School of Medicine and Health Sciences Poster Presentations

Title

Quality of Life Outcomes Following Surgery for Velopharyngeal Insufficiency

Document Type

Poster

Abstract Category

Clinical Specialties

Keywords

pediatrics, otolaryngology, velopharyngeal insufficiency, quality of life outcomes, pediatric surgery, voice surgery

Publication Date

Spring 5-1-2019

Abstract

Velopharyngeal insufficiency (VPI) alters speech quality and intelligibility which can compromise verbal communication. Treatment of VPI begins with a trial of targeted speech therapy, but the majority of patients with severe insufficiency require surgical intervention. Multiple techniques are utilized, but no evidence exists demonstrating significant differences in quality of life outcomes. Additionally, there is little data identifying preoperative factors associated with outcomes following surgical VPI repair. The Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) survey is a 26-question parental proxy survey assessing quality of life measurements including speech, swallow, emotional impact, perception by others, and caregiver impact. VELO has been validated as an effective measure with high internal consistency and test-retest reliability in English and Spanish. We used the questionnaire to determine which preoperative factors correlated with higher VELO scores following corrective surgery. In our IRB approved study, we identified 51 eligible patients and categorized them by presence/absence of genetic syndrome, presence/absence of submucous cleft abnormality (SMC), severity of hypernasality, and surgical technique. We called parents to administer the VELO survey in English or Spanish. We received 26 responses. Eleven of these patients were male and 15 were female. The average age at surgery was 9.4 years. Analysis of VELO scores between patient groups revealed a significantly higher average among non-syndromic patients compared to their syndromic counterparts (83vs69,p=0.043) specifically in subcategories of speech (p=0.030), swallow (p=0.022), and caregiver impact (p=0.008). There was no significant difference in VELO score between surgical techniques, patients with/without submucous cleft abnormalities, or with mild-moderate versus severe hypernasality of speech. Quality of life in this cohort of patients was improved in patients with non-syndromic VPI after surgery. This is not unexpected, as their syndromic counterparts have comorbidities which may impact the VELO results despite correction of VPI. Surprisingly, there was no difference in VELO between patients with/without SMC. We expect a repaired anatomic abnormality to show higher improvement than functional abnormalities postoperatively. This could be explained by a low sample size as well as confounders including length and intensity of speech therapy. Limitations to this study include subjectivity in analyzing parents’ attitudes, which may be discordant with patients’ perceptions of their condition. Furthermore, retrospective collection of VELO scores at different times postoperatively predisposes to recall bias. Prospective research is necessary to explore impacts of medical and surgical therapies in different patient groups to optimize quality of life in children with VPI

Open Access

1

Comments

Presented at Research Days 2019.

This document is currently not available here.

Share

COinS
 

Quality of Life Outcomes Following Surgery for Velopharyngeal Insufficiency

Velopharyngeal insufficiency (VPI) alters speech quality and intelligibility which can compromise verbal communication. Treatment of VPI begins with a trial of targeted speech therapy, but the majority of patients with severe insufficiency require surgical intervention. Multiple techniques are utilized, but no evidence exists demonstrating significant differences in quality of life outcomes. Additionally, there is little data identifying preoperative factors associated with outcomes following surgical VPI repair. The Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) survey is a 26-question parental proxy survey assessing quality of life measurements including speech, swallow, emotional impact, perception by others, and caregiver impact. VELO has been validated as an effective measure with high internal consistency and test-retest reliability in English and Spanish. We used the questionnaire to determine which preoperative factors correlated with higher VELO scores following corrective surgery. In our IRB approved study, we identified 51 eligible patients and categorized them by presence/absence of genetic syndrome, presence/absence of submucous cleft abnormality (SMC), severity of hypernasality, and surgical technique. We called parents to administer the VELO survey in English or Spanish. We received 26 responses. Eleven of these patients were male and 15 were female. The average age at surgery was 9.4 years. Analysis of VELO scores between patient groups revealed a significantly higher average among non-syndromic patients compared to their syndromic counterparts (83vs69,p=0.043) specifically in subcategories of speech (p=0.030), swallow (p=0.022), and caregiver impact (p=0.008). There was no significant difference in VELO score between surgical techniques, patients with/without submucous cleft abnormalities, or with mild-moderate versus severe hypernasality of speech. Quality of life in this cohort of patients was improved in patients with non-syndromic VPI after surgery. This is not unexpected, as their syndromic counterparts have comorbidities which may impact the VELO results despite correction of VPI. Surprisingly, there was no difference in VELO between patients with/without SMC. We expect a repaired anatomic abnormality to show higher improvement than functional abnormalities postoperatively. This could be explained by a low sample size as well as confounders including length and intensity of speech therapy. Limitations to this study include subjectivity in analyzing parents’ attitudes, which may be discordant with patients’ perceptions of their condition. Furthermore, retrospective collection of VELO scores at different times postoperatively predisposes to recall bias. Prospective research is necessary to explore impacts of medical and surgical therapies in different patient groups to optimize quality of life in children with VPI