Results of systematic speech sound monitoring in children with cleft palate

Blowing ratio as an evaluation tool for velopharyngeal function after oral and oropharyngeal cancer resection

BACKGROUND

Our objective was to evaluate the value of the blowing test to measure the speech and swallowing function after resection of oral or oropharyngeal cancer.

METHODS

Speech and swallowing functions of the patients after surgical resection of oral or oropharyngeal cancer were assessed by a speech intelligibility test, blowing time, questionnaires, and oropharyngeal pressures. Blowing time (pressure) ratio was determined by dividing blowing time (pressure) with open nose by blowing time (pressure) with closed nose.

RESULTS

Blowing time ratio had significant correlation with blowing pressure ratio (p = .014), score of speech intelligibility test (p = .0014), questionnaire for aspiration (p = .029), nasopharyngeal backflow (CC = 0.676, p = .032), amount of food to swallow (p = .037), and oropharyngeal pressure during swallowing (p = .024).

CONCLUSION

The present results demonstrated the value of blowing time ratio as a simple objective tool for speech and swallowing ability related to velopharyngeal function after resection of oral and oropharyngeal cancers.

Communicative abilities in toddlers and in early school age children with cleft palate

OBJECTIVES

Evaluation of improvement in communicative abilities in children with nonsyndromic cleft palate.

METHODS

Longitudinal retrospective case history study. Out of 117 children with cleft lip and/or cleft palate born in 1998, 1999 and 2000 and enrolled in the cleft palate team of the University Medical Centre Groningen (UMCG), 63 children were included in the study; 29 (46%) boys and 34 (54%) girls. From these 63 Dutch speaking children communicative abilities were measured when toddlers and at early school age. Cleft types were cleft lip with or without cleft alveolus (CL+/-A; n=10, 5%), unilateral cleft lip and palate (UCLP; n=23, 37%), bilateral cleft lip and palate (BCLP; n=9, 14%) and isolated cleft palate (CP; n=21, 33%). The percentage of problems in language comprehension, language production, articulation, hearing and hypernasality, present when toddlers, were compared with the percentage of problems found at early school age. The treatments executed were also analysed.

RESULTS

Except for hearing problems, problems in all other communicative fields improved significantly. In the total group language comprehension problems decreased from 23% to 2% (p=0.00), language production problems from 21% to 6% (p=0.01), articulation problems from 57% to 25% (p=0.00) and hypernasality from 38% to 10% (p=0.04). Hearing problems appeared more difficult to treat effectively, they decreased from 42% to 31% (p=0.29). Children with BCLP appeared to have the most problems, followed by children with UCLP and then children with CP. Children with CL+/-A show the least problems. In the intervening period, often a combination of treatments was performed. Pharyngoplasty appeared to be very successful in treating hypernasality, with a success rate of 86%.

CONCLUSIONS

At early school age, in children with clefts, speech and language problems were significantly improved following a multidisciplinary approach to treatment and resemble their peers without clefts. Hearing problems were more difficult to treat.

Speech and language development in toddlers with and without cleft palate

OBJECTIVE

The effect of early palate closure on speech and language development in children with cleft palate.

DESIGN

Comparative study.

SETTING

University Medical Center Groningen, Cleft Palate Team (The Netherlands).

MATERIALS AND METHODS

Forty-three toddlers with cleft palate and thirty-two toddlers without cleft palate were analyzed with standardized tests for language comprehension and language production. Moreover articulation and hyper nasality were examined by trained speech therapists.

RESULTS

For language comprehension, language production and articulation there were no significant differences between the children with and without cleft lip and/or palate. This is despite the high percentage of conductive hearing loss (55%) in children with clefts. Significant difference was found for hyper nasality (mean: 35% vs. 0%, p=0.001). In both groups articulation problems raise to a higher percentage than language production problems (63-20%; 24-4%).

CONCLUSIONS

Early surgical treatment is effective for a part of the communicative development, i.e. language development and articulation. Besides conductive hearing loss hyper nasality remains a serious problem in 30-50% of the children with cleft palate. Therefore, speech therapy and pharyngoplasty also are part of the treatment procedure. Because of the high amount articulation problems in all children, standards for articulation development are perhaps too strict. Future research should be carried out after normal variations in articulation development.

A retrospective study of hearing, speech and language function in children with clefts following palatoplasty and veloplasty procedures at 18-24 months of age

Many cleft palate teams currently schedule palatoplasty and veloplasty within the child's first year of life. At Hannover Medical School, palatoplasty and veloplasty are performed at approximately 18-24 months of age. It was questioned which speech and language outcome was achieved and whether it may be influenced by: (1) type and extent of the clefts; (2) velopharyngeal inadequacy; and (3) hearing disorders. A retrospective evaluation of data collected from 1985 to 1993 was performed summarizing receptive and expressive speech and language skills of 370 children aged 4.5 years. Cleft types were unilateral cleft lip and palate (UCLP, 30.0%), bilateral cleft lip and palate (BCLP, 28.7%), cleft hard and soft palate (CP, 21.6%), cleft soft palate (cleft velum, CV, 10.8%), cleft lip and alveolus (CLA, 5.8%) and submucous clefts (SUB, 3.2%). n = 86 had constant normal hearing, and n = 284 had conductive hearing loss > 20 dB (500-4000 Hz). Severe developmental phonology errors were found in 30-50% of children with repaired cleft palate and in less than 8% of patients with CLA and SUB. Posterior compensatory misarticulation was below 15% in the groups UCLP, BCLP, CP, CV and SUB. Nasal resonance and air emission was nearly normal in CLA, but was increased in 27% to 38% of the other cleft types. Children with conductive hearing loss had significantly more and severely affected phonology, morphology, syntax, vocabulary, language comprehension, and auditory perception than normal hearing children. Findings indicated that speech and language function in CLP patients were predominantly related to the hearing status.