospective cohort study, carried out by analyzing the medical records of patients admitted to the Pediatric ICU and followed up until hospital discharge, between 03/2017 and 12/2018. Results Of the 51 patients included, 64.7% were male and the median age 6.7 months. Patients undergoing OTI for a median of 7 days had mild dysphagia and when submitted for more than 14 days had moderate/severe dysphagia and PFD with characteristics of food refusal, with contraindication to oral feeding at hospital discharge. 74.5% of the patients underwent OTI only and 25.5% progressed to tracheostomy afterward. Tracheostomized patients had a higher occurrence of hospital discharge with moderate/ severe oropharyngeal dysphagia, pediatric feeding disorder (PFD) with characteristics of food refusal and alternative method of feeding compared to patients without tracheostomy (p=0.001). Non-tracheostomized patients had a final diagnosis with milder degrees of dysphagia when compared to the initial diagnosis (p<0.001). Conclusion The time of OTI and the presence of tracheostomy are factors associated with the speech-language pathology diagnosis of moderate/severe oropharyngeal dysphagia, presence of signs of PFD with characteristics of food refusal and the need for an alternative method of feeding that persists until hospital discharge, being frequent findings among the swallowing/feeding outcomes in pediatrics.

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Introduction Dysphagia is a relevant symptom in Parkinson disease (PD), and its pathophysiology is poorly understood. To date, researchers have not investigated the effects of combined motor tasks on swallowing. Such an assessment is of particular interest in PD, in which patients have specific difficulties while performing two movements simultaneously. Objective The present study tested the hypothesis that performing concurrent tasks could decrease the safety of swallowing in PD patients as visualized using fiberoptic endoscopic evaluation of swallowing (FEES). Methods A total of 19 patients and 19 controls matched by age, gender, and level of schooling were compared by FEES under two conditions: isolated swallowing and dual task (swallowing during non-sequential opposition of the thumb against the other fingers). The two tasks involved volumes of food of 3 mL and 5 mL. The PD subjects were classified according to the Hoehn & Yahr (H&Y) Scale, the Mini Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). The FEES assessment was performed according to the Boston Residue and Clearance Scale (BRACS). Results The data showed a significant worsening of swallowing in the dual task assessment for both volumes (3 mL: p ≤ 0.001; 5 mL: p ≤ 0.001) in the PD group. A correlation between the MoCA and dual-task swallowing of 3 mL was also found. Conclusion These findings suggest that additional tasks involving manual motor movements result in swallowing impairment in patients with PD. Moreover, these data highlight the need to further evaluate such conditions during treatment and assessment of PD patients.

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Abstract Introduction Dysphagia is a relevant symptom in Parkinson disease (PD), and its pathophysiology is poorly understood. To date, researchers have not investigated the effects of combined motor tasks on swallowing. Such an assessment is of particular interest in PD, in which patients have specific difficulties while performing two movements simultaneously. Objective The present study tested the hypothesis that performing concurrent tasks could decrease the safety of swallowing in PD patients as visualized using fiberoptic endoscopic evaluation of swallowing (FEES). Methods A total of 19 patients and 19 controls matched by age, gender, and level of schooling were compared by FEES under two conditions: isolated swallowing and dual task (swallowing during non-sequential opposition of the thumb against the other fingers). The two tasks involved volumes of food of 3 mL and 5 mL. The PD subjects were classified according to the Hoehn & Yahr (H&Y) Scale, the Mini Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). The FEES assessment was performed according to the Boston Residue and Clearance Scale (BRACS). Results The data showed a significant worsening of swallowing in the dual task assessment for both volumes (3 mL: p ≤ 0.001; 5 mL: p ≤ 0.001) in the PD group. A correlation between the MoCA and dual-task swallowing of 3 mL was also found. Conclusion These findings suggest that additional tasks involving manual motor movements result in swallowing impairment in patients with PD. Moreover, these data highlight the need to further evaluate such conditions during treatment and assessment of PD patients.

