Speech outcome in children born with cleft lip and palate treated with one-stage palate repair : aspects of function and environment

Introduction and aims: This project focused on speech outcomes at 5 and 10 years of age after two different surgical protocols and on peer perceptions of speech in children born with cleft palate. The aim was to gain knowledge about speech outcome in children born with unilateral cleft lip and palate (UCLP) or cleft palate only (CPO), treated with one-stage palatoplasty at approximately 12 months of age, according to two different surgical protocols: minimal incision technique (MIT) and minimal incision technique with muscle reconstruction (MITmr). In addition, the aims included to study how peers not familiar with the speaker describe cleft related speech impairment in their own words and the possible consequences that it might have in a social context. Materials and methods: A total of 217 children born with a cleft palate were included in this project: 69 children with UCLP and 148 children with CPO. In the CPO group, 98 had a cleft in both the hard and soft palate (CPH) and 50 in the soft palate only (CPS). The children were born in the Stockholm region in 1987–2004. In addition, 37 children born without a cleft participated: 18 children as a reference group at 5 years of age and 19 children in focus groups at 10 years of age. Speech outcomes were assessed from audio recordings by external expert speech and language pathologists. Intra- and inter-rater reliability were determined. Three focus groups of peers listened to and described speech samples with different types of cleft speech characteristics as well as normal speech. Results: The children with different cleft types presented a high degree of hypernasality and audible nasal air leakage at 5 years of age, especially in the group operated on according to the MIT protocol. A significant decrease at age 10 was found, except for audible nasal air leakage in children with CPO. With the MIT protocol 43% of the children with UCLP, 42 % with CPH and 4% with CPS had received a velopharyngeal flap. The prevalence of articulation errors, such as retracted oral articulation and glottal articulation, decreased with age. The CPO group showed fewer articulatory errors than the UCLP group. Peers identified normal speech and more pronounced signs of nasality and easily detected and reacted upon even single occurrences of articulatory difficulties and commented on possible reasons why and how these errors could influence communication. Conclusions: The prevalences of nasality and articulation errors were similar to what is commonly reported at 5 and 10 years of age in children born with cleft lip and palate. Nasality and articulation improved with age, except for nasal air leakage in the CPO group, indicating that more velopharyngeal flaps might be required at a later age. In the CPO group, were velopharyngeal flaps common in children with CPH treated with MIT. Velopharyngeal flaps were also common in the UCLP group treated with MIT. Peers detected and commented on moderate to severe nasality and articulatory difficulties including minor errors. This should be considered when planning intervention