THE FACTOR OF SEX
DOROTHY McDUFFE McKERNS
A DISSERTATION PRESENTED TO THE CMADUATE COUNCIL OF
THE UTNIFTRITY OF FLO~mA
w PMMTI MFULILLAENT OF THE REQUIREMlENTS FOR THE
DECREE OF DOCTOR OF PHILOISOPHY
UNIVERSITY OF FLORIDA
Appreciation. and gratitude are: extended to the
chairman of my committee, Dr. Kenneth Bzoch, Professor
and riead of the Department of Communicative Disorders,
College of Health Related Professions, who provided the
opportunity for me to become involved wiith the techniques
and understandings prerequisite to the definition of the
stud~y undertaken. Dr, Bzoch generously allowed his library
of films to be used in this study. The progress of the
investigation wazs imm~easurably assisted by his patient
constructive criticism and many perceptive suggestions.
I wish to than~k the other members of m~y co-nmiittee,
DrI. G. Paul Nioore, Dr. Thomas Abb~ott, Dr. Jam!es H-orel., and.
Dr. Bradford N,. junnell for giving generously of their time
and assistance in bringing the study to its conclusion.
It is no exaggeration to say that this investiZ-
a~tion could not have been carried out without the constant
encouragement and tireless assistance of -y two friends,
Dr. Richardi LeaSue andi ir. Jlilliamr H.jillia-s, They have
ny deepest gratitude.
Appreciation is extended to Dr. Lowell C. Hammer
for help with th- pilot studies and to Dr. John Thornby for
assistance wiith a major statistical problem.
TABLE OF" CONTENTS
I Introduction. .. .. .. ... .. 1
Review of the Literature. ... . .. 2
II Statement of the Problem. .. .. .. 22
Hypothesis. ....... ... .. 23
Purpose of the Study. 29
III Methods and Procedures. .. .. ... 31
Initial Selection of Subjects . ... 31
Procedures for Obtaining Films. 1
Selection of Subjects for This Study. 2
Procedure for Collecting Data .. .. 35
Reliability .. ...... 41
Method of Analysis. ... 43
IV Results .. ... .. ... .. .. 46
V Discussion, Conclusions, Summary.. .. 55
Discussion. .. .. .. .. .. .. 55
Conclusions . .. .. .. ... .. 61
Summary ... .. .. .. .. .. 62
Blibliography. . .... .. .. .. ... 65
Biographical Sketch . .. .. .. .. ... 70
LIST OF IA3LESS
1 K~ruskall-ljallis One-way Analysis
of Variance of Sounds /pi/, /tl/, /ki/. . 34
2 Relationship of Inferior Point of Contact
to Palatal Plane. .. ... .. .. .. 46
3 Saw Data for Females . .... .. .. 47
4 9aw Data for Males .. .. ... .. .. 48
5 Comparison of Mean Yeight of Elevation
between Males and Females .. .. .. .. 49
6 Comparison of iMeans of Amount of Contact . 50
7 Comparison of Means for Males and
Females for LAEC. ........ ... 50
8 Comparison of Mleans for Kales and
Females for Ratio EC:EF . ... . ... 51
9 Comparison of Means of Velar Length
in Bales and Females. .. .. .. .. 51
10 Significance of Difference in
IKeasurements of PNS-X and PNIS-Y .. .. 52
11 Crganization of Subjects by Measurements
of Angle ABC. ... . ... .. .. 57
LIST OF FIGREL_4S
1 An Orientation and Configuration of
the Velum in Closure for Speech. .. .. 12
2 Illustration of Height of Elevation,
Closure, and Lepth of Nasopharynx. .. 16
3 "Squared-off" F~emale and "Arcute"
Male Velar Configurations. . .. ... 25
4 Actual Line Tracing of a Cinefluoro-
graphic Frame of a Female Subject. , 26
5 Actual Line Tracing of a cinefluoro-
graphic Frame of a Xale Subject . . 27
6 Illustration of Ileiasrements Palatal.
Plane, ~epth of N~asoph~arynx AlonT
Palatal Pla~ne a~nd to IDidp~oint Closure. . 37
7 Illustration of LAB . .. .. .. .. 38
8 Illustration of Anount of Contact
and method of Leterminin? ?
9 Frequency Distribution Curve for LAiEC. . 54
10 Frequency Distribution Curve for
Velar Length ... .. .. ... .. 54
The subject of the study reported here is the
velopharyngeal mechanismn for speech in normal young adults
as visualized on lateral cinefluorographic films.
It can be stated as a general principle that for
English, separation of the nasopharynx and oropharynx by
the interpositioning of the velum (soft palate) is usual
for the production of all of the sound elements other than
/m/, /n/, and / /. There are variations in the amount of
nasal resonance on you~els which are related to dialectal
differences in normal speech. However, physiological
aberrations which make it impossible either to achieve or
to maintain appropriate contact of the velun with the
phnaryngeal wrall may result in serious problems of hypernasal
distortion. The velopharyngeal mechanism is thus central to
investigations of both normal and abnormal speech.
Phoneticians, speech pathologists, orthodontists,
and surgeons have used various X-ra~y techniqlues to study the
speech mechanisn according to their special interes-s in the
structures, processes, and problems involved, d~ith regard
to the velopharyngeal nechanism, efforts have been made both
to define what occurs in normal closure for speech and to
Identify and describe velopharyngeal insufficiencies.
The comparatively new technique of cinefluorography
is the method used in the present study. Cinefluorography
is the photographing with a motion picture camera of an
electronically intensified X-ray image projected on a
fluoroscopic screen. The resulting mid-sagittal views of
the speech structures in motion recorded on films can be
projected at life size to be analyzed in detail, In the
study reported in this thesis, the velopharyngeal mechanism
of males, as visualized on such films, was compared with
that of females. The results demonstrated that the con-
figuration assumed by the velum in its functional positions
for speech observed in male subjects differed from that seen
in the females. The nature of this difference has been des-
cribed in detail in the following pages.
Review of the Literature
This review of the literature has been organized to
reveal the concerns of those reporting information about the
velopharyngeal mechanism within three broad areas. Some
papers have had as their major purpose the description of
technical principles and! development of methods which allow
for the application of X-ray to the special problems involved
in revealing the dynamics of the speech process. Other
papers have explained the clinical application of cinefluor-
ography to speech problems resulting from velopharyngeal
insufficiencies. Papers which have reported the systematic
study of diverse questions pertaining to velopharyngeal
function for speech form the final area of review. In some
of these studies, the goal has been to define what occurs
during normal speech production with regard to certain
aspects. In others, the purpose has been to compare the
normal and abnormal functioning of the velopharyngeal mech-
anism~ in terms of specific questions.
The "still" X-ray techniques were the first to be
used in speech. Cephalometrics and laminagraphy have been
described many times. An historical development of cephal-
ometry has been traced by A.G. Brodie (1949). T.M. Graber
(1952) lists, defines, and illustrates the anthropometric
and cephalometric measure points that have been developed
in order to standardize information from lateral X-rays and
make comparisons possible. Wiildm~an (1961) has proposed
that a standardization of measurements such as that pro-
vided by cephalometrics be achieved for lateral laminagraphy
and cinefluorography. He has selected, described, and
illustrated those measurements he feels are most effective
froa the studies of researchers who developed the?. Sloan
et al. (1964) have also described the application of ceph?-
alometries to cinefluorography. Subtelny, Pruzansky~, and
Subtelny (1957) and H'oll (1965) are sources for a descrip-
tion of lamnina3raphy.
Cephalometric techniques w~er-e popular writh
researchers before the advent of cineflucrography and still
have advantages in better resolution of the image. Cine-
fluorography has the advantage of adding the dimension of
motion to the X-ray pictures.
Carrell (1952) described a technique for reducing
radiation effects by synchronizing the roentgen generator and
the picture and commended the application of cineradiogra~phy
to the diagnosis of velopharyngeal closure inadequacies and
for post-correctional evaluation. It was the development of
image intensification that made cinefluorography a practic-
able technique. With this, the image formed on the fluoro-
scopic screen by the passage of roentgen' rays through the
subject is intensified 1,000 or more times in brightness by
means of an electron optical intensifier. Berry and
Hofmann (1956; 1959) have written an excellent description
of the principle of image intensification and other details
of the cinefluorographic technique. Details of the
principles of image intensification and procedures of cine-
fluorography are also provided by M:organ (1961).
A problem which has had to be considered is that of
effective filming rate. This question has been raised in
papers by Moll (1960), Bjork (1961), Bjork and ISylen (1963),
and Shelton et l. (1967). Sparrowr, Brogdon, and Bzoch
(1964) have show~n that for specific types of studies of
velopharyngeal function a filming rate of 30 frames per
second is adequate. They say that this filming rate gives
better image resolution than a rate of 60 frames per second.
