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Early palate repair is recommended to minimize the development of disordered speech. We studied the speech outcome of late palate repair in 131 patients. The success of late palate repair is questioned because of the persistence of learned, compensatory misarticulations that are difficult to correct in spite of the establishment of correct palatal...
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Context 1
... grammarians classify Tamil phonemes into vowels, consonants, and a ''secondary character,'' the a ¯ytam. Tamil language includes six nasal sounds (Table 3). The samples also included counting numerals from 1 to 20 and 60 to 70 in English and sustained phonation of vowels / a/, /e/ /i/, and /u/. ...
Similar publications
BACKGROUND; The World Health Organisation has recommended the need to standardise cleft care globally. In Europe, the Eurocleft project was a concerted effort to improve on the standards of care for children with cleft lip and palate. Certain recommendations were made that were used to judge the standards of care offered, this eventually led to reo...
Citations
... Kaplan suggested palatoplasty before 6 months to ensure proper anatomy at the time of speech development at 9 to 12 months. 21 Whereas Murthy et al. and Zhao et al. reported slightly superior speech outcomes after late palatoplasty, 9,39 other studies report poorer speech outcomes. 9,21-24 Many surgeons would recommend performing primary palatoplasty before 12 months of age to correct cleft palate anatomy before speech patterns have developed. ...
Cleft palate is among the most common congenital disorders worldwide and is correctable through surgical intervention. Sub-optimal surgical results may cause velopharyngeal insufficiency (VPI). When symptomatic, VPI can cause hypernasal or unintelligible speech. The postoperative risk of VPI varies significantly in the literature but may be attributed to differences in study size, cleft type, surgical technique, and operative age. To identify the potential impact of these factors, a systematic review was conducted to examine the risk of VPI after primary palatoplasty, accounting for operative age and surgical technique. A search of PubMed, Embase, and Web of Science was completed for original studies that examined speech outcomes after primary palatoplasty. The search identified 4740 original articles and included 35 studies that reported mean age at palatoplasty and VPI-related outcomes. The studies included 10,795 patients with a weighted mean operative age of 15.7 months (range: 3.1-182.9 mo), and 20% (n=2186) had signs of postoperative VPI. Because of the heterogeneity in reporting of surgical technique across studies, small sample sizes, and a lack of statistical power, an analysis of the VPI risk per procedure type and timing was not possible. A lack of data and variable consensus limits our understanding of optimal timing and techniques to reduce VPI occurrence. This paper presents a call-to-action to generate: (1) high-quality research from thoughtfully designed studies; (2) greater global representation; and (3) global consensus informed by high-quality data, to make recommendations on optimal technique and timing for primary palatoplasty to reduce VPI.
... However, there is evidence to suggest delay does result in long term articulation problems, secondary to learned compensatory behaviours in speech. [12,13] It is expected that there will be a delay in carrying out procedures, far more significant than would typically be the case, this does depend on the impact of COVID-19 on local trusts and the R-value within each region. The total number of cases is likely to increase with new baby referrals in addition to the existing backlog. ...
Introduction
Cleft lip and/or palate is the most common craniofacial anomaly and occurs in 1 in 650 to 700 live births in the United Kingdom (U.K.). The majority of cleft surgery is elective, and as a result, almost all cleft surgery was suspended across the United Kingdom (U.K.) in March 2020 during the first national lockdown. The U.K. has centralised regional Cleft Services which all use the same agreed target-age standards for primary surgery including lip and palate repairs. The COVID-19 response has caused a delay in carrying out procedures. The severity of this delay depends on the impact of COVID-19 on local trusts and R-value within that region. As the country goes through a second and third wave, the impact could be long lasting, and we aimed to quantify it so the data could be used to guide service prioritisation in the NHS and help future workforce planning.
Methods
An online survey was designed based on the cleft quality dashboard indicators and circulated nationally to all nine cleft regions in the U.K. The survey was divided into three main headings: Duration of suspended cleft services, Quantification of the impact on delayed in surgery/services, Changes needed to restart surgery/services
Results
We obtained a 60% response rate with five completed surveys from five out of nine regions. All regions reported that they suspended their cleft services in March 2020 around the time of the first wave and the first national lockdown. There has been an impact on delayed surgical and clinical interventions for cleft patients. Regions were affected differently with some on an exponential waiting list growth projection, whilst other teams are on track to recover from the backlog within 7-22 weeks. There has been an impact on the allied health professionals' services within the cleft multidisciplinary team. The cleft nurses 24-hour reviews, Speech And Language Therapy (SALT), and psychology maintained service delivery in some format. Patient-facing services such as audiology and dentistry were significantly disrupted and continue to experience delays due to reduced capacity.
