Speech outcomes at 5 and 10 years of age after one-stage palatal repair with muscle reconstruction in children born with isolated cleft palate

Abstract

Background: The aim of this study was to investigate speech outcomes in children with clefts in the hard and/or soft palate only (CPH/CPS), in order to determine the prevalence of cleft speech characteristics, the change between 5 and 10 years of age, and the difference in occurrence between CPH and CPS.

Methods: A consecutive series of 88 children born with CPH or CPS were included in a retrospective cohort. All participants were treated with one-stage palatal repair using a minimal incision technique with muscle reconstruction (mean age 13 months). Twelve children (14%) received a velopharyngeal flap. Cleft speech variables were rated at 5 and 10 years of age independently by three experienced external speech-language pathologists. Inter- and intra-rater agreements were determined, and the prevalence of cleft speech characteristics was calculated.

Results: Moderate-to-severe hypernasality and weak pressure consonants were present in 5%–10% of the children at 5 years, with marginal but statistically significant improvement at 10 years of age. Frequently or always occurring audible nasal air leakage was detected in 20% of children at age 5, and increased to ∼35% of the children at 10 years. Ten per cent had compensatory articulation at age 5, and 25% demonstrated s-distortions, whereas few had these problems at age 10.

Conclusions: The results demonstrate low occurrence of compensatory articulation problems in this cohort, even by 5 years of age. The high presence of symptoms of velopharyngeal insufficiency at 10 years of age suggests a need for additional secondary velopharyngeal surgery.

Keywords:

• Cleft palate
• cleft palate repair
• VPI
• secondary velopharyngeal surgery hypernasality
• compensatory articulation

Acknowledgements

This study was presented at the Annual Scientific Conference of the Craniofacial Society of Great Britain and Ireland, Nottingham, Great Britain, April 2016.

The authors are grateful to Christina Persson, SLP, PhD, Emilie Hagberg, SLP, MSc, and Kristina Klintö, SLP, PhD, who performed the speech analyses.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. The procedures followed while conducting this study were in accordance with the ethical standards of the Helsinki Declaration of 1975, as revised in 1983.

Additional information

Funding

Financial support was received from the Stockholm County Council (ALF project) and Berth von Kantzows Stiftelse.