Blog Archives

Relationship Between Occlusion and Lisping in Children with Cleft Lip and Palate.

DISCUSSION: This study failed to reveal an association between lisping and dental arch relationship in children with operated UCLP. Multiple variables may play a role in determining occurrence of lisping, warranting further investigation.

from the Cleft Palate-Craniofacial Journal

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The occurrence of velopharyngeal insufficiency in Pierre Robin Sequence patients

Conclusion
Our findings suggest that children born with a Pierre-Robin Sequence do not have a higher rate of post-operative VPI after cleft palate repair and are no more likely to require additional surgical intervention.

from the International Journal of Pediatric Otorhinolaryngology

Current Practice in Assessing and Reporting Speech Outcomes of Cleft Palate and Velopharyngeal Surgery: A Survey of Cleft Palate/Craniofacial Professionals.

Conclusion: This survey shows considerable variability in the methods for evaluating and reporting speech outcomes following surgery. There is inconsistency in what is considered a successful surgical outcome, making comparison studies impossible. Most respondents thought that success should be defined as normal speech, but this is not happening in current practice.

from the Cleft Palate-Craniofacial Journal

Speech and MRI Results Following Autologous Fat Transplantation to the Velopharynx in Patients With Velopharyngeal Insufficiency.

Conclusions: Autologous fat transplantation to the velopharynx resulted in a significant reduction of the velopharyngeal distance and the velopharyngeal gap area during phonation, as measured by MRI. This was in accordance with a significant improvement in nasal turbulence. However, hypernasality and audible nasal emission did not change significantly and could not be correlated to the MRI findings.

from the Cleft Palate-Craniofacial Journal

Current Training and Continuing Education Needs of Preschool and School-Based Speech-Language Pathologists Regarding Children With Cleft Lip/Palate

Conclusion: When assessing and treating a low-incidence population such as children with cleft-related communication disorders, school-based SLPs need accessible, accurate continuing education resources and collaboration with specialists in the field.

from Language, Speech and Hearing Services in Schools

Submucous Cleft Palate and Velopharyngeal Insufficiency: Comparison of Speech Outcomes Using Three Operative Techniques by One Surgeon.

Conclusions: Double-opposing Z-palatoplasty is more effective than two-flap palatoplasty with muscular retropositioning. For children over 4 years, primary pharyngeal flap is also highly successful, but equally so as a secondary operation and can be reserved, if necessary, following double-opposing Z-palatoplasty

from the Cleft Palate-Craniofacial Journal

Videofluoroscopic and Nasendoscopic Correlates of Speech in Velopharyngeal Dysfunction.

Conclusions: VNE and LVF closure estimates correlated moderately. LVF tended to give smaller gap estimates. Hypernasal resonance and facial grimace are useful clinical indicators of large gap size. Velar movement angle and change in genu angle were identified as anatomical correlates of closure function.

from the Cleft Palate-Craniofacial Journal

Treatment of persistent middle ear effusion in cleft palate patients

(1) The majority of children born with cleft palate do not have middle ear fluid at birth. (2) Most children with cleft palate will likely develop persistent middle ear fluid with conductive hearing loss. Risks of complications from ear tubes in cleft palate patients are few and manageable using standard sized ear tubes.

from the International Journal of Pediatric Otorhinolaryngology

Impedance audiometry in infants with a cleft palate: The standard 226-Hz probe tone has no predictive value for the middle ear condition

In cleft palate babies tympanometry with a 678-Hz probe tone yields clear evidence of middle ear effusion and should therefore serve as an essential instrument before the first surgical step of palate closure. In case of applying the 226-Hz probe tone, we were often confronted with normal function of the Eustachian tube despite of proved existence of middle ear effusion.

from the International Journal of Pediatric Otorhinolaryngology

Maxillary growth in patients with complete cleft lip and palate, operated on around 4–6 months of age

Early cleft palate repair enhances phonological development. Although maxillary growth is affected in cleft palate patients, appropriate orthodontic treatment can achieve normal maxillary growth as measured during adolescence.

from the International Journal of Pediatric Otorhinolaryngology

Cleft Audit Protocol for Speech (CAPS-A): a comprehensive training package for speech analysis

Methods & Procedures: Thirty-six specialist speech and language therapists undertook the training programme over four days. This consisted of two days’ training on the CAPS-A tool followed by a third day, making independent ratings and transcriptions on ten new cases which had been previously recorded during routine audit data collection. This task was repeated on day 4, a minimum of one month later. Ratings were made using the CAPS-A record form with the CAPS-A definition table. An analysis was made of the speech and language therapists’ CAPS-A ratings at occasion 1 and occasion 2 and the intra- and inter-rater reliability calculated.

