Betty Jane McWilliams

Consequences of unremitting middle-ear disease in early life. Otologic, audiologic, and developmental findings in children with cleft palate.

To learn whether chronic otitis media with effusion during early life has lasting otologic, audiologic, or developmental consequences, we evaluated 24 closely matched pairs of children with repaired palatal clefts whose treatment had been equivalent except with regard to persistent otitis media during early life. One group had undergone early (mean age, 3.0 months) myringotomy with placement of tympanostomy tubes, followed by assiduous monitoring and an aggressive treatment program to maintain ventilation in the middle ear. The other group had undergone initial myringotomy later (mean age, 30.8 months) or not at all (two subjects) and presumably had had continuous middle-ear effusion throughout most or all of the first few years of life. Eardrum scarring was equal in both groups. Hearing acuity and consonant articulation were impaired in both groups, but hearing acuity was less impaired (P = 0.05 to 0.10) and consonant articulation significantly less impaired (P = 0.03) in the group undergoing early myringotomy. Mean verbal, performance, and full-scale IQs and scores on psychosocial indexes were normal in both groups and did not differ significantly between the groups. These findings support the hypothesis that early, longstanding otitis media may result in impairment of hearing and of speech, but they do not support the hypothesis that cognitive, language, and psychosocial development are adversely affected.

DIAGNOSIS OF SPEECH PROBLEMS IN PATIENTS WITH CLEFT PALATE

In 1928, Wardill, writing on cleft palate, referred to “one of the rare cases of perfect speech result.” It is unlikely that this statement would be made today, when, in many centers throughout the world, speech free of the stigmata of cleft palate is the accepted clinical goal and, frequently, the actual outcome of treatment. On the other hand, no centre can yet claim perfect results for all its patients. Diagnostic procedures are most essential in the lives of those individuals who do not achieve acceptable speech through surgery alone. The goal of this paper is to discuss some of the problems encountered in diagnosis, to relate them to patient care, and to motivate the reader to further exploration and study.

Speech intelligibility with the buccal flange obturator

habilitation of patients who have undergone extensive surgery for eradication of neoplasm of the maxillae requires restoration of the functions of speech, mastication, and deglutition. The options for rehabilitation of these patients are surgical reconstruction or prosthetic restoration. According to Sharry,’ even when surgical techniques are available, prosthetic reconstruction is chosen most frequently. Prostheses for acquired defects of the hard palate consist of either complete or removable partial dentures with nasal extensions designed to obturate the defect. The objectives of such prostheses as outlined by Aramany and Drane’ are (1) oronasal separation, (2) retention and stabilization of the prosthesis, and (3) rehabilitation of speech.

CHARACTERISTICS OF CHILDREN WITH SPEECH DISORDERS SEEN IN A CHILD GUIDANCE CENTER.

A child guidance clinic caseload was examined to determine the prevalence of children with speech disorders. The clinical descriptions of the children with speech defects were compared with the descriptions of the remainder of the group. Children with different types of speech problem were also compared with each other. Of the 292 cases, 45 (15%) exhibited defective speech, including 27% articulation problems, 24% delayed speech, 20% stuttering, 29% combined disorders. The children with speech defects were somewhat younger than the other children. Soiling, thumbsucking, and wetting were seen more frequently in the speech defective group, and these children were reported to fight less with their parents. On all the other factors, the two groups were similar. Different patterns of symptoms were found in the speech defective subgroups. The children with articulation problems resembled the nonspeech defective group most closely. The children with delayed speech resembled them least closely.

Comparison of Clinical Characteristics of Children with Cleft Palates and Children in a Child Guidance Clinic

Prompted by many statements that children born with cleft lips and/or palates should experience serious problems in their psychological adjustment (e.g. McWilliams, 1956) and by,the h n t k q o f Wylie, et al. ( 1965 ), an attempt was made to assess a sample of children with clefts using a system devised for describing a child guidance caseload. This system coded descriptive data occurring in the case record into a form suitable for machine processing. The information included symptoms, behaviors, and complaints reported by family, clinic scaff, or other collateral informants. Fifty children with clefts, previously evaluated by the staff of the University of Pittsburgh Cleft Palate Research Center were compared with the 292 closed child guidance cases described by Wylie, et al. ( 1965). Proportionately more cleft children were reported to have physical anomalies and chronic illnesses, and to be shy and enuretic, than the child guidance cases. Conversely, the following items were reported more frequently for the child guidance children: fighting with teachers or parents or siblings, poor actention, involiintary movements, poor school achievement, and sensitiviry to criticism. The 17 enuretic cleft children had a mean of seven symptoms reported about them, while non-enuretic cleft children had only four. The child guidance children without speech disorders had a mean of almost seven reported symptoms and those with speech problems a mean of eight. These findings suggest that children with clefts may not present a picture which is congruent with that presented by children referred directly to a facility for adjustment problems, but that they do display evidences of psychological maladjustment. Such data support the idea that the psychological adjustment aspects of the cleft child deserve more emphasis and formal snidy.

Clinical Feedback: Ask the Experts

errors present. The question is: Is there some way to settle this other than by counting votes or by submission to a supervisory fiat? Last year he was seen for a &dquo;medical&dquo; evaluation and the folder states that &dquo;nothing abnormal&dquo; was found. By observation there does not seem to be anything wrong with the soft palate or any other part of the articulation system. We do not have easy access to any fancy instrumentation although we might be able to send a tape (cassette) to one of the state university clinics if that would help. Help.

The Language Handicapped Child and Education

This article presents the problems involved in definitive differential diagnosis of children with delayed language. It suggests the need to describe language, auditory, mental, and emotional functioning as opposed to depending upon specific diagnostic labels which may rely upon clinical bias. The classroom teacher is viewed as an individual competent to devise teaching methods applicable to the peculiar requirements of widely differing children and is encouraged to trust herself in the face of “experts.”