Ewa Söderpalm

Speech Outcomes in Isolated Cleft Palate: Impact of Cleft Extent and Additional Malformations

OBJECTIVE The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome. DESIGN A cross-sectional retrospective study. SETTING A university hospital serving a population of 1.5 million inhabitants. SUBJECTS Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group. INTERVENTIONS A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate. MAIN OUTCOME MEASURES Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists. RESULTS The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function than the reference group. There were, however, no significant differences in speech outcome between the subgroup with a nonsyndromic cleft and the reference group. Cleft extent had a significant impact on the variable retracted oral articulation while the presence of additional malformations had a significant impact on several variables related to velopharyngeal function and articulation errors. CONCLUSION Children with a cleft in the soft palate only, with no additional malformations, had satisfactory speech, while children with a cleft palate accompanied by additional malformations or as a part of a syndrome should be considered to be at risk for speech problems.

Evaluation of a consecutive group of transsexual individuals referred for vocal intervention in the west of Sweden

Male-to-female transsexual individuals frequently experience difficulties in increasing the fundamental frequency so that they can pass as members of the preferred gender. Female-to-male individuals may also meet with vocal problems although hormone treatment lowers fundamental frequency. The purpose of this study was to explore the transsexual individuals who, as part of their reassignment process, were referred to the voice clinic at the Sahlgrenska University Hospital in Göteborg, Sweden, between 1991 and 2002. The group comprised 22 male-to-female and 3 female-to-male transsexuals. Video recorded laryngeal examinations revealed basically normal conditions. More than half the patients showed supraglottal constriction on phonating at both habitual and preferred levels. A comparison between acoustic analyses before therapy and at follow-up visits showed increased fundamental frequencies for male-to-female individuals (p=<0.01). Vocal fatigue was reduced. Degree of satisfaction with the post-therapy voice was not related to number of therapy sessions.

Pre-Speech in Children with Cleft Lip and Palate or Cleft Palate Only: Phonetic Analysis Related to Morphologic and Functional Factors

Pre-speech in 35 children with clefts of the lip and palate or palate only were analyzed for place and manner of articulation. Transcriptions were made from tape recorded babbling sequences. Two children without clefts were used as reference. All of the children with clefts were treated according to a regimen of early surgical repair of the velum cleft and delayed closure of the cleft in the hard palate. The frequency of selected phonetic features was calculated. Correlations between phonetic/perceptual and functional and morphological factors were tested. Supraglottal articulation dominated among all the children indicating a sufficient velopharyngeal mechanism. The results also showed correlations between cleft type and place of articulation. Anteriorly placed sounds (i.e., bilabial, dental, and alveolar sounds) occurred frequently among the children with cleft palate only and in the noncleft children. In children with cleft lip and palate, posteriorly placed articulations predominated. It was postulated that early intervention may have a positive effect on articulatory development.

A longitudinal study of speech in 15 children with cleft lip and palate treated by late repair of the hard palate.

Since 1975, children with cleft lip and palate living in the western part of Sweden have been treated according to a regimen of early repair of the soft palate (at the age of 6-8 months) and late hard palate closure (at about 8-9 years of age). The present paper is a longitudinal study of 15 consecutive patients whose speech development was analysed at the mean ages (years:months) of 5:3, 7:0, 8:5, and 9:7 years. Hypernasality gradually decreased over the years whereas nasal escape almost completely ceased after closure of the residual cleft. There was no glottal articulation at any age. Despite the fact that retraction of apicodental consonants decreased in frequency with age and presumably with speech therapy, it was the main problem throughout the observation period. It was presumably caused by the residual cleft in the hard palate compensating for subnormal pressure in front of the opening to the nasal cavity.

A prospective cross-sectional study of speech in patients with the 22q11 deletion syndrome

UNLABELLED The purpose of this study was to investigate a consecutive series of 65 participants between 3 and 33 years of age (median age of 9 years and 4 months) with a confirmed 22q11.2 deletion, in order to ascertain the frequency and severity of articulation difficulties, velopharyngeal impairment (VPI), and the level of intelligibility. The majority had velopharyngeal impairment; over half of them to such a degree that surgery had been performed or was considered necessary. A high level of correct place and manner of consonants was only found in children with the 22q11 deletion syndrome from age 6. The most misarticulated consonants were stops and fricatives. Glottal articulation assessed in words and sentences was less frequent than expected according to earlier studies. A high prevalence of reduced intelligibility at different ages indicates an obvious communication limitation in younger children, and for some individuals even as teenagers and adults. EDUCATIONAL OBJECTIVES As a result of this activity, the participant will have knowledge about the frequency and severity of: (1) articulation difficulties; (2) velopharyngeal impairment; and (3) the level of intelligibility in patients with a 22q11.2 deletion.

Evaluation of speech after completed late closure of the hard palate.