Conclusions
Various regions have seen a varied impact from COVID-19 on their services, from all cleft regions there seems to be an impact on achieving surgery within the national target age. The adverse effect of the COVID-19 impact is unlikely to be known for a few years to come; however, the data is a useful guide when supporting the allocation of resources within the healthcare setting. A prospective long-term study is required to assess the impact of COVID-19 on cleft surgery, follow up, assess access to allied health professional MDT clinics, and long-term complications.
... A set of Tamil words utilized for articulation disorder test is presented in Figure 3. Analysis of study shows that the severity of articulation disorder is primarily depends on the pronunciation of exact position (Tamil stop allophones: velar, palatal, retroflex, Alveolar, dental and labial) of Tamil words [6]. Figure 4. The outcome of the study indicates that speech training is greatly supports to reduce the place and manner of the pronunciation error found in phonemes misarticulated by patients [7]. Table 1 and Table 2 were used for experimental study. ...
Articulation disorder is referred as difficulty occurs in the pronunciation of specific speech sounds. An irregular coordination of the movement of tongue, lips, palate, jaw, respiratory system, vocal tract, height of the larynx, air flow through nasal leads to the incorrect production of speech sounds. The objective of this paper is to propose a computational model based on Recurrent Neural Network (RNN) algorithm to categorize the phonological patterns of Tamil speech articulation disorder signals into four predefined groups, namely, substitution, omission, distortion and addition. The methodology of the proposed work is described as follows. (1) List of articulation disorder test words suggested by Speech Language Pathologists (SLPs) is selected for this experimental study. (2) Real time speech signals that comprise of Tamil vowels (Uyir eluthukkal) and consonants (Meiyeluthukkal) are collected from people with articulation disorder. (3) Acoustic noise and weak signals are eliminated by applying Low pass filter to acquire the filtered speech signal. (4) Mel-Frequency Cepstral Coefficients (MFCCs) technique is implemented to extract the prominent features from denoised signals. (5) Principal Component Analysis (PCA) method is employed to choose fine-tune feature subset. (6) The refined features are employed to calibrate RNN model for classification. Results show that RNN model achieves 90.25% classification accuracy when compared to other artificial neural network algorithms.
... Six standardized Tamil sentences developed in 1994 which consisted of two oral, two nasal, and two oro-nasal sentences were used as materials (Appendix B) [15,16]. For testing children short three word sentences were used. ...
... Very few studies on nasalance have been done in Indian population [16,24,25]. It is a huge task to record nasalance in Indian population because of the diversity of the Indian languages and various ethnic variations. ...
Objective
The aim of this study was to obtain normative nasalance scores for Indian Tamil-speaking children.
Methods
Mean nasalance scores were obtained from 175 consecutive Tamil-speaking normal children (95 males, 80 females) aged 5–16 years during the repetition of six standardized sentences: two oral, two oronasal, and two nasal sentences. The nasal view was used to obtain nasalance scores for the standardized sentences
Results
Group mean and standard deviation (SD) nasalance scores of children for oral, oronasal, and nasal sentence were 35.65(SD 7.20), 44.42(SD 7.37), and 57.21(SD 8.15), respectively. The mean nasalance values of children aged 9–12 years were greater than children aged 5–8 years and 13–16 years for nasal sentences (p < .001). Males were found to have significantly higher nasalance scores for oral and oronasal sentences (p < .05) although these differences were within the range of normal variation.
Conclusions
The present study provides normative nasalance scores for Tamil-speaking Indian children.
... Surgery must be performed before the child develops the verbal misconceptions [15]. However, the risk of impaired maxillofacial growth and the medial area of the face in early surgery and at lower age is unavoidable, and factors such as the size of the cleft palate and the child' s health status do not allow surgery at that age [16,17]. The purpose of early surgery is that surgery should be performed before the child begins to speak, before 12 months of age [18]. ...
Introduction: The purpose of this study is to determine the incidence of velopharyngeal insufficiency (VPI), fistulae and recurrence development in patients seen by the Isfahan Cleft Care Clinic and also determine the association of gender, age at repair, and cleft type with the incidence of each.