:'oll (1960) noted the failure of most investigators
to quantify information from the films they used to make
descriptive reports. He undertook a study to determine
procedural techniques for obtaining clear cinefluorographic
pictures of the articulatory structures during speech with-
out excessive exposure to radiation. As a second step, he
studied the reliability of extracting information from the
films in terms of objective measurements directly from the
projection of the films or from tracings of the projectlans.
Els paper Is therefore useful for description of equipment
and procedures to be used in quantitative studies. Subse-
quent papers are also useful in this respect (Powers, 1960;
jjork, 1961; ilarren and aofmann, 1961; Sparrow, Brogdon,
and ;jzoch, 1964).
Clinical Application of Cinefluorography
to Speech problems
A partial 11st of papers in which the application
of cinefluorography to clinical diagnosis and treatment is
described and advocated includes those of Cooper (1956),
Calnan (1955-56), F'letcher (1958), Fletcher et al. (1960),
Aram and subtelny (1959), Kirkpatrick and 01mstead (1959),
Smith et l.1 (1960), Ashley et al. (1961), Green (1961),
;iazabert and hofmann (1962), and Kirkpatrick (1964). The
identification of velopharyngeal inadequacy by contrast
with the normal velopharyngeal mechanism, the making of
propnoses, the prescribing of treatment, the placement of
speech bulbs and assessment of their efficacy, have been
topics of the foregoing papers.
Application of X-ray Technicues to Definition
of normal and Abnormal Velcoharynneal Mechanisms
The historic attempts of early phoneticians to
apply standard radiography to the definition of articula-
tory positions have been reviewed in an interesting paper
by IMacmillan and Kelemen (1952). subtelny, Pruzanskxy and
Subtelny (1957) also reviewed the work of the pioneer
phoneticians. Their emphasis was more on tongue-arch post-
tions than on other aspects of articulation.
Specific attention to variations in velar position
began with Allen in 1884. Variations are possible in a
vertical direction in terms of the height to which the velum
rises for closure, and in terms of the vertical span of the
velar tissue making contact with the pharyngeal wall, In a
horizontal direction, variations are possible in the extent
of the gap between the posterior surface of the velum and
the posterior surface of the pharynx.
Variations in velar position have been studied in
terms of the sounds produced. Bloomer (1953) had reported
small and not always consistent variations during the pro-
duction of both vowels and consonants on the basis of
tracings from photographs taken through facial defects.
-arren, Hofmann, and Miller (1961) reported that they found
a significant difference in the elevation of the velum for
different sounds in their cinefluorographic study. Moll
(1960) studied velar changes in two female subjects. He
found a greater extent of velopharyngeal contact for sustained
vowels than for vowels In consonant contexts. For vowels in
consonant contexts there was more contact w~hen the
consonant was a non-nasal than when it was the sound /n/.
Contact for /a/ was less than for /1/, Bzoch (1968) has
shown that in th~e production of the three sounds /i/, /a/,
and /u/, the velumo rises higher for /i/ and /u/ than for
/a/, iiagerty et al. (1958) showed that elevation of the
velum is higher for /s/ than for /z/ when seen in lateral
laminagraphs. Moll (1962) showed that velar elevation was
related to tongue height.
The question whether absolute closing of the velo-
pharyngeal gap is necessary for the production of sounds
perceived acoustically as normal is one that still receives
attention. Earlier research poertaining to this ollestion has
been reviewed by iMc~onald and Baker (1951). It had been
shown that closure as it is visualized by X-ray Is not
always acheievedfor the production of scustained vowtels (I011,
1960). Bijoirk and :;ylen (1963) reported that in many persons
with normal speech, the production of the consonants /k/,
/v/, /s/, /t/, /b/, and /d/ w~as achieved and acoustically
perceived as correct, without complete velophnaryng~eal clo-
sure, as seen wiith- cinefluorography. Their subjects spoke
Swedish, however, BJork (1961) had earlier reported finding
openings only for nasal consonants and neighnboring vowels in
his analysis of the production of four sentences by Swedish
speakers. Ezoch (1967) has subsequently correlated the
points on cinefluorogr~aphic films at which velophary~ngeal
closure appeared absolute with the sounds produced in an
English sentence. In all of his 74 normal subjects there
was an invariant pattern of 3 closures and 4 openings
corresponding to the production of the non-nasal and nasal
sounds respectively. There were, however, occurrences of
assimilatee nasality" on some vowels which preceded or
followFed. nasals: in some subjects.
The condition of cleft palate has been of partic-
ular interest. Using X-ray, the problem in cleft palate
speech has been studied with regard to the importance of
tongue position (Hixon, 1949), and to the size of mouth
opening (Xelly, 1934). However, when Buck- (1953) studied
these factors and the factor of velopharyngeal closure, he
concluded that the extent of velopharynlgeal closure deter-
mined the major difference between his normal and cleft-
palate subjects, Because some persons with cleft palates
nonetheless have worse speech than others also with cleft
palates, the question of other contribution factors has been
studied comparing cleft-palate subjects with each other by
means of cinefluorographny (Powers, 1960). Sloan et al.
(1964) compared the deglutition anda phonation patterns of
normal And cleft-palate subjects in a demonstration study
explicating the use of cineflucrography. These investigators
maintained that, for the production of vowiels, if nasophar-
yngeal closure! is not sustained, hypernasal production w~ill
The question of velopharyingeal inadequacy in the
absence of cleft palate has also been studied for its effect
on speech. Blackfield et al. (196i2) have reviewed the lit-
erature in which velopharyngeal dysfunction without cleft
palate has been defined and described. In their study they
made measurements from tracings of cineflucrographic films
of 24- patients wiith velopharyngeal dysfunction and compared
them with those of 30 individuals with norm-al speech.
Anatomic abnormalities were found to be either excessive
depth of the nasopharynx, short hard and soft palates, short
soft palate but normal hard palate, or inadequacy of palatal
motion when compared with the normals. They concluded that,
with the exception of 2 patients, there was a direct rela-
tionship between the degree of inadequacy of velopharryngeal
closure and the severity of the speech defect. M'azaheri,
Millard and Erickson (1964), on the other hand, clain that
in their study of noncleft subjects with velepharyng~eal
inadequacy they found no relationship between the degree of
velopharyngeal inadequacy and the severity of the speech
defect. Tihe size of the gap between the vehlu and pharyinx
durinE phonation was correlated with judgements of voice
quality and intelligibility.
Shelton (1964) defined six categories of closure
patterns; i.e. patterns of closing the gap between velum and
pharynx and of maintainir? or being unable to maintain
appropriate closure. A nor-al pattern was established by
speakers with no speech problems similar to that reported by
Bjork (1961) and found by Ezoch (1967). Deviations fro-n this
pattern were plotted. for subjects who had palatal inadequa-
01es or who had surgically repaired cleft palates.
Bzoch (1967) showed that the correspondence he found
of velopharyngeal closure and sound produced for his normal
subjects was not achieved by deaf oral speakers, persons
with cleft-palate speech, or with problems of velopharyngeal
insufficiency in which~ there w~as an Inability to achieve or
sustain appropriate timing rates.
One finding based on X-ray studies of velopharyngeal
function about which there seems to be no argument is that
adenoid tissue can provide a surface for the velum to close
against and can be a means of narrowing the distance to be
spanned, so that often where velopharyngeal inadequacy would
otherwise be present, the problem is avoided (Calnan, 1953;
Buck, 1954; subtelny and 9s)ker, 1956t~).
It has been a goal in clinical practice to kcnowa
such things as the expected site of velar contact along the
pharynGeal wrall, the height to which the velum elevates
relative to palatal plane, the amount of tissue making con-
tact, and whether there is a relationship of velar length to
pharyn~eal depth in order to cope more effectively with
rcehailitation in velopharyngeal insufficiency. However,
these variables have not been considered in terns of a total
pattern but rather, in terms of some other variable or
In its functional or closed position, the velum, as
seen in lateral X-ray pictures, assumes a certain configur-
ation resultinS frome the height to which it elevates (rola-
tive to palatal plane), the place on the pharyngeal wall
where it touches, the extent of contract, the area on its
surface which makes the seal, and the position of the uvula
relative to the posterior pharyngeal wall.
The high point on the velar surface seen when in
the closed position for speech has been called "levator
eminence" and defined as the point of insertion of the
elevator muscles (Green, 1961; W~estlakre and Rutherford, 196E,
p. 61). Podvinec (1952) had stated that the point at which
the insertion of levators and of palatopharyngeus cross
causes the "dimpling" seen on the oral surface of the velum.
