Técnica de correção de hipernasalidade causada por adenoidectomia

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Abstract

A tonsila faríngea quando aumentada, pode causar obstrução nas vias aéreas superiores e levar à respiração bucal de suplência¹. Em alguns casos adenoidectomia e/ou adenoamigdalectomia são indicadas para remoção do fator obstrutivo, possibilitando a respiração nasal. Temos observado que algumas crianças mesmo sem apresentar queixas e/ou alterações vocais no período pré-operatório, desenvolvem uma qualidade vocal hipernasal após adenoidectomia12. Este artigo tem como objetivo descrever um caso de hipernasalidade após adenoidectomia e relatar o tratamento fonoaudiológico, bem como, os possíveis riscos e seqüelas após o procedimento cirúrgico.

Translated abstract

Hipertrophic adenoid is a frequent cause of obstruction of the upper respiratory tract and may lead to a mouth breathing condition. in some cases, surgical procedures such as adenoidectomy and or tonsillectomy are necessary to reestablish the nasal breathing. We have observed that following adenoidectomy, many children present with vocal hipernasality, even when there is no previous history or complains. In this paper, the authors describe a case of severe hipernasality following adenoidectomy, as well as detailed steps of the speech therapy approach. The risks and sequelae of this vocal condition related to adenoidectomy are also discussed.

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Most cited references 13

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Velopharyngeal incompetence and persistent hypernasality after adenoidectomy in children without palatal defect.

G Henningsson, A M Isberg, Y. Ren (1995)

Persistent hypernasal speech after adenoidectomy has been reported in children with palatal deficiency. Hypernasality after adenoidectomy can also occur in children with normal palatal function. The aim of the present study was to identify the cause of velopharyngeal incompetence and hypernasality after adenoidectomy in children who did not have palatal defect as a predisposing factor. Sixteen children who developed hypernasality after adenoidectomy were included in the present study. Standard lateral cephalometry, videofluoroscopy, and nasopharyngoscopy were performed to visualize the velopharynx and its function during speech. The results showed that enlarged tonsils and prominent remaining adenoid tissue on the posterior pharyngeal wall were the causes of hypernasality in these children. Incomplete removal of the adenoid tissue should be avoided and enlarged tonsils should be removed at the time of adenoidectomy to prevent the risk for postoperative hypernasality.

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Adenoid involution and developing hypernasality in cleft palate.

R. Mason, D W Warren (1980)

Information about the adenoid mass is reviewed, and the phenomenon of gradual development of hypernasality as a result of adenoidal involution is described in two patients selected from a sample of 122 with repaired cleft palate. Three types of radiographically determined closure patterns of the velum against the adenoid pad are presented. Our clinical experience suggests that the results of aerodynamic studies, completed on a longitudinal basis, may identify patients who are at risk in maintaining normal resonance balance one year or more in advance of perceptual or radiographic evidence of velopharyngeal incompetency.