The Value of Videofluoroscopy in the Clinical Assessment of Velopharyngeal Insufficiency.
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Introduction. Velopharyngeal insufficiency (VPI) is a complex abnormality and should be assessed carefully. Well-executed visualizing assessments such as nasendoscopy and videofluoroscopy can provide valuable information for further treatment decisions, if the four goals of velopharyngeal assessment are met (structure, movement, extent of closure, and timing). Nasendoscopy is the reference standard of visualizing instruments in VPI diagnostics, although it cannot provide objective values. One crucial advantage of videofluoroscopy is the possibility of obtaining measurement ratios and reaching objective and comparable assessment outcomes. However, in clinical practice it is not clear what value videofluoroscopy has in VPI assessment next to nasendoscopy, in terms of usability, the four goals and decisions of further treatment. Methods. In three meetings specialists of the CLPT analyzed retrospective material, videofluoroscopic recordings (n=22), on usability, the four goals and further treatment decisions. Inclusion of participants was based on availability of videofluoroscopies. Paired nasendoscopies (n=15) were rated based on the same criteria. Recordings declared as usable were graded on the four goals based on severity scales. Treatment decisions were also made based on patients’ history, speech components and recordings. The ratings were summarized and represented in percentages. In subgroup analyses usable videofluoroscopies and nasendoscopies were set in relation to the four goals and treatment decisions. Results. Based on the quality of the recording 12/22 videofluoroscopies and 4/15 nasendoscopies were not to moderately usable. In videofluoroscopies the majority is not to mildly abnormal but proportionally more surgical treatment decisions were made. Discussion. Recordings included in this study did not have an added value in the VPI assessment. They may even result in unnecessary burdening surgeries. However, to support this statement, more research is needed. For prevention of unusable recordings research and clinical practice should concentrate on standardization of videofluoroscopic assessment.