Outcomes & Results: Trained therapists showed consistency in individual judgements on specific sections of the tool. Intraclass correlation coefficients were calculated for each section with good agreement on eight of 13 sections. There were only fair levels of agreement on anterior oral cleft speech characteristics, non-cleft errors/immaturities and voice. This was explained, at least in part, by their low prevalence which affects the calculation of the intraclass correlation coefficient statistic.

Conclusions & Implications: Speech and language therapists benefited from training on the CAPS-A, focusing on specific aspects of speech using definitions of parameters and scalar points, in order to apply the tool systematically and reliably. Ratings are enhanced by ensuring a high degree of attention to the nature of the data, standardizing the speech sample, data acquisition, the listening process together with the use of high-quality recording and playback equipment. In addition, a method is proposed for maintaining listening skills following training as part of an individual’s continuing education.

from the International Journal of Language and Communication Disorders

The Management of Otitis Media With Early Routine Insertion of Grommets in Children With Cleft Palate—A Systematic Review

Conclusions: There is currently insufficient evidence on which to base the clinical practice of early routine grommet placement in children with cleft palate.

from the Cleft Palate-Craniofacial Journal

Speech assessment in cleft palate patients: A descriptive study

Conclusion
Phonetic and phonological development in cleft child are not only due to the surgical strategies and the surgeon experience, but also influenced by the willingness to collaborate of the patient and especially of the parents, the timeliness of the logopaedic intervention, and by inborn capabilities of the child to control the emission of the air from nasal and oral cavities.

from the International Journal of Pediatric Otorhinolaryngology

Middle ear disease in children with cleft palate: Protocols for management

Objective
There is wide international variation in the protocols used for middle ear disease management in cleft palate patients. Ventilation tube (grommet) insertion may occur routinely at the time of palatoplasty or selectively on a separate occasion if symptomatic middle ear disease develops. The audiological and otologic outcomes of cleft palate patients were studied in a single institution over a timeframe in which both protocols were utilised.

Methods
This was a retrospective study of 234 cleft palate patients who underwent palatoplasty from 1990 to 2005 at Middlemore Hospital, Auckland, New Zealand. Data on hearing loss, middle ear disease, and tympanic membrane abnormalities was collected from clinical notes. Audiological data was obtained from pure tone audiogram reports.

Results
Forty-five patients had routine grommets inserted concurrent with palatoplasty and 189 patients were managed conservatively with selective grommet insertion if indicated. Grommets were subsequently required in 79 (41.8%) of these 189 patients. There was no difference in the incidence of persistent conductive hearing loss, but recurrent middle ear disease, tympanic membrane abnormalities, and the total number of grommet insertions were significantly higher in the routine grommet group. Poorer outcomes were noted in patients who had undergone a greater number of grommet insertions.

Conclusion
No significant deterioration in audiological outcomes and better otologic outcomes were found in cleft palate patients undergoing selective grommet insertion compared to routine grommet insertion. It is recommended that ventilation tube placement occur in patients selected on the basis of symptomatic infection or significant hearing loss.

from the International Journal of Pediatric Otorhinolaryngology

An Examination of Nonspeech Oral Motor Exercises for Children with Velopharyngeal Inadequacy

The velopharyngeal closure mechanism is the articulator that separates the oral and nasal cavities during speech and swallowing. Articulation and resonance may be adversely affected if velopharyngeal inadequacy (VPI) is present. VPI is generally corrected through surgery or speech prosthetics. There is, however, a small subset of clients who may improve with treatment using muscle rehabilitation procedures that are task specific to speech. Nonspeech oral motor exercise treatment has been used but found ineffective.

from Seminars in Speech and Language