Eight men and seven women completed the airflow assessment and questionnaire portion of the study. The same subjects with sex and age-matched control subjects were used for the speech record­ings. Five additional UPPP subjects returned the questionnaire but did not participate in the airflow or speech recording aspects of the study. The 20 UPPP subjects had undergone UPPP surgery between 1986 and 1988 in a medium-sized midwestern hospital. Five UPPP subjects had septoplasty and two subjects had nasal turbinectomy. An additional two UPPP subjects had both septo­plasty and turbinectomy. They were between the ages of 28 and 68 years with a mean age of 48.8 years. The control subjects were drawn from the same community as the UPPP subjects and were matched within one year of age.

Airflow Assessment

Airflow assessment included screening measures of nasal air emission. The first screening measure was a mirror fogging test. Each subject was asked to produce nonnasal consonants in isolation, single syllable words and multisyllable words. While holding one nostril closed and placing the mirror below the other, condensation on the mirror was rated as mild, moderate or severe.
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Secondly, a device called the See-Scape was used. With one nostril occluded, a nasal olive was placed in the other nostril. The nasal olive was connected to flexible plastic tubing that led to a rigid plexiglass tube. The plexiglass tube contained a styrofoam ball that rose if nasal airflow entered the tube. As the patient counted, a reading between 0 and 8 was taken on the degree of styrofoam ball elevation within the tube (0=no nasal emission, 8 = maximum nasal emission).

Aerodynamic measurements of velopharyngeal adequacy were obtained by a modified version of an airflow technique described by Warren and DuBois. The adequacy of the velopharyngeal port was assessed by measuring the airflow through it. Nasal airflow was recorded by means of a heated pneumotachograph connected to plastic tubing that fit snugly in the subjects nostril. The other nostril was occluded by a cork stopper. Airflow data were collected while the subject produced ten repetitions of [p^], [s^], and [m^].

Airflow was recorded on a Dynograph ink pen recorder. The airflow measurement equipment was calibrated with a flowmeter (Fischer Porter model 10A). Flow measurements were calibrated to provide full-scale deflection of 80 ml/s for flow (7 mm = 20 ml/s).

Speech Recordings

A stereo cassette recorder (Sony, model TC-FX600) was used to record the speech samples using a pressure zoned microphone (Realistic, model PZ-M). The first paragraph of the Rainbow Passage was used for listener evaluations.

Four experienced speech pathologists were selected to serve as listeners. In the first set of 30 speech samples, the recordings of 15 UPPP subjects and their age and sex-matched controls were played in pairs. The listeners were asked to discriminate between the UPPP and the matched non-UPPP subjects.

In the remaining three sets of 30 samples, the degree of abnormal nasal resonance, articulation, and phonation was judged separately. Nasal resonance logically might be expected to be effected by the UPPP surgery because of the substantial amount of tissue removed. Articulation involves positioning of the tongue, lips and other structures. Phonation is most closely related to laryngeal activity (ie, the approximation of the vocal folds). The latter two parameters, articulation and phonation, conceivably could be affected by the UPPP surgery in an indirect fashion. Moreover, the data of Monoson et al warranted inclusion of these two parameters.

A l-to-7 equally appearing interval scale was used to evaluate nasal resonance, articulation and phonation. A judgment of 1 indicated normal speech and 7 was the most severely disordered speech. Prior to the EAI evaluation, a tape was played to the judges demonstrating the range of severity.
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The listening session was repeated three months following the initial session to determine intra- and interjudge reliability. The 15 paired comparisons for identifying UPPP versus non-UPPP subjects resulted in an inteijudge reliability of 82 percent.

Intrajudge reliability measures for the speech descriptors (pho­nation, articulation, and nasal resonance) were determined by a mean difference score. Across all four judges, the average difference in speech descriptor ratings for session 2 versus session 1 was 0.5 for phonation, 0.3 for articulation, and 0.2 for nasal resonance.


The questionnaire generated for this study (available from au­thors) contained questions which provided information relating to several factors before and after surgery. The subjects were asked to rate the severity of five recovery conditions at one week, one month, and three months following surgery on a scale of 1 to 4 (1 = no problem, 4 = severe problem).