Monday, November 26, 2012

Hypernasality/VPD

Today's appointment at the ENT was a bit surprising. First of all, let me give the boys props for being SO good at the appointment. They each sat in the chair and allowed the doctor to poke and prod both of their ears, mouths and noses without any resistance - thank goodness!

The boys each have the exact same problems. They both have ear infections right now (um, what?!) and they both have Hypernasality - Velopharyngeal Dysfunction (VPD).

First, the ear infections... I was shocked! I know the boys started a cold this weekend, but there have been no fevers or even much of a runny nose. The boys were active, happy and being their crazy 4 yr old selves. I felt like the worst parent in the world! The doc said that he believes there may be drainage issues, and that the boys are used to the feeling in their ears, so they don't act differently - so there's no way to know until it gets to the point of a fever or lingering cold.
He put them both on Amoxacillin for the next 10 days, and wants to re-test their hearing and have a re-examination in 6 weeks. If the problem continues to be chronic (he will check again 6 weeks after that) we will discuss tubes. He was actually surprised to learn that Jax passed his hearing test 6 weeks ago. He thinks that a drainage issue lends to a lot of hearing issues, which then lends to speech issues. If a child goes in and out of proper hearing, they have articulation issues. So if this is a problem, clearly tubes will be necessary.

The other issue of the Hypernasality is trickier. We don't know to what extent of it is adding to the boy's speech issues, and we don't know what exactly is creating the malfunction (length of soft palate or palate not closing all the way). So rather than performing a scope on the boys today, only to have to do it again, the doctor decided to only do one scope with a cranial-facial team. There's a team at Children's Hospital that specializes in children with cleft palates. Now obviously the boys don't have cleft palates, but they speak very similar to that of a child who does have one. Oddly, this is what the boy's teacher told me a few months ago. I've told a few people over the past 2 years that Brady has an underlying 'sound' to him that always really bothered me and seemed off, but I didn't know how to even describe it.
So this team will meet with the boys and decide who performs the scope, and if a speech therapist will also be on hand to help during the process. I believe the scope is done on the child awake, and it's a camera that goes down their nose. The camera will watch the soft palate perform during speech exercises.

The doctor asked if the boys have food come out of their noses during drinking or eating and I said no, but Jax often vomits out of his nose (he did this morning). After I left, I realized that Brady used to reflux out of his nose as a baby - so I wonder of course if this is a reason. He had the boys say particular words, and the moment they said them, he nodded and said he can hear it very easily. (Hear what? Air escaping?) The two women in the room with him both nodded in agreement that the boys definitely had Hypernasality like their speech therapist had thought.

I told the doctor that Brady was diagnosed with Apraxia, and Jax may too in a few months when he has his appointment, so wouldn't THAT be the speech issue? He said that Apraxia can definitely be another symptom of VPD because sometimes the soft palate doesn't close all the way due to a neurological issue - which is what Apraxia is, so it all sort of can play together. Apparently many people in a family can have Velopharyngeal Dysfunction with the palate not closing all the way, but they can work through it with therapy by training the palate to close enough so that the dysfunction is only detectable with small articulation problems - therefore a thorough exam is never sought out. Also, the possible drainage issue that the boys have is apparently something that often happens with VPD, which I'm not sure how/why - that was a lot of info to take in by myself.

I'm supposed to hear from the team within a week. So I wonder what will come of all this. They will either say the problem can be worked through with proper speech therapy, or surgical intervention needs to happen.

3 comments:

Momma Bird said...

As I have said before, I am a speech therapist so feel free anytime to just sent me a quick question if you don't understand something...I would be happy to help. I know for me I sometimes thing of questions AFTER I leave the office for my kids or I forget them when I go! Best of luck to your adorable boys. Glad to hear you may finally be getting a few answers!

Melissa said...

Cassie had a cleft palate, we saw Dr Jensen at Children's. I'm assuming you will see him or Dr Denny. We still go to children's for speech to make sure she is not having air escape out her nose when she talks. Currently she has some air escape, we don't hear it but can see it when the speech therapist holds a spoon under her nose.

Melissa said...

And when they say they can hear air escaping with certain words,.... example ,when you say "p" all the air should blow out of the mouth, a child with cleft palate the air escapes out the nose and you can hear this happen.