Mind the Gap: How Velopharyngeal Gap Size Influences Consonant Accuracy
Taylor D. Snodgrass, Elizabeth Alvarez-Montoya, Megan Donner, Kelly Nett Cordero, Jamie L. Perry, Jenny Philp, Davinder J. Singh, Thomas J. Sitzman, Jessica L. Chee-WilliamsObjective
Assess if velopharyngeal gap size during speech is associated with consonant accuracy and whether hypernasality severity and compensatory misarticulation errors (CMAs) mediate this relationship.
Design
Cross-sectional.
Setting
Metropolitan hospital.
Participants
Eighty-one patients undergoing assessment for velopharyngeal insufficiency (VPI).
Assessment(s)
Each patient completed a preoperative magnetic resonance imaging protocol during sustained /i/ production and a perceptual speech evaluation. Velopharyngeal gap size was measured in millimeters. Hypernasality was rated using the Cleft Audit Protocol for Speech-Augmented-Americleft Modification. Percent consonants correct (PCC) and percent of CMAs used were derived from transcriptions of the American English sentence or phrase sample.
Main Outcome Measure(s)
A generalized structural equation model was used to examine whether velopharyngeal gap size is associated with PCC indirectly through hypernasality severity and CMA use.
Results
Larger velopharyngeal gap sizes were associated with more severe hypernasality (
Conclusions
These findings suggest hypernasality severity is the key mediator between gap size and speech accuracy. Patients with more severe hypernasality may benefit from timely surgical remediation of VPI to increase overall consonant accuracy.