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PURPOSE: To describe and characterize a finding, i.e., delayed posterior leakage of food residue during swallowing, according to age, gender and food consistency, which occurred in the event. METHODS: Data were collected through the analysis of each functional videonasoendoscopy test of swallowing previously recorded in a specialist outpatient clinic. The study population included 200 patients, both males and females, aged between 46 and 87 years, with and without an underlying pathology for dysphagia. The images were studied individually by the researcher and analyzed by judges in order to identify and select images that would confirm the presence or absence of the study event. RESULTS: Delayed escape was found in 45 out of the 200 analyzed tests. The tests selected for the study showed delayed posterior bolus leakage in at least one consistency. The highest frequency of delayed posterior leakage occurred with fluids. The analysis showed the significance of the study event with the population related to older ages in the sample analyzed. CONCLUSION: Delayed posterior leakage occurs predominantly in the liquid consistency in older populations with no gender predominance.

OBJETIVO: Descrever e caracterizar um achado, o escape posterior tardio de resíduo alimentar na deglutição, segundo idade, gênero e consistência do alimento, que ocorreu no evento. MÉTODO: A coleta de dados ocorreu por meio da análise de cada exame de videonasoendoscopia funcional da deglutição anteriormente gravado em um ambulatório especializado. A população do estudo contemplou 200 pacientes de ambos os gêneros, na faixa etária entre 46 e 87 anos, com e sem patologia de base para disfagia. As imagens foram estudadas individualmente pelo pesquisador e analisadas por juízes, com o objetivo de identificar e selecionar imagens que constatassem a presença ou ausência do evento em estudo. RESULTADOS: Verificou-se o escape tardio em 45 exames do total de 200 analisados. Os exames selecionados para o estudo apresentaram o escape residual posterior tardio em pelo menos uma consistência. A maior frequência do escape posterior tardio ocorreu com o líquido. A análise mostrou significância do evento em estudo com a população que apresentava idades mais avançadas da nossa amostra. CONCLUSÃO: O escape posterior tardio ocorre predominantemente na consistência líquida, em população mais idosa e sem predomínio de gênero.

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BACKGROUND: Early mobilization is part of the rehabilitation process for critically ill patients and is currently considered a means of preventing ICU-acquired muscle deterioration and worsening of physical function. We sought to determine whether the use of speaking valves in tracheostomized patients would improve their mobility. We evaluated the changes in mobility performance with the use of speaking valves in tracheostomized subjects. METHODS: We performed a cohort study of a series of subjects who were tracheostomized and were being weaned from mechanical ventilation between April 2016 and May 2018. The subjects were those able to tolerate a speaking valve for a minimum of 30 min. Demographic data, comorbidities, cause of ICU admission, days in the ICU, duration of mechanical ventilation before tracheostomy, and days free from mechanical ventilation before tracheostomy were collected. Mobility status was evaluated using daily measurements of the Perme Intensive Care Unit Mobility Score. RESULTS: During the study period, 63 patients were tracheostomized. Patients with deficiencies in language (n = 2) or cognitive deficits (n = 36) and patients in exclusive palliative care (n = 7) were excluded. Eighteen subjects were enrolled in the study. The mean age of the subjects was 64.6 ± 14.2 y (55.5% were male), and the most common reason for ICU admission was pneumonia (n = 7; 38.8%). Perme scores increased from 11.3 (interquartile range 10.1-12.0) on the day before initiation of the speaking valve to 18.2 (IQR 16.2-20.1) immediately after the initiation of a speaking valve (P < .01). These changes were maintained during all periods of speaking valve use. CONCLUSIONS: The use of speaking valves in tracheostomized subjects improved mobility.

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RESUMO Objetivo Descrever e caracterizar um achado, o escape posterior tardio de resíduo alimentar na deglutição, segundo idade, gênero e consistência do alimento, que ocorreu no evento. Método A coleta de dados ocorreu por meio da análise de cada exame de videonasoendoscopia funcional da deglutição anteriormente gravado em um ambulatório especializado. A população do estudo contemplou 200 pacientes de ambos os gêneros, na faixa etária entre 46 e 87 anos, com e sem patologia de base para disfagia. As imagens foram estudadas individualmente pelo pesquisador e analisadas por juízes, com o objetivo de identificar e selecionar imagens que constatassem a presença ou ausência do evento em estudo. Resultados Verificou-se o escape tardio em 45 exames do total de 200 analisados. Os exames selecionados para o estudo apresentaram o escape residual posterior tardio em pelo menos uma consistência. A maior frequência do escape posterior tardio ocorreu com o líquido. A análise mostrou significância do evento em estudo com a população que apresentava idades mais avançadas da nossa amostra. Conclusão O escape posterior tardio ocorre predominantemente na consistência líquida, em população mais idosa e sem predomínio de gênero.