This point, according to Podvinec, also becomes the center or
focal point of the velar tissue which effects the closure
and is as well in the area of greatest excursion from rest
to closure. FiS. 1 illustrates an orientation of the veluma
in closure similar to that which has been described and/or
illustrated by rPodvinec (1952), Riclketts (1954), nagcerty et
gl, (1958), and Green (1961). As it has been described in
the above papers, the uvula, is a~ngled well forward.
On the basis of observations nade possible by the
use of Xi-ray, the area of the velum~ which malres closure had'
been defined as the middle third (Calnan, 1955-56). Eaxever,
when Graber, Bzoch and Aoba (1959) divided the outline of
the velun into quadrants rather than thirds they found that
the third quadrant made closure in 100 percent of their sub-
jects and in 27 percent the fourth quadrant w~as also in-
volved. The highest point on the upper surface did not co-
incide with the area of contact but was farther forward at
Figure 1. An orientation and configuration of
the velum in closure for speech.
the midpoint of the middle third. The midpoint of the
palate sihowed the greatest extent of upward and backwardp
Mazaheri, Millard and Erickson (1964) used 10
normal subjects as controls in a study of velopharyngeal
inadequacy. They also said that they found a significant
difference between the high point on the superior velar sur-
face and the height of the superior point of velar contact
with the pharynx. Further than this, they stated that the
height of velopha~ryngeal closure took, place belowu the palatal
plane in 80 percent of their normal subjects.
In the G~raber, Bzoch and Ao0ba (1959) study 22 of
the 44 subjects wrere females, and in the KIazaheri, Millard
and Erick:son study, 8 of the 10 normal subjects w~ere females
but no significance was attached to this in interpretinS the
findings in either study.
Ricketts (1954) pointed out that the size and shape
of the pharynx are influenced by the bones which surround
it--the occipital, the sphenoid, and the ethnoid. He showed
in particular the effect of variations in the inclination of
the b-silar part of the occipoital bone. ;:hen this was in-
clin~ed nore horizontally the nasophnarynx bsecamne wid~er, and
as it was nore vertically Inclined thle "cranial bzse" became
acute and the nasophrarynx correspond~in31y n~arrower.
R~ick~etts claimed the velum~ accommnodated itself to the space
provided in the pharynx by a~ssuing either obtuse or acute
angles wiith reference to the posterior nasal spine w~hen in
the rest position. Rickett's study pointed out the ponsib-
ility that structural variations might account for varia-
tions in the dimensions of velopharyngeal closure. The
velum might accommodate itself to the space available in the
pharynx in its functional position, Just as Ricketts said it
did in the rest position,
dlarren and iEofmann (1961) tried to determine
possible relationships between velar length and pharyngeal
depth; pharyngeal depth and velar height during closure; and
velar length and velar height during closure. Cinefluoro-
graphy was used for their study. They concluded there was
no relationship between soft palate length and pharyngeal
depth. An inverse relationship was found between length of
palate and height of closure--the longer the palate, the
lower the elevation. Warren and Hiofma~nn suggested that the
reason for this inverse relationship is the anterior sloping
of the pharyngeal wall as it becomes the nasopharynx, which
causes depth to decrease with height. They theorized that
a short velum would have to rise higher to contact the
pharyngeal wall than a longer one which could span the
wider distance at a lower level. It wazs their opinion that
velar length was a more significant deterniner of closure
height than pharyngeal depth.
%azaheri et al. (1964) found a correlation between
length of velua and depth of the pharynx, in contrast to the
findings of Wasrren and Hiofmann, They found no significant
relationship between depth of nasopharynx and eight of
elevation above palatal plane or between length of velum and
height of closure (in contrast again to larren and Hiofrgnn);
nor between length of velum and height of elevation,
M~azaheri et al. say that the theory of warrenn and E:ofmann
that the short velum elevates higher than the long to achieve
closure does not necessarily hold true.
Fig, 2 illustrates how depth of the nasopharynx,
height of elevation, and height of closure are defined.
B~jork and Nylen (Bjork, 1961; Bjorkr and Nylen,
1963) are the only investigators found to have considered in
any way the possibility of a sex difference in any of the
variables involved in velopharyngeal closure. They found no
difference that was significant between males and females on
measures of amount of excursion, amount of contact, height of
elevation, or velar length in the rest position.
Ha~gerty et _al. (1958) reported that there were some
differences in the amount of excursion from rest to closure
between their Kegro and white subjects and som~e difference in
amount of contact of velum writh pharyinx in the tw;o groups.
Age as a variable in thne velophnarynseal m3echasnies
has been considered, Aram and Subtelny (1959) found that
th~e amount of velar tissue ma'ing the seal with the pharyn-
geal wall decreased with age. The average for this neasure-
ment in their subjects ageE 4 to 5 w~as 3.6 nm. and in their
oldest subjects, aged 18 to 20, it w~as approxlhately one
half as much,
A~ran and Subtelny (1959) found changes in the site
of closure writh age as well. They described the site for
their younger age groups as being the "superior and/or the
superior-posterior aspects of the nasopharynx." Site of
Figure 2. Illustration of height of elevation, height
of closure, and depth of the nasopharynx.
closure for the older groups was described as "posterior
pharyngeal wall." The transition tooke place in their 9 to
11 age group.
Calnan (1955-56) stated that the area just above
palatal plane would be the probable site of closure. He
then defined three possible relationships of the palatal
plane to the backc wall. The highest site, level with
basisphenoid, was described as the "Infantile." The adult
position, Calnan said, was normally level with the upper
border of the arch of the atlas or lower.
Both Aram and Subtelny (1959) and calnan (1955-56)
stated that the higher position for velopharyngeal closure
in young children was due to the fact that the hard palate
was closer to the upper limit of the nasopharynx. As growth
of the face occurs downwa~rds and forwards, the palate
descends and the distance increases from the posterior phar-
yngeal wall, according to these authors. Calnan (1955-56)
expressed the opinion that closure is higher in children
because the forward inclination of the posterior wall at the
point of contact is at an angle of h50 to the horizontal,
while It may be vertical in some adults.
BJork and Nylen (1963) found the site of closure in
children; to be lower than in their adult subjects. They
state the reason for t`?is is because of the Greater forward
inclination of the posterior wall in children as opposed to
the almost vertical plane of the adult. Thus, the sane
hypothesis has been used to explain opposite findings.
Some attention has been given to determining
whether the action of Passavant's pad is significant in the
normal velopharyngeal mechanism. Calnan (1953: 1955-56) has
completely discounted it, Graber et al. (1959) claim it wias
present in 3 percent of their subjects. Others say they
have found no anterior movement of the posterior pharyngeal
wall in normals (Cooper, 1956; Wiarren and Hiofmann, 1961; and
Bjork; and Nylen, 1963). Hagerty et al. (1958) said they did
not think Passavantrs pad was significant in normal speech
Another concern about the mechanism of muscle action
by which closure Is achieved has been with the role of the
muscles in the lateral wall of the pharynx, Harrington
(1944) determined the presence of a palatal origin (different
from the hamular origin) of the pterygopharyngeus muscle in
8 of 10 cadaver dissections. He felt that these pterygo-
pharyngeus fibers with a palatal origin probably contributed
to mesial movement of the pharyngeal walls, Becau~se the
pterygo7pharynqeus also has connections writh palatophasrynseus,
Harrington suggested that approximation of the palato-
pharyngeus muscles could. also contribute to mesial movement
of the lateral pharyngeal walls,. L.E'. Strong (1949) reported
that he and Lochi, indsependently of each other, had pro-
posed as ea-rly as 19!c3 that the: palatine bundle of the
superior constrictor wias a "niajor force component in naso-
pharyn Cal occlusion," This proposal w!as made by these
authors, StronG said, as a mechanismn to account for the
ability of palatopharyngeus to move medially. In their
mechanism, palatopharyngeus is forced medially by the con-
tractions of the palatine bundle of the superior constric-
An action of salpingopharyngeus muscles causing
medial movement of the lateral walls was reported by
Harrington (1944). This action was viewed in one subject
who had had a radical resection of the left axillary sinus.
Bloomer (1953) stated his opinion that the salpinsopharyn-
geal folds were more likely brought into approximation by
the sphincteric contraction of the superior constrictor and
the palatopharyngeus muscles than by their own action.