Materials and Methods: In this retrospective study, 320 children who had undergone a primary cleft palate surgery and who had come to the cleft lip and palate clinic in Isfahan in 2010-2017 were studied based on the medical records and information about each patient. Then all patients were evaluated by standard speech assessment methods for severity of hypernasalitis and screened for clinical manifestations of fistula and recurrence.
Results: According to the results of this study, the incidence of velopharyngeal insufficiency after initial repair was 78.1% and most of these patients had severe form. The results also showed that by increasing age at surgery also increased the intensity of velopharyngeal insufficiency, and the severity of this complication has nothing to do with gender. In the case of fistula and recurrence of cleft showed that, in patients who are undergoing the new procedure to be significantly less than other patients.
Conclusion: According to the study, palatoplasty complications such as velopharyngeal insufficiency, fistula, and recurrence were less common in patients treated with microsurgery, Therefore, it can be concluded surgical repair of cleft palate should be performed before 12 months ages and in microsurgery methods. It seems that follow up of these patients after surgery for monitoring of speech complications is necessary.
Keywords: Cleft palate; Velopharyngeal insufficiency; Fistula; Palatoplasty; Microsurgery.
... Early age, considered in various studies, ranges from 6 months to 2 years and 2 to 6 years is generally considered as late. 22,23 Hardin-Jones and Jones 24 in their attempt to study speech outcome following early primary palatoplasty found that early surgery is required for the development of adequate VP function and normal speech. Few studies have also included direct observation along with perceptual speech assessment in children with early cleft palate repair. ...
Introduction Timing of cleft palate repair and the method of speech outcome measurement in children with cleft lip and palate are much debated topics. The associated problems and quality of life in these children depend on the timing of the surgery.
Aim The aim of this study was to investigate the velopharyngeal (VP) function and resonance parameters in children following early cleft palate repair.
Method A total of 25 Kannada-speaking children with early repaired cleft palate were subjected to speech assessment and videofluoroscopic assessment. Perceptual speech parameters measured were severity of hypernasality and presence of nasal air emission. Videofluoroscopy was interpreted in terms of closure ratios to predict the severity of VP dysfunction.
Results The analysis of videofluoroscopic images indicated that 48% of children had complete VP closure and 52% had perceptually normal resonance. A good correlation was found between the closure ratio and hypernasality.
Conclusion Understanding the perceptual speech parameters and their structural correlates for outcome measurement will give better evidence for refining the existing treatment protocols. Data on a larger population are warranted for establishing predictors of optimum speech outcome.
... Speech results following late primary palate closure (over 8 years of age) were reported by Murthy [17] and Bruneel [18] (Table 1). In late repair groups, the incidence of articulation disorder was remarkably higher than those of early repair groups of other studies. ...
Objective:
We aimed to assess whether patients who underwent early palatoplasty have normal speech.
Methods:
19 patients with unilateral cleft lip and palate were enrolled in this study. At 6 months of age, we performed simultaneous lip, maxilla, and palate repair using presurgical orthodontics. Speech development was assessed by evaluating velopharyngeal function (VPF) and development of articulation for 10 years.
Results:
No articulation disorders were observed after 4 years of age. Although palatalized articulation was evidently temporary in 3 cases before 4 years of age, all patients recovered without any speech training. Normal VPF rates were as follows: at 4 and 7 years of age 78.9% (n = 15), 10 years of age 73.7% (n = 4). 10 patients temporarily presented with mild VPI after 5 years of age although they had a normal VPF until 4 years of age.
Conclusion:
Early palatoplasty after narrowing the cleft palate using presurgical orthodontics is beneficial for development of articulation. The rate of normal VPF did not decrease over the years.
... For the intelligibility rating it was 2.42 (0.76). 17 Although the intelligibility rating in our hospital were no more than 2.0, the data were not comparable due to lack of sample size. The patients with poor velopharyngeal competence had further endoscopy examination, and one of them received repalatoplasty using furlow palatoplasty technique. ...
