Speech Outcome and Self-Reported Communicative Ability in Young Adults Born With Unilateral Cleft Lip and Palate: Comparing Long-Term Results After 2 Different Surgical Methods for Palatal Repair

Abstract

Objective: To compare speech outcome and self-reported speech and communicative ability (SOK) in young adults treated with one-stage (OS) or two-stage (TS) palatal repair. Furthermore, to compare with normative data on individuals without cleft lip and palate and to study the relationship between patients’ and experts’ judgments. Design: A cross-sectional group comparison study with long-term follow-up. Participants: Patients born with unilateral cleft lip and palate treated at 2 cleft centers; 17 with OS at 14 months and 25 with TS, soft palate repair at 7 months and hard palate repair at 6.2 years. Pharyngeal flap surgery was performed in 53% (OS) and 24% (TS) of patients. Main Outcome Measure(s): Speech characteristics were blindly assessed by speech and language pathologist from audio recordings, SOK at 19 years of age. Results: No group differences were found. Although the occurrence of nasality symptoms was low in both groups, only 60% (OS)/65% (TS) were assessed with competent velopharyngeal function (VPC). Articulation proficiency (percentage of consonants correct [PCC]) was 91%/97%, the /s/-sound specifically 87%/91%. Good intelligibility was found in 91%/87%. Patient opinion was in agreement with norms and significantly associated with intelligibility ( rs = 0.436, P < .01), PCC ( rs = −0.534, P < .01), and correct /s/ ( rs = −0.354, P < .05). Conclusions: No differences in speech outcome were related to operation method. The low prevalence of VPC was not clearly reflected in nasality symptoms. Patient opinion was related to articulation and intelligibility. A higher burden of care in terms of pharyngeal flap surgery was seen after the OS technique.

Long-term longitudinal follow-up of individuals with UCLP after Gothenburg twostage palate closure: surgical and speech outcomes

“…However, this method of soft palate closure is considered not to affect the growth, which is why it is included in the results of the surgical treatment as well as and as well as in a growth study of the same cohort. In this study, 22% of the participants had secondary velopharyngeal surgery which is a comparatively high number, but in line with the speech results of many other studies; a recent study of two cohorts of patients born with UCLP in Sweden showed 24 and 53% rates of pharyngeal flap surgery, respectively [23]. To use the prevalence of secondary velopharyngeal surgery as an evaluation method of speech results after primary surgery is difficult, as indications for surgical intervention can vary over time.…”

“…It could also be argued that with time, most patients born with a cleft palate develop normal speech, so the relatively small differences at younger ages are of less importance. However, a child may develop at less favorable attitude to communication if they speak in a way that is deviant from the norm and perhaps are less intelligible during their pre-school years [12,23]. A study of 10-year-olds' communication attitudes revealed a more negative attitude in children born with a cleft involving the palate compared with children without clefts [24,25].…”

Treatment Outcomes of Interdisciplinary Care on Speech and Health-Related Quality of Life Outcomes in Adults With Cleft Palate

“…Although severe resonance disorders do not occur frequently in young adults with a CP±L, mild to moderate hypernasality and nasal emission/turbulence are found in respectively 2 to 56% and 4 to 60% of this population Not for broad dissemination (Farzaneh et al, 2008(Farzaneh et al, , 2009Havstam et al, 2008;Kappen et al, 2017;Lohmander et al, 2012;Moren et al, 2017;Peterson et al, 2021;Van Lierde, Monstrey, et al, 2004). These extreme variations in incidence might be attributed to differences in evaluation scales and/or lack of objective measurements.…”

“…Several studies have described speech outcomes of adults with a CP±L, using an array of perceptual and instrumental assessments to measure various parameters in the speech and communication domains (Allori et al, 2017;ICHOM, 2018). Whereas Lohmander et al (2012) reported good overall long-term speech outcomes at age 19 with little to no residual speech deficits, other authors have taken note of consonant production errors (Farzaneh et al, 2008(Farzaneh et al, , 2009Havstam et al, 2008;Kappen et al, 2017;Moren et al, 2017;Peterson et al, 2021;Van Lierde, Monstrey, et al, 2004), hypernasality (Farzaneh et al, 2008(Farzaneh et al, , 2009Havstam et al, 2008;Kappen et al, 2017;Moren et al, 2017), audible nasal emission and/or turbulence (Farzaneh et al, 2008(Farzaneh et al, , 2009Havstam et al, 2008;Moren et al, 2017;Peterson et al, 2021), and reduced speech intelligibility (Kappen et al, 2017;Van Lierde, Monstrey, et al, 2004).…”

“…rote speech, structured speech samples at the word or sentence level, or spontaneous speech), either with or without the use of formal phonetic transcription, is generally used (Farzaneh et al, 2008(Farzaneh et al, , 2009Havstam et al, 2008;Kappen et al, 2017;Moren et al, 2017;Peterson et al, 2021;Van Lierde, Monstrey, et al, 2004). Peterson et al (2021) have additionally measured articulation proficiency by use of the percentage of consonants correct (PCC), to quantify consonant production in a more standardized and reliable manner. They found a lower score in young adults with a CP±L compared to normative data for the general population.…”