Incidence and Risk Factors of Velopharyngeal Insufficiency Postadenotonsillectomy
Bibliographic record
Abstract
OBJECTIVES: To evaluate the incidence and risk factors of velopharyngeal insufficiency (VPI) postadenoidectomy, posttonsillectomy, and postadenotonsillectomy. STUDY DESIGN: Retrospective chart review. SETTING: Academic tertiary care center (2007-2014). SUBJECTS AND METHODS: Retrospective review of patients who underwent adenoidectomies, tonsillectomies, or adenotonsillectomies by 1 pediatric otolaryngologist. Patient's age, sex, type of surgery, indication for surgery, medical syndromes, tonsil grade, adenoid size, and pre- and postoperative nasal air emissions were obtained. RESULTS: The VPI risk at 3 weeks postoperatively was 13.6% (95% CI: 9.0%, 18.2%) for adenotonsillectomies, 3.2% (95% CI: 1.2%, 7.6%) for adenoidectomies, and 2.2% (95% CI: 2.1%, 6.5%) for tonsillectomies. There was a significantly higher risk of VPI with combined procedures in comparison with adenoidectomies (P = .02) or tonsillectomies alone (P = .03). There was no significant difference in risk of VPI between adenoidectomies and tonsillectomies (P = .78); between surgical indication groups (sleep-disordered breathing vs other; P = .15); or in terms of sex (P = .80), age (P = .11), tonsil grade (P = .96), or adenoid size (P = .15). There was no qualitative difference in postoperative nasal air emissions between patients with and without medical syndromes. CONCLUSION: Our data are consistent with the literature that most VPI after adenotonsillectomy is temporary in nature and resolves by 5 months postoperatively. Combined procedures were shown to have a significantly higher risk of VPI. Our rates of VPI were much higher than that previously cited and may be indicative of subclinical cases of VPI, which were accounted for due to this study's unique methodology.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".