ABSTRACT Purpose To describe and characterize a finding, i.e., delayed posterior leakage of food residue during swallowing, according to age, gender and food consistency, which occurred in the event. Methods Data were collected through the analysis of each functional videonasoendoscopy test of swallowing previously recorded in a specialist outpatient clinic. The study population included 200 patients, both males and females, aged between 46 and 87 years, with and without an underlying pathology for dysphagia. The images were studied individually by the researcher and analyzed by judges in order to identify and select images that would confirm the presence or absence of the study event. Results Delayed escape was found in 45 out of the 200 analyzed tests. The tests selected for the study showed delayed posterior bolus leakage in at least one consistency. The highest frequency of delayed posterior leakage occurred with fluids. The analysis showed the significance of the study event with the population related to older ages in the sample analyzed. Conclusion Delayed posterior leakage occurs predominantly in the liquid consistency in older populations with no gender predominance.

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The primary purpose of this study was to investigate the effect of dual-tasking on swallowing performance and attention in patients with Parkinson Disease (PD). Twenty six participants were included, thirteen patients with PD and thirteen controls matched by age and education. All subjects were evaluated at single swallowing task and attentional dual-tasking. Swallowing parameters were analyzed by using Fiberoptic Endoscopic Evaluation Swallowing Safety Study (FEESS). The attentional dual-tasking was realized using an adaptation of "Stroop color test" on video. Images about swallowing parameters in both conditions were analyzed by three experienced evaluators using literature definitions. Both groups underwent cognitive screening using MoCA. Although significant difference between swallowing parameters in both conditions were not found, in PD group there was an association between changes in parameters according to graduation and cognitive performance. The results show the dual-tasking influence worsening in PD patients with low scores on cognitive screening and low graduation. The results suggest more attention to PD patients that have worse cognitive status and / or low levels of education as the worsening of dysphagia and aspiration risk in performing dual-tasks to feed themselves.

O objetivo principal deste estudo foi investigar o efeito da dupla tarefa atencional no desempenho da deglutição em pacientes com doença de Parkinson (DP). Vinte e seis participantes foram incluídos, treze pacientes com DP e treze controles pareados por idade e escolaridade. Todos os sujeitos foram avaliados em tarefa única de deglutição e dupla tarefa atencional. Os parâmetros da deglutição foram analisados por meio do Fiberoptic Endoscopic Evaluation Swallowing Safety Study (FEESS). O attentional dual-tasking foi realizado usando uma adaptação do "Stroop color test" em vídeo. Imagens sobre os parâmetros de deglutição em ambas as condições foram analisadas por três avaliadores experientes utilizando definições da literatura. Ambos os grupos foram submetidos a triagem cognitiva usando MoCA. Embora não tenha sido encontrada diferença significativa entre os parâmetros da deglutição nas duas condições, no grupo DP foi encontrada associação entre alterações nos parâmetros de acordo com a graduação e desempenho cognitivo. Os resultados mostram que a influência da dupla tarefa piorou nos pacientes com TP, com baixa pontuação na triagem cognitiva e baixa graduação. Os resultados sugerem maior atenção para os pacientes com DP que apresentam pior estado cognitivo e / ou baixos níveis de escolaridade como o agravamento da disfagia e risco de aspiração na realização de tarefas duplas para se alimentar.

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Introdução: A disfagia é um sintoma de alteração no processo da deglutição, que acarreta dificuldade em formar ou mover o bolo alimentar de forma segura e eficiente. Os métodos investigativos da disfagia se dividem em avaliação clínica e instrumental, os quais necessitam de protocolos que conduzam suas práticas. O objetivo desse estudo foi elencar informações acerca dos protocolos utilizados pelos fonoaudiólogos responsáveis pelas avaliações da deglutição em adultos e idosos de um hospital público de referência, compilar elementos norteadores e limitações desses instrumentos e verificar a necessidade da elaboração de um protocolo moldado à instituição. Métodos: Estudo qualitativo realizado em um hospital público de referência. Seis fonoaudiólogos, que executam as avaliações clínicas e instrumentais da deglutição na população adulta e idosa, responderam um questionário, o qual buscou informações acerca dos protocolos utilizados na prática clínica dos participantes. Os dados obtidos foram analisados por meio do método de análise temática do conteúdo. Resultados: Os dados foram agrupados em quatro categorias temáticas: Falta de Itens, Limitações da Oferta, Elementos Norteadores e Limitações ao Exame Instrumental. Todos os participantes afirmaram utilizar protocolos de marcação de dados em suas avaliações, referiram que os mesmos apresentam limitações e confirmaram a necessidade da criação de um protocolo de avaliação moldado às demandas da instituição. Conclusão: Verificou-se a demanda da criação de um protocolo para avaliação clínica e instrumental da deglutição de adultos e idosos, customizado ao hospital estudado. Foram identificados elementos norteadores e limitações nos instrumentos utilizados pelos participantes, os quais contribuirão para a construção de um protocolo moldado à instituição. (AU)

