Your Visit | Overview
In order to provide a comprehensive treatment plan, please be prepared for your first appointment to last up to two hours. Expect that your visit will include seeing a speech and language pathologist as well as the otolaryngologist. If this visit is in our Velopharyngeal Dysfunction Clinic, your child will also meet with the plastic surgeon.
Please bring your insurance cards plus any relevant medical documentation such as prior exam reports and endoscopic pictures or speech reports.
- It is very likely your child will need to undergo a videolaryngoscopy, which is camera about the size of a cooked spaghetti, that will go in the nose and down the throat. This is the best way to view the larynx and vocal cords. This procedure does not require sedation but we will use a nasal numbing spray to help with any discomfort. We suggest letting your child know this test may happen in advance so they are prepared for their visit. Prior to the videolaryngoscopy we will review the process with you and your child during the visit and younger children will have the option of sitting on their parents lap to ease any anxiety.
- The nasal numbing spray that is used prior to the videolaryngoscopy leaves an unpleasant taste in the mouth. We encourage you to bring your child's favorite drink or even a hard candy to suck on to help with the taste.
- Because the appointment can last up to 2 hours, we suggest bringing some of your child’s favorite toys, books or activities to help pass the time during the wait period.
- We will record a video of your child’s examination and still frames of the exam will be printed and given to you for your records. We do provide the option to have the complete video of the exam so please let us know that day if that is something you would like to have. At the end of the visit findings are summarized by the team and recommendations are made. A report is created and mailed to the referring pediatrician and/or referring speech clinician.
- If your child’s appointment is on a school day we will be happy to give you school and work excuse note forms when checking out after your visit, so please be sure to ask for one at our front desk.
Please feel free to call or email us. Let us know if there is anything we can do to help ease any fears or concerns you or your child may have before the day of your appointment. Please also let us know if there are any special circumstances we should be aware of.
Note: We ask for any adult attending a visit at Boston Children’s please have a photo ID on them. Adults may be asked to show photo ID prior to entering the hospital.
Voice clinic evaluation
A typical appointment will take up to two hours, including meeting with an ORL physician and with a speech pathologist. The evaluation includes general medical and otolaryngology-specific history and examination performed by Dr. Nuss or Dr. Hseu. A computerized voice analysis is then performed by the speech/voice clinician. We will obtain an acoustic measurement, or digital recording, of your child's voice, which allows for interpretation of fundamental frequency, range, loudness, and other characteristics.
After careful explanation, a videolaryngoscopy is performed and captured digital video images are reviewed with the patient and family. After making an accurate diagnosis, recommendations are made for management of the problem, which may include voice/speech therapy, medical treatment, as well as surgical intervention. We communicate regularly with your referring physician and/or your speech clinician.
Velopharyngeal dysfunction evaluation
A child with velopharyngeal dysfunction (VPD) may demonstrate difficulties with palatal closure. This may result in air escape through the nose during speech, with a nasal rustling sound and hypernasal resonance. A typical clinical evaluation in the VPD clinic involves a perceptual assessment of speech and resonance by our speech pathologists. This is followed by an evaluation by the ORL physicians (Dr. Nuss or Dr. Hseu) and also one of the plastic surgeons (Dr. Meara or Dr. Rogers). A nasopharyngoscopy is performed, and an accurate diagnosis and recommendations are made.