Westlake and Rutherford (1966, p.55) point out that the sal-
pingopharyngeal folds which can be seen on oral inspection
in people who have either thin palatopharyngeus muscles or
whose palatopharyngeal muscles do not move medially in
closure, probably act to na~rrowa the oral and nasal pharynx,
There seems to have been sone shift of opinion amon~
those using X-ray away from the idea of any kind of
sphincteric or narrowing of the pharyng-eal dimensions in
the normal velopharyrngea~l mechanism. Calnan (1955-56) has
stated flatly that closure is not "sphinater-like" and that
the superior constrictor does not play an important part in
speech, Bjork (1961) and, Bjork and Nylen (1963) reported
the results of tomodraphy used in their study to estin~ate.
the role of lateral movements of the pharyngeal w~all in the
nasop~harynx. They asserted that there were no im-portant
changes in lateral dimensions in normals, In cases of
velopharyngeal incompetence, such contractions are compen-
satory, in their opinion.
The review of the literature so far has shown that
the area for investigation into the velopharyngeal mechanism
for speech is extremely broad in scope. There are still
many unanswered questions within those problems which have
been the focus of attention. Interest in some other direc-
tions is just beginning to develop.
J. Subtelny (1964) has pointed out that progress in
the physiological aspects of phonetics has not kept pace
with progress in acoustic phonetics. She has suggested the
need for making more correlations between shifts in velar
positions and the rest of the vocal tract and changes in
Behind the effort which has been put into velar
research, there seems to have been an implicit belief that
the velum functions as an articulator with adjustments being
made as appropriate by the muscles of the velum. MIoll and
Shriner (1967) have raised the question of whether the velui
really functions as an articulator at all. They feel that
the velum may act nerely as an "on-off" valve. The valve
would be "on" for non-nasals and "off" for nasa~ls and have
a ready position in between "rest" and "on," The more
subtle adjustments would be due to changes in and restraints
resulting from tongue position and time available.
In response to this question, Lubter (1968) has
undertaken electromyographic and cinefluoroeraphic studies
and has reported that his findings do not support the
suggestion of Moll and Shriner. Hie finds evidence to the
contrary, that the velum does in fact change in response to
activation of its own muscles,
M~ore evidence is needed regarding this question.
The difference between an "on-off" valve and a "precision"
articulator would be immense. When the velum is considered
as an articulator, the question of the significance of velar
variations for acoustic output is a relevant one and the
question of the muscle actions involved in making the
variations remains as important as ever.
The definition of the velopharyngeal mechanism? into
discretely different confiGurationsn as seen cinefluorograph-
ically could be a useful first step toward the further study
of such proolels.
jTATEMEiNT OF THE PROBLEM~
The factor of sex as a variable in the velophar-
yngeal mechanism has been considered in only one previous
study. Bjork and Nylen (1963) obtained some measurements
for males and females separately for the purpose of com-
paring adults to children, and normals to cleft-palate
subjects. They reported finding no significant differences
between the sexes on the measurements they made. Nonethe-
less, it may be possible that certain differences do exist.
The possibility remains that failure to consider
sex as a variable may have influenced the results in some
studies. Data obtained. in studies where the subjects are
all males may not be comparable to data from studies in
which the subjects are all females or which include members
of both sexes.
Because information obtained about the normal
process has such immediate practical application in the
identification and treatment of abnormalities, there has
been a tendency on the part of investigators to focus on
comparison between normal and abnormal. In these compar-
1sons, normal subjects and subjects with velopharyngeal
inadequacies have been matched for sex as well as age in
some studies, but all subjects have then been treated only
as either normal controls or as experimental subjects with-
cut sex comparisons.
In other studies where the objective has been to
define what occurs in normal velopharyngeal closure, sub-
jects have been classified as normal on the basis of having
no velopharyngeal inadequacies or speech deviations and
then treated equally, Kean measurements for normal indiv-
iduals have then been determined without regard to possible
sex differences. Graber, Bzoch and Aoba (1959) included
equal numbers of males and females in their study but did
not makle comparisons,
A review of the literature reveals no study which
has specifically considered velar configuration er se or
the possible significance of variations from basic confiS-
urations. It has been recognized that velar configuration
as it is revealed in lateral X-rays is the result of the
balance of muscle forces exerted upon the velum in achiev-
ing closure (9ickette, 1954), but it seems that velophsryn-
geal closure has been assumed to vary only in accordance
with individual differences (Ilazaheri et al., 1964;
destlak~e and %utherford, 1966. P. 5j).
It is hypothesized that, as it is visualized on
cinefluorographic films, the velopharyngeal mechanism is
different for males as compared to females. This difference
is manifested in a different orientation of elevator eminence
to uvula so that the configuration of the velum for females
has the appearance more of a right angle within the pharynx
and that for males an acute angrle as shown in Fig. 3. Fig.
4 is an actual line tracing of a female subject and Fis. 5
Is of a male subject.
This hypothesis was derived from subjective impres-
sions of the closure patterns of males and females viewed at
the normal filming rate of 30 frames per second on cinefluor-
ographic film. Certain differences in motion and configura-
tion of the velum could be discerned. In the films of males
the velun as it elevates is seen to lift at the levator
"bulge" elevatorr eminence). This bulge then rises In a
throbbing mannier and seemns to thrust toward closure at the
basi-occipital level. This is essentially the upper limit
of the nasopharynx along the posterior wall. The presentin3
surface of the velumo is curved as it contacts the pharyngeal
wall. The uvula is pointed anteriorly so that considerable
space Is formed between it and the pharyngeal wall.
In the female pattern, as the velum elevates for
closure it usually moves posteriorly in a relatively
st~raight-backe notion along the palatal plane wiith a comnpr-
atively flat presenting surface. The "thrusting" of the
elevator bulge is in an upward direction while the direction
of palatal movement as a whole is bacl:ward. The uvula
Figuvre 3. "Square2-off" female and "acute" male
velar configurations. Arrowsi showr directions of move-
ment. drokEln lines show velum a~t rest,
Figure 4. Actual line tracing of a cinefluoro~raphic
frame of a female subject.
Figure 5. Actual line tracing of a cinetwuorographic
framce of a nale subject.
points downward and often even posteriorly so that there is
a notch between it and the pharyingeal wall rather than the
definite space of the male pattern.
Green (1961) had called the configuration of the
veluma in closure "comma-likxe" with the elevator eminence
forming the apex. Ricketts (1954) had described the velum
in closure as being a "hooking" action. Their descriptions
fit wiell what is being described here as the male configur-
ation. The action of the velum in the female could be
called "squared-off" as contrasted with the other hookingn"
action. The male configuration is here described as "acute."
Pilot studies have shown that it is possible to
tell male from female subjects on the basis of judgement of
the pattern of notion in movement and the configurations of
the velum in closure during connected speech. It has been
found to be relatively simple, with experience, to classify
85 percent of the subjects with 100 percent accuracy. Those
subjects w~ho wsere not readily classified have required a
most judicious balancing of clues from the perceived motion
toward closure and the configuration in closure in7 order to
be declassified. The subtleties are such that furth-er analysis
will be required to objectify the significant; clues.
In a pilot study, twro independent viewers had no
clues other than representative drawings of the two velar
configurations and the instructions: "In your opinion, does
the velum of the subject on the filn look~ more like (3C
or (2i ) when in closuree" Thle 12 films viewed wnere
randomly selected from 71: films. One viewer knew the purpose
of the study and one did not. Decisions were made accord-
ing to a seven-point scale, Their results showed selection
in the right direction wuith a P=.0256.
The score obtained by this investigator when the
choice was either "male" or "female" for 27 subjects, was
correct as determined by a Fisher's Exsct Probability Test
at a level P=.ooco5, At the time of these studies, no
criteria for making a decision had been specifically
discerned, but it was felt that the ultimate deciding factor
was the "angle the velum made w~ith itself" in closure.
Purpose of the Study~
This study was undertaken to determine whether it
would be possible to demonstrate in an objective manner
that the apparent differences between the velopharyngeal
mechanisms of males and females which had been subjectively
perceived do exist. The following questions were formu~lated:
1, Can it be shown by an angular measurement that
the basic orientation of the velum to the pharynx is diff-
erent in the sexes?
2.-Can it be established by measurement of the
height of elevation above palatal plane, the amount of con-
tact, the distance of the uvula from the pharynsell wall,
and determination of the site on the pharyneeal wall at
which the inferior point of contact falls relative to pal-
ata~l plane that discretely different configurational
patterns are manifested?
3, Can differences in configuration be accounted
for on the basis of the ratio between velar length and
pharyngeal de pth?
Rationales for the establishing of certain
measurements not previously described in the literature and
for other questions arising during the analysis of the data
are described in the following chapter.
