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Straw test of hypernasality, nasal emission, and hyponasality. ( From Kummer AW. Cleft Palate & Craniofacial Anomalies, 3E. Ó 2014 Delmar Learning, a part of Cengage Learning, Inc. Reproduced by permission.)
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Children with cleft palate are at risk for speech problems, particularly those caused by velopharyngeal insufficiency. There may be an additional risk of speech problems caused by malocclusion. This article describes the speech evaluation for children with cleft palate and how the results of the evaluation are used to make treatment decisions. Inst...
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Context 1
... is important to determine the cause of each error or distortion, and particularly to identify obligatory distortions versus compensatory errors. This is important because the treatment is different de- pending on causality. For example, obligatory distortions do not require speech therapy. Once the structure is corrected, the distortion disappears. In contrast, compensatory errors require speech therapy, preferably after correction of the structure. Dysphonia is common in individuals with VPI. In particular, vocal nodules often occur in patients with a small velopharyngeal gap or a nasal grimace. This condition is thought to be caused by strain in the entire vocal tract with attempts to achieve velopharyngeal closure. In addition, breathiness is sometimes used as a compensatory strategy to mask the hypernasality or to mitigate the nasal emission. In addition, patients with VPI secondary to a craniofacial syndrome are at higher risk for laryngeal anomalies. Therefore, the speech pathologist listens for characteristics of dysphonia, including hoarseness, breathiness, roughness, glottal fry, hard glottal attack, strain, inappropriate pitch level, restricted pitch range, diplophonia, or inappropriate loudness. When present, these findings are often rated on a severity scale from mild to severe using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). 15 There are a few low-technology tools that can be used to assist with the evaluation. 7,9,10 The most common are discussed here. The examiner can place a dental mirror under the child’s nares while the child produces pressure- sensitive oral sounds ( Fig. 5 ). If the mirror fogs, it indicates nasal air emission. A problem with this test is that the mirror needs to be placed under the nose after the individual starts speaking and removed before the individual stops speaking to avoid fogging as a result of nasal breathing. Another disadvantage is that there is no way to know whether the nasal emission was consistent or just occurred on one phoneme. In addition, the clinician must be aware that when certain compensatory productions (eg, nasal fricatives) are present, mirror fogging may also result. A straw is perhaps the best tool in assessing hypernasality and nasal emission. (It is also cheap, always available, and disposable.) One end of the straw is placed in the patient’s nostril and the other end is placed near the examiner’s ear ( Fig. 6 ). The child is asked to repeat syllables or sentences with oral consonants only. Even slight hypernasality or nasal emission can be heard easily through the straw. The straw amplifies the sound, similar to a stethoscope. If hyponasality or upper airway obstruction is suspected, the child is asked to repeat syllables with nasal phonemes (ie, ma, ma, ma) or prolong an /m/ while the examiner listens through the straw. A muffled sound suggests obstruction. There are many perceptual rating methods to describe speech disorders associated with cleft palate. These methods include categorical judgments (eg, mild, moderate, severe); equal- appearing interval scales; direct magnitude estimation; paired comparison; and, more recently, visual analog scaling. 14 There are also some standardized protocols for rating different parameters of speech and velopharyngeal function that can be used to compare speech outcomes in intercenter studies. These protocols include the Cleft Audit Protocol for Speech-Augmented (CAPS-A) 16,17 and the Universal Parameters. 18 Speech parameters that are typically rated include hypernasality, hyponasality, audible nasal air emission and/or nasal turbulence, consonant production errors, and voice. Although severity ratings can be helpful in reporting and comparing intercenter outcomes, ratings of severity do not usually affect management decisions or the type of surgery selected for correction. Because outcomes are usually determined based on auditory perception, it is important to obtain a high-quality digital video recording (or at least an audio recording) of a representative speech sample as part of each assessment. These recordings should be retained in the patient’s medical record. They can also be used for pretreatment and posttreatment comparisons, or for outcome studies and intercenter comparisons. Although the status of velopharyngeal function cannot be determined through an intraoral examination, an oral examination has some importance in the evaluation of VPI and abnormal resonance in patients with a history of cleft palate. 