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Head and Neck Surgery

Nasalance After Pharyngeal Augmentation in Head and Neck Cancer Patients

Monday, October 2, 2023
8:30 AM - 8:36 AM East Coast USA Time
Location: 201AB

    Co-Author(s)

  • Veena Kallambettu, MA, CCC-SLP, BCS-S

    Speech-Language Pathologist
    The Ohio State University Wexner Medical Center
    Powell, OH, United States

    • Presenting Author(s)

  • Apoorva T. Ramaswamy, MD

    Assistant Professor
    Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio - James Cancer Center at Ohio State University Medical Center, Columbus, Ohio
    Columbus, OH, United States

Introduction: Velopharyngeal dysfunction (VPD) is a common deficit following treatment for head and neck cancer and its management is surprisingly understudied. In this retrospective study, we analyze nasalance outcomes following in-office augmentation to the posterior pharyngeal wall.

Methods: A retrospective review was completed for patients who underwent in office pharyngeal augmentation between October 2022 to January 2023. 83 patients underwent pharyngeal augmentation. Of these, 6 had pre- and post-procedural nasalance assessments. Pharyngeal augmentation was completed in office under visualization with nasopharyngoscopy. A 22-gauge needle was utilized to inject calcium hydroxylapatite into the posterior pharyngeal wall. Speech assessment was completed using a nasometer and a standardized speech protocol. Patients were instructed to say a set of oral consonant + vowel syllable words (e.g., pa, ta, ka) into the nasometer. Nasalance scores were generated via the computerized program. Means were obtained to assess change in nasalance. A paired t-test was completed to assess pre and post outcomes.

Results: In this pilot study, 100% of patients demonstrated improvement in nasalance scores post procedure. This was found to be statistically significant (p = .03, t =3.14, df =5). Endoscopically, good augmentation was noted with decreased endoscopic evidence of nasopharyngeal reflux with thin liquids across all patients. 1 patient whose score did not improve initially returned to clinic in 1 month and received a second augmentation following which his nasalance scores fell within normal limits. All patients were provided with post-operative antibiotics and steroids and 0 patients presented with any post-operative complications.

Conclusions: Pharyngeal augmentation is a minimal risk, yet effective procedure to improve velopharyngeal closure in patients experiencing hypernasality following radiation for head and neck cancer. Objective evaluation via nasometry can serve as an effective method of assessing change following augmentation.