NETHODS AND PROC~3UESS
A library of films made by the process of cine-
fluorography has been built in the D~epartment of Communica-
tive Disorders, University of Florida Health Related
Professions. The procedure for the selection of subjects,
photographing, and analyzing has been described previously
(Sparrow, Brogdon and Ezoch, 1966; Bzoch, 1968) but is
summ~arized here for convenience.
Initial election fS2 et
The subjects were sales and females between 18 and
30 years old. They were monolingual (General American
dialect), had Angle Class I occlusion, no articulation or
voice deviations, and hearing= acuity of between f10 dB
through the speech frequencies for both ears.
Procedures for Obtainini Films
A Ficker fluoroscopic unit with an 8-inch image
intoensfier and a modified 16 un. Cstman Cine II camera
were used. Kodak Linagrzap Shellburst filmn was used and
processed in a Smith-Picker automatic processor, Careful
body positioning and the use of a lucite cephalortat pro-
vided stability during filming and uniformity in head, neck,
and body positioning in the upright position. A monitorinp
directional Electro Voice microphone Hotel 644 was placed
6 inches from th~e subject's mouth and recording was on a
Mlagnacord Model MI90-A tape recorder.
Each subject performed a speech sample within a
limit of 90 seconds. Radiation dosage was less than 3
roentgens. Filming rate was 30 frames per second.
Selection of Subjects for This Study
From the library of films available, 40 subjects
(20 males and 20 females) were chosen for this study. The
subjects had been filmed randomly with regard to sex just as
they camce in for their appointments. The films to be used
here w~ere therefore taken in order front subject; number one
on. The only criterion for rejecting a film as a subject of
study wias lack of sufficient clarity for tracing.
The total speech sample filmed consisted of nine
consonant-vowrel (CV) "syllable" sets, a list of 13 words,
and a sentence. The sentence was repeated three times at
increasing effort. Nornal pitch and conversational effort
level were used for the syllable sets and word series. A4
speech sample lasting lI mins, could be observed for each
subject, A characteristic pattern of mnovement toward clos-
ure and velar configuration in closure could be recognized
for each subject.
For analysis, one frame" for each subject was chosen
from any one of the syllable sets containing the vocalic
A syllable set consists of seven CV combinations.
These CV combinations were either /pi/, /pa/, /pu/; /ti/,
/ta/, /tu/; or /ki/, /ka/, /kcu/, The organization into
speech utterances was according to the following system in
which /pt/, /pa/, /pu/ is used as illustration:
Inspiration: (A) pi pi pi pi pi pl pi
(B) pa pa pa pa pa pa pa
(C) pu pu pu pu pu pu pu
Inspiration (D) pa pa pa pa pa pa pa
(E) pu pu pu pu pu pu pu
(F) pi pi pi pi pi pi pl
Inspiration (G) pu pu pu pu pu pu pu
(d) pi pl pi pi pi pi pl
(I) pa. pa pa pa ps pFa pa
It can be seen that, using series A. F, or H, there
were 21 occurrences of the production of syllables contain-
ing the vowiel /1/. Any frame within series Al, F?, or a w~as
used if it provided sufficient clarity for tracing. It had
been established earlier (Bzoch, 1968) that once closure
was achieved for the production of these syllables, opening
did not occur again until the end of series C, ?, or I. It
is not known precisely what ninor variations may have
occurred from frame to frame w~ith the velurm in closure all
the while, but it is believed they wiould not be of a nature
to affect the! measurements relevant to the: major pur'poset of
this study. Because it can be plainly seen On the fillmS in
notion thrat w~hen velopsharyrngeal closure occurs for the pro-
duction of these syllable sets it is according to a charac-
teristic pattern, it was concluded that the selection made
was representative of the velopharyngeal mechanips for each
of the 40 subjects.
Twenty subjects said /pl/ on the films used, 13
said /ti/, and 7 said /kl/. In order to determine the
effect of the different consonants on the measurements, a
Kruskal-Wallis One-way Analysis of Variance Test was ap-
plied for each measurement for the females and for the males
separately. Anything greater than .05 was not considered
statistically significant for the purpose of this study. It
can be seen from Table I that, with the exception of the
measurement of height of elevation for females, nothing was
found to be significantly different.
KRUiSKAL-WAgLLIS ONE-WIAY ANATLYSIS OF VARIANCE
OF SOUNDoS /pi/, /ti/, AND /ki/
measurement Females Males
neight elevation 7.294 .03
Angle ABC 2.56 .4o
Eight contact 4.59 2.39
Amount contact 3.95 1.75
Leng-th .80 .82
*Significantly different from zero at the 5 percent level.
A Mann-Wihitney U Test comparing height of eleva-
tion in females between /pi/ and /ti/, /ti/ and /ki/, and
/Pi/ and /ki/ revealed no significant difference between
/pi/ and /ti/ but a difference between /ti/ and /ki/ and
between /pi/ and /ki/ both at a level P=.015. It is be-
lieved, therefore, that the influence of the /ki/ would
cause the mean height of elevation in females to be higher
than it would have been without the /ki/ sound. Films of
only twoe males producing /k~i/ were used in the study.
Procedure for Collectino Data
During filming, each subject had inserted a radio-
opaque narker into his mouth backe to the wvall of the pharynx
so that it would subsequently be possible by measuring the
distance between the holes on the marker to gauge the pro-
jection size. After determining that projection was at life
size, structures from the chosen frames were traced by hand
onto ordinary 16 lb. white bond typing paper as shown in the
reproductions of actual tracings in Figs. 4 and 5.
A piece of Dietzgen draft film (clear acetate paper
with a matte surface) was laid over each tracing so that the
lines needed for measuring could be drawnm on it, leaving the
actual tracing unmlarked. Lines wrere: drawn and mreasurements
taken according to the following descriptions using dividers,
a millineter ruler, and a protractor.
This line was drawn according to the usual proced-
ure in the literature; i.e. fromn the tip of the anterior
nasal spine (AN;S) through the post~erior nasal spine (v;,S) and'
projected. to the back wall of the phairynx to point X, as~
seen in Fi5. 6.
CDeth of the nesonhgranx~
The depth of the nasopharynx has usually been
defined as the distance along; the palatal plane from PNS to
the back pharyngeal wall. The distance PNS to X represents
the depth of the nasopharynx along palatal plane in Fig, 6.
Depth of the nasooharynx at midpoint of closure
A line w;as drawn from PNS to the midpoint of the
area of the velum naking contact with the pharyngeal wall to
represent the depth of the nasopharynx at the midpoint of
closure. PNS to Y is the line illustrating this measure in
Angle ABC was constructed to s~how the basic orien-
tation of the volum to the pharyngeal wall. The point on
the posterior nasal spine intersected by the palatal plane
line became A. The superior point of contact between velum
and pharynx became B and the inferior point (midpoint) of
the uvula became C. Angle AFC was thus formed by lines from
the PNdS to the superior point; of contact, and from the
superior point of contact to the inferior point of the uvula.
This angrle is shown in Fig. 7,
The length of the velum, was mealsured according to
the procedure described bjy Graber, Bzoch, and Aoba (1959).
In this procedure, velar length in the functional position
for speech, is determined by measuring along the superior
curvilinesr border from the posterior nasal spine to the
nidpoint of the uvula,
Amount of contact: with shsryn-real wa~ll
The measurement in mm. of the distance spanned by
ANS to X = palatal plane
PNS to X. = depth of nasopharynx
along palatal plane
PNS to Y = depth of nasopharynx
to midpoint of closure
Figure 6, Illustration of the neasurements palatal plane,
depth of the nasopharynx along palatel plane, and depth of
the nasopharynx to midpoint of closure.
Fig~ure 7. Illustration of LJABC which is formed oy lines
drawn froms the poster-ior nasal spine to the superior
poit of contact and from the superior point of contact
tothe midpoint of the uvula.
the velar tissue contacting the pharyngeal wall measured
along the pharyngeal wall from the superior point of con-
tact to the inferior point of contact is the definition of
"amount of contact." This is shown in Fig. 8.
Height of elevation
Height of elevation has been measured in the manner
usually described. In this, a line perpendicular to the
palatal plane extending to the highest point on the superior
surface of the velum? in the closed position is measured in
Imm, This has been shlown in Fig, 2.
HeigJUL of closure
The height of closure is the perpendi~cular distance
from the palatal plane to the superior point of contact,
measured in mm., as illustrated in Fig, 2.