19 A very thin velum is noteworthy because hypernasality can be caused by transmission of sound through thin tissue. During phonation, the position of the velar dimple and uvula are examined. If the velar dimple is skewed to one side or the uvula points to one side, the muscle function on the opposite side may be inadequate, causing a lateral velopharyngeal gap. If the uvula is consistently deviated to the side of a large tonsil, this indicates that the tonsil is pushing against the posterior faucial pillar and probably extends into the oropharynx. Large tonsils should be noted because they can cause pharyngeal cul-de-sac resonance and even affect articulation. In addition, dental occlusion is noted because malocclusion can have a significant effect on speech sound production. Instrumental procedures can provide valuable information to augment the perceptual evaluation results. 20–22 There are 2 basic categories of instrumental procedures for evaluation of velopharyngeal function: those that give indirect but objective information (eg, nasometry and aerodynamic instrumentation), and those that give direct but subjective information (eg, videofluoroscopy and nasopharyngoscopy). Nasometry is a computer-based procedure used to measure the acoustic correlates of resonance and audible nasal emission. As such, nasometry provides indirect information regarding the function of the velopharyngeal valve ( Fig. 7 ). 20–23 During production of the speech passage, the Nasometer II (KayPENTAX, Montvale, NJ) cap- tures data regarding acoustic energy from both the nasal cavity and the oral cavity during speech in real time. It then calculates the average ratio of nasal/total (nasal plus oral) acoustic energy and converts this to a percentage value for the nasalance score. This score gives the examiner information about the relative percentage of nasality (hypernasality and audible nasal emission) in speech. Because nasometry measures both hypernasality and audible nasal emission, there is not a good correlation between velopharyngeal gap size and the nasalance score (because nasal emission is more audible with a small opening than a large opening). However, with the knowledge of the speech characteristics, the speech pathologist can use the nasalance results to confirm clinical impressions, and to do presurgical and postsurgical comparisons. Speech aerodynamics is a procedure to measure the mechanical properties of airflow and air pressure during speech production ( Fig. 8 ). 20–22,24 The aerodynamic procedure involves the use of oral and nasal catheters that are connected to pressure transducers, and a flow tube that is connected to a heated pneumotachograph. The transducers convert the detected air pressure or flow into electrical signals. The pneumotachograph determines the rate of airflow. Aerodynamic instrumentation can be used by the speech pathologist to ...
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The aim of this study was to evaluate functional and speech outcomes of superiorly based pharyngeal flap (SBF) pharyngoplasty combined with radical intravelar veloplasty (RIVVP) for the management of velopharyngeal insufficiency (VPI) following surgically repaired cleft palate.
A case series with chart review. The study was conducted in academic te...
Background:
This study aimed to identify the initial diagnostic characteristics and treatment status of children with submucous cleft palate (SMCP) and to examine the relationship between the timing of surgical correction and the degree of articulation and resonance improvement.
Methods:
This retrospective study included 72 children diagnosed wi...
Velopharyngeal dysfunction in cleft palate patients following the primary palate repair may result in nasal air emission, hypernasality, articulation disorder and poor intelligibility of speech. Among conservative treatment methods, speech aid prosthesis combined with speech therapy is widely used method. However because of its long time of treatme...
Background
There is a lack of high-level evidence on the surgical management of cleft palate. An appreciation of the differences in the complication rates between different surgical techniques and timing of repair is essential in optimizing cleft palate management. MethodA comprehensive electronic database search will be conducted on the complicati...
Citations
... Depending on the phenotype and extent of oral cleft, patients may suffer from functional and aesthetic impairments such as transient delay in development of speech and disorders in articulation and resonance as well as maxillary hypoplasia. 1,2 Speech of patients affected with cleft palate is often characterized by resonance and articulation errors. Resonance characteristics are hypernasality (air flow into nasal cavity) and nasal emission (nasal air release). ...
... Consequently, children may develop new motor speech patterns such as compensatory articulation patterns to compensate for these speech disorders and facial grimacing, as an attempt to inhibit nasal air leak by constriction of the nasal/facial musculature. 2,4 A general hypothesis is that in case of prolonged persistence of an anterior palatal defect, these compensatory mechanisms are hard to eliminate at older age. 2,[5][6][7][8] The ultimate objective of cleft care is finding a balance between the best intelligible speech and reaching the optimal midfacial growth at skeletal maturity and, at the same time, reducing the burden of care for patients with cleft. ...
