(0737) The Effect of Pharyngeal Augmentation on Nasometry Scores in Head and Neck Cancer Survivors

Introduction: Hypernasality is a common speech pathology in head and neck cancer (HNC) survivors and indicates the presence of velopharyngeal dysfunction (VPD) and the inability of the pharynx and soft palate to achieve closure. Injection pharyngeal augmentation (PA) represents an option for adding occlusive bulk at the velopharynx.

Methods: HNC survivors undergoing PA were included and nasometry was conducted before and after the PA procedure. In-office Injection PA utilized Hyaluronic acid (Restylane) or Calcium hydroxyapatite (CaHA) as filler medium. Subject speech was elicited for oral and nasal “ah” and “I” with included consonants along with prolonged vocalization. Nasalance scores were recorded for 18 vocal tasks by a Speech and Language Pathologist.

Results: In total, 40 head and neck cancer survivors met inclusion criteria, of which 75% were male (n=30) and had a mean age of 65.9 years (±9.1 year). The most common primary site of head and neck cancer was the oropharynx (n = 23, 57.5%) followed by oral cavity (n=7, 17.5%), and the larynx (n=2, 5.0%). Patients had received radiation (75%), either as Surgery with chemoradiation (CRT) (15%), Surgery with radiation (RT) (35%), CRT only (25%) or RT only (5%) and two were treated surgically. In total, 29 subjects saw improvements in their mean nasometry scores. Significant reductions in nasalance scores were seen for oral “a” sounds (p = 0.037), oral “i" sounds (p = 0.026) and prolonged sounds (p = 0.029). These improvements were specifically observed in the oral consonants such as pa, ta, ka, sa, pi, ti, ki, si, shi and prolonged “eee” (p < 0.05). Categorical improvements in oral “i” nasalance scores correlated significantly with subjective improvements in speech quality (p=0.002) and with subjective improvement in nasopharyngeal reflux events (p = 0.020).

Conclusions: Pharyngeal augmentation is an effective intervention for the treatment of hypernasality of speech in survivors of head and neck cancer. The prospective testing of a patient reported outcome measure could delineate improvements in quality of life.