An arbitrary line was draw:n froll the midpoint: of
the measurement of the depth of the nasopharynx along pal-
atal plane (poinlt i in FIg, 8) perpendicular to the palatal
plane. Tlhis line intersects another line drawn parallel to
the palatal plane at 'he level of the inferior point of the
uvula at point I3. The distances SC (th-e distance fro-? pointf
Z to the midpoint of the uvula) and 2? (th~e distance from
point X to the back iall of the pharyn~x) w;ere CeaSUr~ed in
mn. The ratio of the distance EC:;F ? wa calculat~ed and
called "ratio 1`C:3?."
Inferior 3oint of contact
The inferior point of contact of velum wlith pharyn-x
Figure 8, Illustration of amount of contact and method
of determinin? ratio EC:ZF.
has been defined In terms of being above, on, or below
The reliability of tracing: technique was deter-
mined by a tracing-retracing procedure separated by consid-
erable periods of time. In no instance was there any
change in the features such that the outcome of the results
would have been affected. When the original data were
compared wuith retracings of the same frames for 12 subjects,
the following levels of correlation wcere obtained using a
Pearson _r test: amount of contact=.927, height of eleva-
tion=.95, angle ABC=.989, velar length=.993, depth of the
nasopharynx along palatal plane=.970, and depth of the
nasopharynx to midpoint of closure=.938.
nhen all tracings had been made, validity was con-
firmedi by another independent experienced tracer according
to the following procedure.
1, The criteria, as they had come to be understood,
on which to Dake a decision as to the sex of the subject on
th~e fil-: .were learned by the second tracer. The first step
in the procedure for confirming the accuracy of the tracinge
was for the second tracer to decide the sex of the subject
wibh no clues other thran the application of the defined
criteria to the viewing of the films. Thirty-eight of the
40 subjects wrere correctly classified in this wa7y, Subjects
hos. 30 and ?8 w;ere at first incorrectly classified.
This does not represent error in Judgement, however, as
these twvo subjects do not fit the pattern for their sex.
(See Table XI .)
2. The outline of the velum as seen directly on
the projection was then pointed out, according to the
following routine: "This is a (male) (female). I see the
velum as follows (outlined). Hjere is posterior nasal
spine. The back wall of the pharynx if here. Eere is
superior point of contact, Closure would be (above) (on)
(below) palatal plane. Here is inferior point of contact.
The curve of the velum below; inferior point of contact is
here. The tip of the uvula is here."
j. The original tracing, not seen by the second
tracer before, was produced and Judg~ement made that it ob-
viously wcas not a gross misrepresentation of what had just
been pointed out.
4. The original tracing was laid on th~e projec-
tion and lined up with it. A nani1a folder was then held, in
front of the tracing to obscure it and to provide a new sur-
face for the projection. The film was run backwards to a
point where the velum was seen in rest position. The film
was run forwsardi again so that the entire movement into
closure could be watched, and thre actual. outline in closure
identified again apart from any confusion c'ue to other
overlying structures, particularly all surfaces and pro-
cesses of the mandiole.
5. TPhen all points on. the tracings w~ere re-estab-
lished by agreement. The shadow of a pencil point was made
to lie on the point to be established, the manila folder
was pulled away, and if the identifying point was located
correctly, the shadow was observed to fall directly on its
corresponding point on the tracing,
6, Minor changes were made on the original trac-
ings in accordance with the preceding procedure so that the
measurements made were from tracings which represented the
best judgement of two tracers.
Method of Analysis
The configuration of the velum during velopharyn-
geal closure for speech as it is visualized on lateral
cinefluorographic films results from the arrangement of
extrinsic nuscle insertions and front the dimensions of the
velum, the surrounding structures, and the nasopharyngeal
cavity. The factors of height of elevation, height of
closure (site of superior point of contact), amount of clo-
sure, and the site of the inferior point of contact rela-
tive to the palatal plane are used to describe this
configuration. There is further, a factor of orientation
of the velum to the pharyngeal wall. Two attempts have been
made to describe this orientation. Angle ABC, illustrated
in Fig. 7, has been devised as an attempt to define the
basic orientation of velun to pharynx. The ratio LC:EE nae
been calculated in an attempt to show the orientation of the
uvula to the posterior pharyngeal w:all.
TLhe followiing specific m~ethnods of analyzing the
data obtained front makine the defined measurements uere used:
1. The inferior point of contact has been classi-
fied for each subject as above, on, or below palatal plane.
2. The Hiann-W;hitney U Tiest was used to determine
the significance level of differences in scores of males
and females for measurement of a) LAE-C, b) velar length,
c) height of elevation, d) amount of contact, and e) ratio
3. An attempt was made to determine the possible
significance of the depth of the nasopharynx and length of
the velum to the orientation assumed by the velum as des-
cribed by L;ABC. Tihe rationale for the specific question
asked was as follows. There is a distance of a given
measurement to be spanned (the depth of the nasopharynx) by
a structure of a given length (the length of the velun in
closed position). In effecting closure, the velum in some
subjects assumes an orientation which can be defined approx-
imately in terls of an acute a~ngle and in another group of
subjects, in terms of a right angle. The specific question
became: Loes the ratio of the length of the velum to the
depth of tnle nasopharynx determine the angle which is
assumed by the velum in effecting closure, or is this angle
determined according to the ser. of the subject on so-e other
basis? To deter-ine the answer, an analysis of co-vnriance
wras ma~de by constructing an e-atninated linear nodel to define
the effect of sex on LA;;C and the effect of depth-to-length
ratio on L[ABC. In this analysis, depth of the naeopharynx
was defined as the distance from the posterior nasal spine
to the midpoint of closure as this was the actual distance
4. In 16 subjects, the distance from the post-
erior nasal spine to the midpoint of closure was the same as
the distance fromo the posterior nasal spine to the pharyngeal
wall measured along palatal plane. In 4 cases, the distance
from the posterior nasal spine to the midpoint of closure
was more than the distance along palatal plane, and in 20
subjects, the depth of the nasopharynx at the midpoint of
closure was less than the depth along palatal plane. A
llcoxon Xatched-Palrs Signed-Ranks Test was used to deter-
mine whether changing the site of the midpoint of closure
from palatal plane made any significant difference. The
specific question was: If it is assumed that there is an
optimal distance which can most effectively be spanned by
t~he velum, and closure is effected above, on, or below pal-
atal plane accordingly, was the distance significantly
changed as revealed by the difference between the depth of
the nasopharynx along palatal plane and the depth from PNS
to midpoint of closure?
5. Frequency distributions were plotted for velar
length and measurement of ZABC by sex.
Raw data for all female subjects are provided in
Table III and for male subjects in Table IV. The results
of the analyses made using these data are as follows.
1. Relationship of inferior point of contact to
Wihen tabulations are made of the relationship of
the inferior point of contact to palatal plane, as in Table
II, it can be seen that, whereas 17 of 20 males have the
inferior point of contact on or above palatal plane, an
equal number of females have this point below palatal
RELATIONSHIP OF INc'FRIOR POINT OF CONTACT TO
Above On Belowr
hales (20) 12 5 3
Females (20) 3 0 17
2. Height of elevation
As shown in Table V, the mean height of elevation
L& o Rel. Inf. Pt.
C) contact to ( 2
2 aa Palatal P~lane rl
17 A 15 90 2 27.76 7
19 43 14 92 2 9.7
26 40 11 90 25 25 .76 X 7 6
27 38 8 86 25 24 .63 X( 5 3
36 39 11 98 25 25 .67 x 5 5
38 44 5 75 25 24 .50 x 8 8
42 39 8 80 28 28 ,70 X 7 5
43 35 8 92 27 27 .75 x 4 3
45 38 ? 102 25 27 .71 X 1 0
46 40 11 98 27 27 .86 x 5 4
50 41 8 85 27 27 .63 X 2
51 44 12 90 25 25 .70 x 3 1
54 45 11 90 28 28 .72 x 5 5
56 46 5 75 32 29 .~55
61 36 9 90 24 24 67 X 6 5
62 38 6 76 27 23 .69 X 10 8
69 45 9 90 30 30 .66 X 7 6
88 42 ? 86 29 28 .75 x 8 6
93 40 9 90 26 25 .7.5 x 6 6
RAW DATA FOR FEMALES
r Rel. Inf. Pt.
a 0 aContact to > A
18 61 6: 50 40 3 .0 6 1
20 w47 8 7 2 5
22 57 6 5 40 3 3 .247 x 16 13
24 57 7 70 35 31 .50 x 16 12
25 48 7 66 27 28 .53
2851 6 77 31 30 .57 X 11 8
30 48 9 80 27 27 .43 X 7 4
31 48 5 63 29 25 .35 x lo lo
39 lc0 7 80 23 23 .45 x 3 3
40 38 5 64 25 22 .4 1
47 39 6 51 23 22 .18 X 8 7
49 48 8 70 29 27 .36 X 9 9
55 44 5 68 27 27 .34 X 9 8
57 45 3 59 30 29 .50 x 9 6
58 46 6 73 30 30 .50 x 7 3
59 48 6 65 31 26 .31 X 11 11
60 50 4 65 33 31 .57 x 14 14
81 51 7 65 28 26 .36 X 9 8
95 51 6 65 35 31 .57 x 15 14
RArj DATA FOR MALE~S
for males is correspondingly higher than that for females.