... 2,4 A general hypothesis is that in case of prolonged persistence of an anterior palatal defect, these compensatory mechanisms are hard to eliminate at older age. 2,[5][6][7][8] The ultimate objective of cleft care is finding a balance between the best intelligible speech and reaching the optimal midfacial growth at skeletal maturity and, at the same time, reducing the burden of care for patients with cleft. Although current literature is still not conclusive on the exact impact of the timing of palatal repair on midfacial growth, the focus of the treatment is increasingly shifted on the enhancement of speech at an earliest age as possible. ...
... Depending on the phenotype and extent of oral cleft, patients may suffer from functional and aesthetic impairments such as transient delay in development of speech and disorders in articulation and resonance as well as maxillary hypoplasia. 1,2 Speech of patients affected with cleft palate is often characterized by resonance and articulation errors. Resonance characteristics are hypernasality (air flow into nasal cavity) and nasal emission (nasal air release). ...
... Consequently, children may develop new motor speech patterns such as compensatory articulation patterns to compensate for these speech disorders and facial grimacing, as an attempt to inhibit nasal air leak by constriction of the nasal/facial musculature. 2,4 A general hypothesis is that in case of prolonged persistence of an anterior palatal defect, these compensatory mechanisms are hard to eliminate at older age. 2,[5][6][7][8] The ultimate objective of cleft care is finding a balance between the best intelligible speech and reaching the optimal midfacial growth at skeletal maturity and, at the same time, reducing the burden of care for patients with cleft. ...
... 2,4 A general hypothesis is that in case of prolonged persistence of an anterior palatal defect, these compensatory mechanisms are hard to eliminate at older age. 2,[5][6][7][8] The ultimate objective of cleft care is finding a balance between the best intelligible speech and reaching the optimal midfacial growth at skeletal maturity and, at the same time, reducing the burden of care for patients with cleft. Although current literature is still not conclusive on the exact impact of the timing of palatal repair on midfacial growth, the focus of the treatment is increasingly shifted on the enhancement of speech at an earliest age as possible. ...
Background The best timing of closure of the hard palate in individuals with cleft lip, alveolus, and palate (CLAP) to reach the optimal speech outcomes and maxillary growth is still a subject of debate. This study evaluates changes in compensatory articulatory patterns and resonance in patients with unilateral and bilateral CLAP who underwent simultaneous closure of the hard palate and secondary alveolar bone grafting (ABG).
Methods A retrospective study of patients with nonsyndromic unilateral and bilateral CLAP who underwent delayed hard palate closure (DHPC) simultaneously with ABG at 9 to 12 years of age from 2013 to 2018. The articulatory patterns, nasality, degree of hypernasality, facial grimacing, and speech intelligibility were assessed pre- and postoperatively.
Results Forty-eight patients were included. DHPC and ABG were performed at the mean age of 10.5 years. Postoperatively hypernasal speech was still present in 54% of patients; however, the degree of hypernasality decreased in 67% (p < 0.001). Grimacing decreased in 27% (p = 0.015). Articulation disorders remained present in 85% (p = 0.375). Intelligible speech (grade 1 or 2) was observed in 71 compared with 35% of patients preoperatively (p < 0.001).
Conclusion This study showed an improved resonance and intelligibility following DHPC at the mean age of 10.5 years, however compensatory articulation errors persisted. Sequential treatments such as speech therapy play a key role in improvement of speech and may reduce remaining compensatory mechanisms following DHPC.
... Therefore, it gives an idea about the amount of nasal acoustic energy and the relative percentage of nasality in a speech D J sample. (22,23) Nasalance was collected as a mean percentage for each syllabus, and placed on a 2-point nasalance scale, where nasalance greater than 30% represents "1" (i.e., hypernasality) and less than 30% represents "0" (i.e., no hypernasality). This scale is based on studies by Dalson et al (24) and Hardin et al (25). ...
... Presence or absence of Passavant ridge can also be noted. (23,27) A score from zero to three was given according to the closure of the VP sphincter; zero complete closure, one mild gap, two moderate gap, and three severe gap. Two scores were recorded for each patient, one for velar closure, and one for lateral closure. ...