Introduction: Dysphagia is a symptom of abnormality in the deglutition process that leads to difficulty in forming or moving the food bolus safely and efficiently. Investigative methods of dysphagia are divided in clinical and instrumental assessments, which require protocols to conduct their practices. The aim of this study was to list information about protocols used by speech therapists responsible for evaluation of swallowing in adults and the elderly at a public reference hospital, to compile guidelines and limitations of these instruments and to verify the need to elaborate a protocol adapted to the institution's needs. Methods: Qualitative study carried out in a public reference hospital. A total of six speech therapists who perform clinical and instrumental evaluations of swallowing in the adult and elderly population, answered a questionnaire, which sought information about the protocols used in clinical practice of participants. The obtained data were analyzed by the method of thematic content analysis. Results: Data were grouped in four thematic categories: Lacking items, Offer limitations, Guidelines and Limitations to instrumental examination. All participants reported using data collection protocols in their evaluations, mentioned their limitations and confirmed the need for the creation of an assessment protocol to meet the institution's demands. Conclusions: It was verified the demand for the creation of a protocol for the clinical and instrumental evaluation of swallowing in adults and the elderly, customized for the studied hospital. Guidelines and limitations in the instruments used by the participants were identified, which will contribute to the construction of a protocol adapted to the institution. (AU)

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Objetivo Avaliar a viabilidade e segurança da ressonância magnética funcional para a avaliação de áreas corticais envolvidas na deglutição. Estratégia de pesquisa Conduziu-se uma busca entre abril de 2003 e abril de 2013, usando as palavras chave “functional magnetic resonance imaging” or “fMRI” and “dysphagia” e “functional magnetic resonance imaging” or “fMRI” and “swallowing” na base de dados PubMed. Critérios de seleção Os estudos foram revisados por análise de seus títulos e abstracts e os critérios de inclusão utilizados foram: pesquisas envolvendo seres humanos, utilização de exames neurofuncionais, referência à função de deglutição, análise de população adulta e/ou idosa, relação com patologias neurológicas. Resultados A estratégia de busca resultou em 1167 citações, das quais apenas 35 preencheram os critérios de elegibilidade. Conclusão A ressonância magnética funcional foi considerada segura e viável para a avaliação de áreas corticais envolvidas na deglutição. Entretanto, os relatos de utilização de ressonâcia magnética funcional diferiram entre os estudos revisados e houve variabilidade na metodologia utilizada, dificultando as comparações. .

Purpose Evaluate the feasibility and safety of functional magnetic resonance imaging (fMRI) for the evaluation of cortical areas involved in swallowing. Research strategy The search was conducted from April 2003 to April 2013, using the keywords “functional magnetic resonance imaging” or “fMRI” and “dysphagia” and “functional magnetic resonance imaging” or “fMRI” and “swallowing” in “PubMed” database. Selection criteria Studies were reviewed by analyzing their titles and abstracts with the following inclusion criteria: research involving human subjects, use of neurofunctional tests, reference to swallowing function, adult and/or elderly population analysis and association with neurological disorders. Results the search strategy resulted in 1167 citations, from which only 35 met the eligibility criteria. Conclusion the functional magnetic resonance imaging was considered safe and feasible for evaluating cortical areas involved in swallowing. However, the reports of functional magnetic resonance usage differed between the reviewed studies and the variability in the methodology used, made meaningful comparisons difficult. .