The mean of this measurement for males (10.05 mm.) is
almost double the mean for females (5.9 mmn.). It has
already been noted that the sound produced may have
influenced this measurement for females in an upward direc-
tion. FIve female subjects (Naos. 56, 61, 62, 69, and 84)
produced the sound /ki/. TIhe mean height of elevation for
these subjects was 8 mm. as contrasted wijth the over-all
mean for females of 5.9 mn. The mean height of elevation
for females may thus be higher than otherwise because of
this difference. Only 2 males had said /ki/ and the effect
was not significant for the males' hei3'ht of elevation.
COMPAR'~ISONl OF MEAN; ;IGn-T CF ELEVATION BET EENl u
KALES AND FEMALUS
lMales (20) Females (20) U
Range 3-16 mn, 1-10 mm3.
iMean 10.05 mm. j.9 3m.
S.D. 9,66 2.2
*Significantly different from zero beyond the .0003 level..
3 Amount ofcontact
The means for the anou~nt of contact of velar tissue
with pharyngeal tissue as shown in Table VrI .ho:w that this
measure in females is almost twice what it is in males.
Males (20) Females (20) U
Range in nm. 3 to 9 5 to 15
Mean 5.7 9.5
S.D. 1,41 2.74
*Significantly different from zero beyond the .00005 level.
The differences between nales and females for the
measuremnent of LA;C are shown in Table VII. It can be seen
that the difference between the means for the sexes is
COIPAr~ISC;: CFr';AN:S FO ALE;fS A?;D FEM;iALES
iiales (20) Fenales (20) U
Range in degrees 50-84 75-102
iNean 69.7 88.1
s.D. 9.28 7.33
"Significantly different from zero beyond the <.00003 level.
5. aetto .ne:i2
There wass less variation in this ratio for females
as seen in the comparison of the range for this measurement
for males and femalese shown in Table VIII. The proportion
of the distance sP taken up by the distance EC in males
COMPArlIJON OF iHEANiS OF AHOCUNT OF CONTACT
ranged from 18 percent to 57 percent and averaged 43 per-
cent. For the females, the distance EC was from 50 to 75
percent of the total distance to the pharyngeal wall (EF),
with an average of almost 69 percent. This measurement
shows, therefore, that the tip of the uvula is angled sig-
nificantly farther away from the posterior pharyngeal wall
COMPARISONS: OF MEANS FOR PEALZS AND3 FEMALES
FOR RAT'iIC EC:E~F
Mazles (20) Fema~les (20) U
Change .18 to .57 .50 to .75
Mean .433 .689
S.D. .114 .076
qSignificantly different from zero beyond <.00003 (nil).
6. Velar length
The length of the velum varies more amon3 males
than anon3 fenales, as shown in Table: IX.
COMPAHI~',SO.\ OF ;;EA;;S OF V-LAr" L;=IiGT3: IN
MALES ANDC FTEALESU~
Hange (21.) 38 to 61 36 to 46
acan 47.8 41.0
*Significantly different from zero beyond the <.0"003 level.
It can be seen from the frequency distribution graph in
Fig. 10 that, while all females are found within the inter-
vals between 35 and 46 mm., only 8 males are within these
7. Significance of difference in measurements
of death of the nasocharynx alonrr palatal plane
and fron "aS to midpoint of closure
A Wilcox~on N~atched-P~airs Signed-Ranks Test showed
thaet the difference in the two measurements of depth of the
nasopharynx was significant for males at the 1 percent
level but not significant for females. This is shown in
Table X in which PNS-X represents the depth of the naso-
pharynx along palatal plane and PNS-Y is the depth to the
midpoint of closure.
SIGI:IFICAN;CIE OF jI~iFFEREN1CE
IY iR;ASUR S:: ET'iS OF PL.S-X AUiJ ?NS-Y
Iuesn Diff. Ad-Justed
in mm. N iloon5 T
nales -1.65 20 16 8i
Females -.3 20 8 9.5
?'The adjusted .;ilcoxon ii is lees th-n 20 in each case due to
the mieasuremrentfi s were no differences was observed. :dumber
of cases in eact group was 20.
* i"-inificantly different front zero at the .01 level.,
8. -;n~~lysis of _p~ z d-c-veriec ftecntiuino h
The equatione calculated howed that the t for sex
was 6.13 and was significant at the 4,001L level for its
contribution to the LAB~C. The t for the velar length:
pharyngeal depth was 0.84 and not significant for LABC,
The equations for the estimated angles and the coefficient
Y =67.93 +27.19 (9Rtio .6140) (M~ales)
Y = 87.38 + 23.19 (Ratio .6140) (Females)
The angle assumed by the velum in closure is not
determined by the ratio of the length .of the velumn to the
distance to be spanned (depth of the nasopharynx) but is
determined on som~e other basis which appears: to be related
B Females ---
3 1 a Females --
!I P Males~ -,
Figure 10, Frequency distribution ourve for elarC length
DISCUSSION,, CONCLUTSIONS, SUMM!ARZY
The organizing of subjects in terms of their
measurements for LABC offers a systematic scheme for con-
sidering all measurements in relation to a total pattern.
When this is done, some interestingi questions can be raised
It has been claimed here thant LABC describes the
basic orientation of the velum to the pharynx. Ratio SC:TE
has been calculated to Sather supporting evidence for the
idea that the uvula is angled a~n-triorly a'a-y from the
pharyngeal wall in males but not in females. This could be
a result of either or both a pulling forward of the avula
in the male or a pulling: backw:ard in the female. The
orienetaton of the superior point of contact is diagonal to
the inferior tip of the uvula when the measurements of
LABC are acute. AE the neasurements of LABC approximate a,
right an-Le, the ori~entation of the superior point of con-
tact to the tip of the uvula beco-es vertical owiLng to an
apparent pulling; back of the tip of the uvula to t're phor-
yngeal wall. This difference in orientation can be seen in
Figs. 3, 4-, and 5.
.:hen the chan~e in orientation is toward the
vertical, there seems to be a concomitantly greater amount
of contact of velum with pharynx, a site of closure such
that the inferior point of closure is below palatal plane,
and a height of elevation relative to palatal plane which
is also concomitantly lower. These differences are not
explainable by chance.
Table XI, in which subjects are organized accord-
ing to measurements of LPABC showYs that total patterns for
each sex among the several variables describing the velo-
pharyngeal mechanism do emerge.
In the male pattern, amount of contact is less, and
height of elevation is greater than in the female. The
Inferior point of contact is most often above palatal plane.
In the female pattern, the reverse of these situations is
It can be seen from Table XI that the measurement
of 740 defines the upper limit for a "clear-cut" male
category in which no femlales are found. The lower linit
for defining a corresponding "clear-cut" female category is:
Fifteen of the mFale subjects fell into the clear-
cut male ca~tegor-y and 16 of the femal~es into the female
category. F'ive marles and four fonales madie up an overlap-
ping category in conformity with the freouency distribution
for LkAM alone shown in Fig. 9, The limiits for j(AEC in
the "ovlerlapo" category were 750_ggo
But statistically spceakinr, there are two basic
Amount Helstionship of
LABC Subj. of Inferior Pt. Contract Helsht :.eight Velar
ho. Contact to Palatal Plane 'Jev. Closure Length
Above On Below
heans 5.8 11 1
28 6 X 11 P 51
21 4 X 5 8
75-7 *38 5 x 8 G
*56 59 7 6
*62 t X 10 s 38
h*2 8 X 7 5 39
80-FII 20 7 X 7 6 l
30 9 :: 7 4 ii?
39 7 X 3 3 L0
rneans b,] 7.5 .
ORGANIZATION OF SUBJECTS BY MEASUREMENiTS OF AN-Lr: ABC
patterns into which all subjects have fallen. All subjects
with measurements for LABC of 790 or less are found to fit
the male pattern as it has been defined here, and all writh
measurements of 800 or more fit the female pattern. Then 3
of each sex are found in the category of the opposite sex.
A clear-cut sex differentiation would seem to be compromised
Extrapolating from these findings, it could be
expected that 85 percent of all individuals who would fit the
male pattern of velopharyngeal mechanism would, in fact, be
males, and similarly, 85 percent of all persons who would
fit the female pattern would in truth be females.