... It was used to evaluate movement of the velopharyngeal structures from the lateral view and detect the deficiencies in velopharyngeal closure. (23) The lateral view represents a midsagittal plane through the VP portal that demonstrates the relationships between the velum and posterior pharyngeal wall. Videofluoroscopy possesses the advantage of being able to record the speech simultaneously with the roentgen imaging, thus providing valuable observation of both at the same time. ...
INTRODUCTION: The velopharyngeal (VP) sphincter is ineffective in individuals with cleft lip and palate (CL/P), among other abnormalities in the speech-producing structures. Premaxilla protrusion, posterior crossbite, and maxillary hypoplasia are common symptoms in adult CL/P patients. Thus, orthognathic surgery is typically necessary, which could involve a segmental Le Fort I (SLF-1) osteotomy. The VP function may be impacted in different ways by this procedure. OBJECTIVE: This study's objective was to assess SLF-1's impact on adult CL/P patients' speaking characteristics. METHODOLOGY: Nine patients between the ages of 15 and 25 who had a history of CL/P, a maxillary skeletal deformity that needed to be corrected, and chronic alveolar defects were chosen. All patients had their speech evaluated prior to surgery and six months later. This included videofluoroscopy, nasoendoscopy, nasometry, and auditory perceptual evaluation. Maxillary advancement was 4.1 mm on average. RESULTS: Except for three patients who developed hypernasal changes, postoperative findings for all parameters remained unchanged, according to nasometry results alone. CONCLUSION: This shows that advancement through SLF-1 has no impact on the VP function, and that there may be other factors that have a compensatory effect.
... This is in accordance with findings in the present study, and in addition, those with a cleft involving the palate reported challenges with respect to articulation and speech. This corresponds with a previous study by Kummer [35] who described individuals with a cleft palate as being at risk of recurrent speech problems. From a Finnish cohort, Corcoran [27] reported no difference in the OHIP-14 score according to gender and the type of clefts. ...
Objective: To assess the association between clinical orthodontic indicators and oral-health-related quality of life, adjusted for socio-demographic factors, focusing on 16-year-old patients with cleft lip and/or palate (CL/P). Participants: One hundred and twenty-two patients with CL/P, representing cleft-lip (CL), cleft-palate (CP), unilateral/bilateral cleft-lip-palate (UCLP/BCLP), enrolled in the national CLP-Team, Bergen, Norway. Method: A cross-sectional study by two orthodontists assessing the number of teeth, intermaxillary sagittal relation (ANB-angle), dental arch and occlusion of 16-year-old patients with CL/P. All completed a digital questionnaire including self-reported socio-demographic variables, OHIP-14 questionnaire and dental aesthetics. Cross-tabulations with Pearson’s Chi-square test were used to identify associations between self-reported OHRQoL and socio-demographic and clinical indicators. Multiple variable analyses were conducted with binary logistic regression analysis using the odds ratio (OR) and 95% confidence interval (CI) to assess associations between OHRQoL and clinical indicators adjusted for socio-demographic variables. Ethical approval was granted by the regional ethics committee. Results: Patients with UCLP and BCLP had poorer clinical indicators compared to patients with CL and CP (p < 0.05). A total of 80% of the patients had OHIP-14 > 0. The highest oral impact was reported for psychological domains and articulation and the least for functional domains. Respondents with BCLP and those with poor intermaxillary relationships (ANB < 0°) reported a high impact on OHRQoL (p < 0.05). No statistically significant associations between other clinical indicators and socio-demographic variables such as gender, educational aspiration, and place of residence were reported. Conclusions: The study revealed an association between severe cleft diagnosis, missing teeth, misaligned teeth, negative overjet, and poor OHRQoL, but a statistically significant association was found only between OHRQoL and poor intermaxillary sagittal relations (unfavorable profile). To improve OHRQoL among patients with clefts, there is a need for an individual follow-up and prioritization of oral healthcare.
... Identifying the presence of hypernasality through auditory-perceptual assessment is essential for the initial diagnosis of velopharyngeal dysfunction and for the assessment of the effectiveness of the treatment, even if subjectively 3 . Instrumental measures (nasoendoscopy, videofluoroscopy, nasometry, and pressureflow technique) are commonly used to complement the diagnosis, as they offer valuable information with perceptive findings 4 . ...
