Which finding is a sign of a fistula after palate repair?

• A. Air escaping through the nose during swallowing.
• B. Nasal regurgitation during feeding.
• C. Abnormal speech resonance.
• D. Normal hearing.

Answer: (B)

A fistula after palate repair means there is an opening between the mouth and the nasal cavity. The clearest sign of that opening is nasal regurgitation during feeding—liquid passes through the fistula into the nasal passage and comes out through the nose. This direct transfer of material from the oral to the nasal cavity is what makes nasal regurgitation the best indicator.

Air escaping through the nose during swallowing can happen with velopharyngeal insufficiency, where the seal between the oral and nasal cavities isn’t perfect during swallowing or speech, but it’s not as specific to a true fistula. Abnormal speech resonance also points to issues with the airway’s closure during speech, often related to VPI rather than a discrete fistula. Normal hearing doesn’t reflect the presence of a fistula at all.