This raises the question of what factors could be
operating within or on the velopharyngeal mechanism to re-
sult in such a high correlation on a sex basis and yet still
allow for some "crossing over."
Configuration could be anatomically ordained on the
basis of either structural (skeletal) variations and their
consequent influence on the orientations of muscles, or
differences in mechanisms of muscle actions. On the other
hand, the configurations could represent the effect of
muscle adjustments which must be made by whatever muscle
action necessary to achieve certain balances between reson-
ating cavity proportions for the purpose of achieving
certain acoustic effects.
There has been essentially only one question asked
in the literature with regard to structural differences,
and that has been with reference to velar length and
pharyngeal depth relationships. The finding reported here
that the difference between the depths of the nasopharynx
measured along palatal plane and at actual site of closure
is significant only for males is evidence against the idea
that shorter palates have to rise higher to achieve
closure. It is the males who have the higher height of
elevation and who also have the greater mean velar length.
This, together with the finding that the ratio of the
leng-th of the velum to the depth of the naseopharynx does
not influence the orientation of the velhn in closure (as
described by LAB9C) sug-gests that the question asked about
structural differences has not been the relevant one.
This would not preclude the possibility of there
being other significant structural relationships within
which differences could be found.
For example, the diagonal orientation between
superior point of contact and tip of the uvula in ma~les,e
which is manifested in the acuteness of LABC, could be due
to a particular orientation of levator palatini to palato-
glossus muscles existing because of particular head size
and oral and pharyngeal disensiions
The corresponding vertical orientation of the
superior point of contact and tip of the uvula in fenales
could be due to a vertical orientation of elevator and palat-
opharynJaus such that palsto510ssus was not in the line of
major influence. Tihis could be the resultant of a differ-
ence in sku~ll size, orientation of skcull to cervical
column, or oral and pharyrngeal size differences, Such
hypotheses would allow for some cross-over between the
sexes because of size differences.
Size considerations aside, it could be possible
that the two different velar orientations are the end pro-
ducts of two different mechanisms of muscle actions, It
may be that in those persons having the male pattern, the
palatopharyngeus muscles are caused to move medially,
allowing levators and palatoglossus to act antagonistic-
ally to cause the "hookinS" action described by Ricketts
(19~54). In those individuals having the fenale pattern,
movement of palatopharyngeus muscles could be posterior-
ward so that they become the direct antagonriscts of the
elevator muscles, thus causing the tip of the uvula to be
directed downward and causing closure to occur at the level
of palatal plane with a conconitant decrease in height of
elevation above palatal plane.
The whole purpose for velopharyngeal closure in
speech has been defined as the regulation of nasal reson-
ance. The different velar orientations and configurations
could have some special significance to the acoustic output
during speech. TIhe differences in the measu~rements of the
variables contriouting to the configurations could represent
adjustments which have to be made in one sex or the other to
compensate for the basic difference in fu~ndamrental frequency
compoundced by differences in the oral and pha~ryngeal
cavities. It may be that such compensations must be made
in order to achieve comparable phonetic results.
1. The velopnaryngeal mechanism as it is visualized with
lateral cinefluorography has been found to differ for males
and females in every measure studied. Control for sex as
a variable should be a part of studies of the velopharyngeal
2. The basic orientation of velum to pharynx is different
for the sexes and configuration of the velum in outline is
conconitantly different according to specific patterns. The
basic orientation of the velum to pharynx in males can be
described in terms of an acute angle, and that of females
more approximately a right angle. Velar length is greater
in males, the height of elevation is greater, the amount of
contact is less, and the inferior point of contact is most
usually above palatal plane. The reverse of these findin_7s
is the usual condition in the female pattern.
These differences are not due to chance and are
not explainable on the basis of a velar length to pharyngeal
3. The establishing of the basic pattern of configuration
for experimental subjects un'er controlled conditions could
be a useful technique to use in the further study of
variations within the velopharyngeal mechanism for thn
definition of anatomic or physio-acoustic relationships,
It has been hypothesized that the velopharyngeal
mechanism as visualized on cinefluorographic films is
different in young adult males as compared with young adult
females. Evidence has been presented that the basic orien-
tation of the velum to the pharynx is different in the
sexes. In males, the uvula is seen to angle forward away
from the posterior pharyngeal wall. The orientation of the
superior point of contact with the mnidpo0int of the uvula is
such that when a line is drw~n~ from the midpoint of the
posterior nasal spine to the superior point of contact and
another line is drawn from the superior point of contact to
the midpoint of the uvula, an angle of acute dimensions is
formed. In females, the angle described by comparably
placed lines approximates a right angle. The descriptive
angle has been designated L.ABC. The upper limit that w~lll
define a male measurement of this angle has been found to be
790. In females, the measurement will be 800 or larger.
The orientation of the velun to the pharynx has
been further defined by a ratio which describes the distance
of the tip of the uvula fromi the back pharyngteal wiall. This
ratio has been called EC:EF.
There are different patterns of configuration out-
lined by the veluml in closure which are concomitants of the
basic orientations. Once the basic orientations have been
established, the configurations are the further result of
the amount of contact, height of elevation, and the place on
the pharyngeal wall relative to palatal plane which is the
site of the inferior point of contact.
The following specific findings have been
1. Seventeen of 20 males had the inferior point of contact
on (5) or above (12) the palatal plane. Seventeen of 20
females had this point below palatal plane.
2. Height of elevation was greater for males. The mean
height of elevation for males was 10.05 nm. while for
females it was 5.9 mm.
7. The mean amount of contact for females was 9.5 ne. and
5.7 nm. for males.
4. The mean measurementi of LABC in males was 69.7 and for
females it was 88.1. W~ith 790 defined as the upper limit
for a male category as defined by LAaC, and 800 the lower
limit for a female category, 17 out of 20 of each sex were
in their appropriate categories and 3 of each sex w~er-e in
the category for the opposite sex.
5. The average ratio of Ec to ZF in males was 43 percent
and was 69 percent in females demonstrating that the uvula
is angled forward away from the posterior wall of the
pharynx in males.
6. VlarT length was significantly greater in nales, rang-
ing from~ 38 to 61 ma. wcith ae -ean of 47.8 ?im. The! ranre for
females ;;as 3; to 46j with a miean of 41 -m,
7. Tihe depth of the nasopharynx was ~eas~uredi fro- P::S along
palatal plane and from Pi;S to th~e midpoint of closure. Tihe
difference in the two measurements was significant only for
It wias concluded that the velopharyngeal mechanism
was significantly different for the sexes on every measure
tested. This difference could not be due to chance,
The basic orientation of the velum to the pharyn-
geal wall as defined by measuremcents of LABC and Ratio
EC:EF is different for the sexes. This difference in
orientation as defined by LrABC does not depend on a ratio of
velar length to pharyngeal depth. As angle measuremenlt
increased, amount of contact increased, and height of eley-
Some speculation as to reasons for the differences
was included. Plans for future research include the inves-
tigation of possible acoustic correlates of variations from;
the basic configurations which might be induced as well as
the possibility of a difference in muscle necha7nismis.
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Dorothy Vivian McDuffe McKerns w~as born in
Brandon, Mianitoba, Canada, on Maiy 3, 1923, Hier primary
and secondary education were received in Canada, She and
Kenneth McKerns were married in 1947 and have two
daughters, Maureen and Leslie, and a little granddauGhter,
Laura. The Mc~erns family has lived in Edmonton, Montreal,
and Toronto in Canada, and St. Andrews, Scotland before
coming to the United States in 1956 to make their home in
iNew Jersey. while e living in N~ew Jersey, Dorothy attended
Paterson State College in azyne, N.J. and Fraduated cum
laude in June, 1960 with a Bachelor of Arts in ilementsry
Education. She entered the University of Florida in
September, 19t0, when she and her family moved to Gaines-
ville, and received, a M~aster of Ed~ucation degree in Second-
ary education (Snglish) in December, 1.962. Worke toward a
doctorate in Speech Pathology was begun in September, 1963.
American citizenship was granted in October, 1963. Special
interests aside from those involved in the field of~speech
include th-ose shared writh her husband in his w~ork inl endo-
crinolo-gy, and. in their home, gardecn, and family.
This dissertation was prepared under the direction
of the chairman of the candidate's supervisory committee
and has been approved by all members of that committee. It
was submitted to the Dean of the Coll~ege of Arts and
Sciences and to the Graduate Council, and wvas approved as
partial fu~lfillment of the requirement for the degree of
Doctor of Philosophy,
Dean, Graduate School