Background: Speech is the primary goal of palatoplasty, however, there is no current data available about the long term speech evaluation after palatoplasty in our hospital which is the national referral hospital that has the only cleft craniofacial center in Indonesia. The initial data of speech outcome is required for further research which assessment should be standardized and applicable to Indonesian children that mostly speak bahasa. This study aims to get initial data by evaluating speech outcome of patients that underwent palatoplasty with adapted perceptual assessment words in Indonesian language, and describe factors influencing speech. Method: This research is a cross-sectional study to evaluate speech outcome of patients underwent palatoplasty in Cipto Mangunkusumo Hospital from October 2010–December 2012 conducted from December 2017 – July 2018. Result: Total 23 samples were measured for articulation rating where 17 (74%) patients had normal production of majority of phonemes, while there were 6 (26%) patients had predominantly distortion of phonemes. The hypernasality rating were normal in 12 (52%) patients, mild in 5 (22%) patients and moderate in 6 (26%) patients. The speech intelligibility rating were dominantly normal which all speech is understood in 17 (74%) patients and the rest of 6 (26%) patients were listeners attention needed. The velopharyngeal competence were good in 16 (70%) patients, fair in 1 (4%) patients and poor in 6 (26%) patients. Conclusion: Management of cleft palate patients will be achieved by well integrated services including speech pathologist and orthodontist. By giving the long term follow up to the patients, the optimal outcomes will be achieved. This research can be used as a reference for speech outcome evaluation in cleft palate patients in Indonesia.
... They concluded that delayed palatal repair is insufficient to eliminate nasal airflow errors, resonance abnormalities, and articulation disorders which leads to unintelligible speech. In Indian context, Murthy, Sendhilnathan, and Hussain (2010) studied the speech outcome of 131 individuals with CLP who underwent primary palate repair after the age of 10 years. Baseline assessment was done and all the individuals were counseled, oriented, and demonstrated the correct place and manner of articulation for the phonemes misarticulated by them. ...
... With respect to the CPEs across EIG and DIG, the overall CPEs were less in EIG than in DIG (but it was not statistically significant). This result is in consensus with the findings of the following previously done studies: Henningsson and Karling (1984), who reported that early complete closure group had lower articulation errors than the delayed closure group; Rohrich et al. (1984), who reported more articulation errors in the delayed closure group than early closure group; Murthy et al. (2010), who reported more residual speech problems with 131 individuals with CLP who underwent late palatal surgical intervention, Bruneel et al. (2017), who also found a higher prevalence of articulation errors in Ugandan participants with CLP who had delayed primary palatal closure age; Nikhila and Prasad (2017) who found that the children in early surgical group showed less compensatory errors when compared to the late surgical group. This suggests that children who have undergone an early palatal surgery have a better velopharyngeal closure. ...
Surgery of palate is one of the important rehabilitation for children with cleft lip and palate. In most of the children with cleft lip and palate (CLP), speech errors persist even after surgical repair of the palate. However, the timing of palatal repair plays a vital role. The associated problems in children with cleft lip and palate differ based on the timing of the palatal repair. Resonance and articulation are the crucial measures of disordered speech and they form the important areas of therapeutic interv2ention for children with repaired cleft lip and palate (RCLP). Thus, the present study aims at profiling resonance and consonant production errors (CPEs) in children with RCLP among early intervention group (EIG) and delayed intervention group (DIG). The research design employed was standard group comparison. The participants consisted of eight Kannada speaking children with RCLP (6 to 12 years) in each group (EIG and DIG). They were asked to repeat 10 meaningful bisyllabic words loaded with pressure consonants to assess the resonance and 8 non-meaningful bisyllabic words loaded with stop consonants to check CPEs. The responses were recorded in a sound-treated room and were presented to three Speech Language Pathologists for assessing resonance and CPEs using Henningsson's protocol. The results revealed a statistically significant reduction in the resonance and few CPEs in EIG than in DIG. 'Nasalized voiced pressure consonants' and 'weak oral pressure' were found to be significantly lesser in EIG than DIG. The present study concludes that early surgical intervention has a direct impact on reducing hypernasality and CPEs in children with CLP. Children with CLP require early surgical intervention and therapy to establish appropriate oral motor skills that are necessary for normal speech production.
... Nasal emission, nasal resonance, and speech intelligibility were rated on a 4 point severity rating scale using simple words, sentences, and spontaneous speech. The results showed that the delayed palatal closure group performed significantly poorer in articulation, phonation, oral resonance and speech intelligibility than early palatal closure group The study concluded that delayed closure of the hard palate significantly reduces the chance for normal speech development [6][7][8][9][10][11][12][13][14][15]. ...
... Though postoperative speech samples assessment revealed improvement in speech intelligibility, there were residual speech problems in most of the individuals with repaired cleft lip and palate (RCLP), requiring further evaluation and appropriate treatment. The study concluded that more residual speech problems are found with late palatal surgical intervention [12]. ...