Speech was analyzed about 1 year postoperatively in 30 patients with cleft lip and palate who were the first ones to undergo late closure of the hard palate in Gothenburg, Sweden. Fourteen had bilateral and 16 had unilateral clefts. Soft palate closure had been performed at the mean age of 8 months, and the hard palate was closed at the mean age of 8 years with a range of 7-11 years. Imitated and spontaneous speech was analyzed at an average of 15 months after palatal repair. Six percent had moderate to severe hypernasal speech and 23% had retraction of dental consonants. No glottal articulation was found. Hoarseness and deviant s articulation were frequent. For 6 of the patients the same speech analysis was also made 1-3 months postoperatively. At this time there was no change in the speech of these 6 children compared with preoperative speech. Thus, the closure of the palate did not improve the speech directly. The improvement of the speech seems to be a gradual process.

Language skills in 5-8-year-old children with 22q11 deletion syndrome.

BACKGROUND Language impairment and delayed language onset have been described, although not investigated in detail, in children with 22q11 deletion syndrome. AIMS To investigate different areas of language: the ability to retell a narrative, phonology, syntax and receptive vocabulary in a group of 5-8-year-old children with 22q11 deletion syndrome regardless of whether or not they had a history of speech and language difficulties. Gender differences were also investigated. METHODS & PROCEDURES Nineteen consecutively referred children with 22q11 deletion syndrome, ten girls and nine boys, between the ages of 5 and 8 years, participated in the study. The mean full-scale IQ of the group was 78. Six children had an autism spectrum disorder, attention deficit/hyperactivity disorder, or a combination of these. Three different language tests were used: (1) the Bus Story - a test of narrative speech and language; (2) an articulation test including all Swedish phonemes in different positions; and (3) the Peabody Picture Vocabulary Test - Revised (PPVT-R). OUTCOMES & RESULTS All but two children had an information score in the retelling task of 1 SD below the population mean. A negative correlation between age and the information score implied that the older the children, the more severe the problems. One child had an average sentence length within the normal limits and five children had subordinate clauses within normal limits. A median of 4% of the utterances included grammatical errors. About 50% of the children had a complete consonant inventory. The phonological process analysis implied delayed rather than deviant development. The group had a moderately low score for receptive vocabulary. CONCLUSIONS Language difficulties in all investigated areas of language were found. It is suggested that speech-language impairment is a common feature of 22q11 deletion syndrome. An implication of these results is that follow-ups of language skills are important not only for pre-school children, but also for school age children and adolescents with 22q11 deletion syndrome.

Residual Clefts in the Hard Palate: Correlation Between Cleft Size and Speech

OBJECTIVE This study was conducted to evaluate the relationship between size of residual clefts in the hard palate and speech. SUBJECTS Fifteen 7-year-old children born with complete cleft lip and palate were investigated. METHODS All of the children were treated according to a surgical regimen involving early soft palate repair and delayed hard palate closure. Measures were taken of the area, length, and maximal width of the residual cleft in the hard palate about a year before its closure and correlated with a perceptual judgment of several speech variables. RESULTS Significant positive correlations were obtained between the size of the cleft and two variables: weak pressure consonants and hypernasality. Nasal escape was very common among the patients, and almost half the children had retracted palatal or velar articulation of dental stop consonants. Neither of these two variables correlated with the size of the residual cleft. CONCLUSION Perceived oral pressure and, perhaps, resonance seem to be related to size of the opening of the residual cleft, whereas audible nasal escape and articulatory compensations are not, at least not the latter once established.

A Comparison of Babbling and Speech at Pre-Speech Level, 3, and 5 Years of Age in Children with Cleft Lip and Palate Treated with Delayed Hard Palate Closure

Babbling and speech in 21 children with cleft palate were compared at pre-speech level, 3, and 5 years of age. The aims were to study if misarticulations in pre-school speech appear to be articulatorily related to the sound productions in pre-speech, whether the feeding technique influenced the prevalence of anterior articulation, and if there was a relationship between speech and the size of the residual cleft at 3 and 5 years of age. All the children had the soft palate closed, whereas the cleft in the hard palate was left open to be closed later on. Perceptual judgement of speech revealed a high prevalence of hypernasality, nasal escape and retracted oral articulation of dental or alveolar plosives. The latter was correlated with the size of the residual cleft area. There was a tendency towards a relationship between absence of anterior sound productions in babbling and retracted oral articulation in speech. The feeding technique, however, appeared not to have had any influence on articulatory place.

Maxillary dental arch and occlusion in patients with repaired clefts of the secondary palate. Influence of push back palatal surgery.

Maxillary morphology and dental occlusion were studied from infancy to age 10 years in 32 patients born with isolated cleft palate. Wardill-Kilner push back repair of the palate had been done at a mean age of 7.5 months. Measurements obtained from casts of the jaws showed that the average maxillary dimensions before as well as after operation were less than those reported for children without clefts. The mean reduction was similar whether the cleft reached into the hard palate or affected the soft palate only. Preoperative anterior maxillary arch width in particular, and also distance from scar line to selected teeth seemed to influence postoperative development of the maxillary dental arch in individual patients.