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Velopharyngeal dysfunction may cause impaired verbal communication skills in individuals with cleft lip and palate; thus, patients with this disorder need to undergo both instrumental and auditory-perceptual assessments. OBJECTIVE: To investigate the main methods used to evaluate velopharyngeal function in individuals with cleft lip and palate and to determine whether there is an association between videonasoendoscopy results and auditory-perceptual assessments. METHOD: We conducted a systematic review of the literature on instrumental and auditory-perceptual assessments. We searched the PubMed, Medline, Lilacs, Cochrane, and SciELO databases from October to November 2012. SUMMARY OF FINDINGS : We found 1,300 studies about the topic of interest published between 1990 and 2012. Of these, 56 studies focused on velopharyngeal physiology; 29 studies presented data on velopharyngeal physiology using at least 1 instrumental assessment and/or 1 auditory-perceptual assessment, and 12 studies associated the results of both types of assessments. Only 3 studies described in detail the analysis of both methods of evaluating velopharyngeal function; however, associations between these findings were not analyzed. CONCLUSION: We found few studies clearly addressing the criteria chosen to investigate velopharyngeal dysfunction and associations between videonasoendoscopy results and auditory-perceptual assessments...

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The velopharyngeal sphincter (VPS) is a muscle belt located between the oropharynx and the nasopharynx. Investigations of velopharyngeal function should include an auditory-perceptual evaluation and at least 1 instrument-based evaluation such as videonasoendoscopy. AIM: To compare the findings of auditory-perceptual evaluation (hypernasality) and videonasoendoscopy (gap size) in individuals with cleft lip/palate. METHOD: This was a retrospective, cross-sectional study assessing 49 subjects, of both sexes, with cleft lip/palate followed up at the Otorhinolaryngology Service and the Speech Therapy outpatient clinic of Hospital de Clínicas de Porto Alegre (HCPA). The results from the auditory-perceptual evaluation and the videonasoendoscopy test were compared with respect to the VPS gap size. RESULTS: Subjects with moderate/severe hypernasality had more severe velopharyngeal closure impairment than those with a less severe condition. The interaction between hypernasality severity and the presence of other speech disorders (p = 0.035), whether compensatory and/or obligatory, increased the likelihood of having a moderate-to-large gap in the velopharyngeal closure. CONCLUSIONS: We observed an association between the findings of these 2 evaluation methods...

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INTRODUCTION: Velopharyngeal dysfunction may cause impaired verbal communication skills in individuals with cleft lip and palate; thus, patients with this disorder need to undergo both instrumental and auditory-perceptual assessments. OBJECTIVE: To investigate the main methods used to evaluate velopharyngeal function in individuals with cleft lip and palate and to determine whether there is an association between videonasoendoscopy results and auditory-perceptual assessments. METHOD: We conducted a systematic review of the literature on instrumental and auditory-perceptual assessments. We searched the PubMed, Medline, Lilacs, Cochrane, and SciELO databases from October to November 2012. SUMMARY OF FINDINGS: We found 1,300 studies about the topic of interest published between 1990 and 2012. Of these, 56 studies focused on velopharyngeal physiology; 29 studies presented data on velopharyngeal physiology using at least 1 instrumental assessment and/or 1 auditory-perceptual assessment, and 12 studies associated the results of both types of assessments. Only 3 studies described in detail the analysis of both methods of evaluating velopharyngeal function; however, associations between these findings were not analyzed. CONCLUSION: We found few studies clearly addressing the criteria chosen to investigate velopharyngeal dysfunction and associations between videonasoendoscopy results and auditory-perceptual assessments.

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INTRODUCTION: The velopharyngeal sphincter (VPS) is a muscle belt located between the oropharynx and the nasopharynx. Investigations of velopharyngeal function should include an auditory-perceptual evaluation and at least 1 instrument-based evaluation such as videonasoendoscopy. AIM: To compare the findings of auditory-perceptual evaluation (hypernasality) and videonasoendoscopy (gap size) in individuals with cleft lip/palate. METHOD: This was a retrospective, cross-sectional study assessing 49 subjects, of both sexes, with cleft lip/palate followed up at the Otorhinolaryngology Service and the Speech Therapy outpatient clinic of Hospital de Clínicas de Porto Alegre (HCPA). The results from the auditory-perceptual evaluation and the videonasoendoscopy test were compared with respect to the VPS gap size. RESULTS: Subjects with moderate/severe hypernasality had more severe velopharyngeal closure impairment than those with a less severe condition. The interaction between hypernasality severity and the presence of other speech disorders (p = 0.035), whether compensatory and/or obligatory, increased the likelihood of having a moderate-to-large gap in the velopharyngeal closure. CONCLUSIONS: We observed an association between the findings of these 2 evaluation methods.