Listener judgments did not identify a nasal reso­nance problem in this group of UPPP subjects as might be expected on the basis of the velopharyngeal tissue removed. It appears that velopharyngeal func­tioning was adequate for the production of speech following UPPP. This finding does not conclusively rule out that velopharyngeal functioning was normal for all activities in that nasal regurgitation did occur in these subjects at least up to three months postopera- tion.

Speech performance depends on a number of physiologic variables that interact and not just the ability of an individual to achieve complete velopha­ryngeal closure during the production of single words. It may be that the inability to completely close the velopharyngeal port did occur in these subjects follow­ing UPPP, as suggested by the nasal regurgitation of liquids and some solids and also by the measured nasal air emission, but these subjects may perform well with regard to nasal-oral resonance balance for speech due to their adequate anatomic configuration of the oral and nasal cavities and the ability of the speech structures to adapt to the modified anatomic environment. Such adaptation has been referred to as “plasticity.”

This study revealed that phonation (voice or laryn­geal) disorders, and to a lesser extent articulation disorders, were present in these subjects following UPPP The presence of speech disorders in this population may not necessarily be a result of the UPPP surgery, as speech problems also were identified in sleep apnea subjects who had not undergone UPPP surgery. Viagra Soft Tabs

Related to the identification of phonation disorders in these subjects may be the presence of persistent oropharyngeal dryness that could result in surface irritation of the vocal folds. Several factors may account for this dryness: 1) increased airflow into the oropha­ryngeal and laryngeal area from reconstructed nasal passages; 2) removal of turbinates, as is done in many UPPP patients, depriving the air entering the pharyn­geal and laryngeal area of its natural filtering, temper­ature control, and humidifying system; 3) removal of the uvula, thus eliminating some mucus-secreting glands; 4) the entrance of foreign particles into the laryngeal airway during nocturnal obligate mouth breathing which occurs as the patient is gasping for air while attempting to terminate the apneic episode; and 5) any agent or condition resulting in generalized dryness (medication, alcohol).

In addition to dryness, snoring might be related to voice disorders in this population. Loud and intense snoring is common in the apneic population. In the patient with long standing sleep apnea the pharyngeal tissue has undergone years of continuous vibration during snoring. Swelling of the soft tissues might occur. If this swelling is generalized to the laryngeal area, vocal fold mass might increase and pathology might result.

Minor articulation problems were found in this group of apnea subjects. Although Monoson et al identified significant articulation problems in their apnea subjects, they indicated that phonation was the most influential factor in identifying the apnea group. Our findings are in agreement with those of Monoson and colleagues. The subjects in the present study also exhibited a more severe phonation disorder, whereas articulation problems were relatively mild.

Nonspeech oropharyngeal aspects also were of in­terest in this study. Severe difficulty with swallowing was common for almost all the subjects immediately following UPPP surgery. This is not an unexpected finding due to the surgical procedure performed. The subjects also complained of problems with gagging and choking extending beyond the three-month post­operative period.
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In relation to the continued problems of swallowing difficulty, nasal regurgitation, choking and gagging after three months, a sensory impairment may be implicated following UPPP Cutaneous sensory recep­tors in the oropharyngeal area may have been com­pletely removed or significantly reduced as a result of the UPPP surgery. This may be particularly important when one considers the swallowing and gagging prob­lems.