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March 28, 2008

New Video Example of a Failed Pharyngeal Flap for VPI

A new video has been posted of an exam showing a patient with a pharyngeal flap that failed to correct his hypernasal speech. Historically, the patient had a cleft lip and palate that was repaired and because of a persistent velopharyngeal insufficiency producing hypernasal speech, a pharyngeal flap was performed. However, this flap was not successful as the hypernasal speech persisted.

The reason for the persistent hypernasal speech in spite of the pharyngeal flap was made apparent on flexible nasopharyngoscopy. The pharyngeal flap was slightly off center AND too small! Compare this with a perfect outcome pharyngeal flap shown here.

Click here to read more and watch the video!

What is a parent of a child with hypernasal speech to do? Well, the first thing is to obtain a video/audio recording of a flexible nasopharyngoscopy (also known as video nasal endoscopy or VNE) just like what was performed here. This exam documents IF there is velopharyngeal insufficiency, WHERE it is located, and HOW BIG the defect is. Than you need to find a plastic surgeon with tremendous experience who can than perform the right surgery that will precisely resolve the defect... and hopefully not create a flap that is too small as in this case. Too big is not good as that would lead to nasal obstruction.

In our practice, we work closely with the INOVA Fairfax Craniofacial Team which has on staff very experienced plastic surgeons headed by Dr. Craig Dufresne.

March 24, 2008

New Webpage on Dizziness

A new webpage describing dizziness and its various causes has been created. Though our office does not consider itself "dizzy experts," and is unable to provide the comprehensive evaluation and treatment of this problem other than those disorders due to the ear or allergies, we are often able to at least point patients in the right direction even if in the end we are unable to provide relief.

March 21, 2008

Minimally Invasive Surgery to Correct Hyper-Nasal Speech

Dr. Chang performs minimally invasive correction of nasal speech due to velopharyngeal insufficiency. This procedure entails the use of endoscopic techniques to precisely correct the defect without the use of incisions or soft palate reconstruction. Only patients with a small defect are candidates. In order to determine the size of the defect to see if a patient is a candidate, video nasal endoscopy is performed. Examples of exams are shown on this webpage as well.

Please contact our office if you would like to make an appt to see if your hypernasal speech is amenable to this minimally invasive procedure.

If You Live Far Away
Our office has treated patients who live far away. If this is true for you as well, these are the steps to take:

1) Have a local ENT video record a nasopharyngoscopy exam as shown on our website. How the exam is performed is shown here. Make sure the exam records BOTH VIDEO AND AUDIO!!! During this exam, say the following words/phrases shown on this document, especially those in bold.
2) Mail the video/audio exam to Dr. Chang.
3) After Dr. Chang reviews the exam and feels you are a good candidate, check with your insurance company to see if you can come to our office for an appointment and have surgery. If Dr. Chang is out-of-network, have your local doctor help you obtain out-of-network insurance coverage.

Guest Editorial in ENT Journal by Dr. Chang

Dr. Chang was recently invited to write a guest editorial for the ENT Journal regarding how to get the most out of a practice website without costs. It was published in the February 2008 volume. Read the editorial here.

March 16, 2008

Podcast Library on ENT Topics Created

Podcasts are becoming increasingly popular especially in this day of iPods and other mp3 players for people on the go. Although most podcasts are not medically related, there are a few well-produced medical podcasts... and even fewer dedicated to ENT topics. Those few medical podcasts on ENT topics are now listed on our website here. If there are others, please let us know and we will add to the list.

March 10, 2008

LECTURE: The Ears in Sickness and In Health

Drs. Phillips and Chang along with Catie Chalmers, MS, CCC/A will be giving a talk about how ears work in health and in sickness. The lecture will be given on May 22 at 7PM at the Fauquier Hospital Chestnut Room. The lecture is free, but please call 540-316-3588 to register (or email

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VIDEO: How Does the Human Voicebox Work?


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