Purpose
to describe the auditory-perceptual training for the assessment of hypernasality in individuals with cleft lip and palate.
Methods
an integrative literature review in the databases Virtual Health Library, SciELO, and PubMed, aimed to answer the following guiding question: 1) What are the characteristics of auditory-perceptual training to assess hypernasality in individuals with cleft lip and palate? Articles in Portuguese and English, available in full access, without the restriction of the publication date, which presented programs of training for speech hypernasality, unprecedented, adapted, or replicated, were included. The pursuit of descriptors, selection, extraction, and synthesis of data was performed by three independent evaluators.
Literature Review
10 articles were included in this study, based on established criteria. Five articles investigated the effectiveness of training on speech analysis by listeners, regardless of experience level. Another five articles pertained to training when validating speech assessment protocols. Consensus analyses and reference samples were the most used training reported. Perceptual rating of phrases, using the equal appearance scale and in person training, was the most reported one.
Conclusions
the auditory-perceptual training of listeners to identify hypernasality showed variability in the proposed strategies, particularly when proposed for non-experienced listeners. The difficulty in maintaining acquired skills in the long term is pointed out.
Keywords:
Cleft Palate; Velopharyngeal Insufficiency; Speech; Speech Disorders; Mentoring
... A identificação da presença da hipernasalidade por meio da avaliação perceptivo-auditiva é essencial para o diagnóstico inicial da disfunção velofaríngea e, também, para aferir a efetividade do tratamento, mesmo que subjetivamente 3 . Medidas instrumentais (nasoendoscopia, videofluoroscopia, nasometria e técnica de fluxo--pressão) são comumente empregadas para complementação do diagnóstico, por oferecerem informações valiosas que corroboram achados perceptivos 4 . ...
Purpose
to describe the auditory-perceptual training for the assessment of hypernasality in individuals with cleft lip and palate.
Methods
an integrative literature review in the databases Virtual Health Library, SciELO, and PubMed, aimed to answer the following guiding question: 1) What are the characteristics of auditory-perceptual training to assess hypernasality in individuals with cleft lip and palate? Articles in Portuguese and English, available in full access, without the restriction of the publication date, which presented programs of training for speech hypernasality, unprecedented, adapted, or replicated, were included. The pursuit of descriptors, selection, extraction, and synthesis of data was performed by three independent evaluators.
Literature Review
10 articles were included in this study, based on established criteria. Five articles investigated the effectiveness of training on speech analysis by listeners, regardless of experience level. Another five articles pertained to training when validating speech assessment protocols. Consensus analyses and reference samples were the most used training reported. Perceptual rating of phrases, using the equal appearance scale and in person training, was the most reported one.
Conclusions
the auditory-perceptual training of listeners to identify hypernasality showed variability in the proposed strategies, particularly when proposed for non-experienced listeners. The difficulty in maintaining acquired skills in the long term is pointed out.
Keywords:
Cleft Palate; Velopharyngeal Insufficiency; Speech; Speech Disorders; Mentoring
... This excessive nasal resonance during the production of oral sounds (1) occurs due to abnormal coupling of the resonance cavities (oral and nasal). Although instrumental techniques (nasoendoscopy, videofluoroscopy and flow-pressure technique) are recommended to corroborate the diagnostic of VPD, the auditory-perceptual assessment is the initial tool used by clinicians to identify speech symptoms suggestive of VPD after primary palatoplasty (2,3) . Through their auditory impressions, the clinicians identify the presence and severity of hypernasality, which favor clinical decision-making and evaluation of the effectiveness of the treatment (4) . ...
... Table 1. Analysis of the agreement and association of the absolute frequency distribution of the classification of the hypernasality of each evaluator with the gold standard rating, before the auditory-perceptual training, by degree of hypernasality (1) Before Table 2. Analysis of the agreement and association of the absolute frequency distribution of the evaluation of the hypernasality classification of each evaluator with the gold standard evaluation, after auditory-perceptual training, by degree of hypernasality (2) Before ...
Purpose
To analyze the effect of auditory-perceptual training by inexperienced speech-language pathologists in the classification of hypernasality in individuals with cleft lip and palate and compare their classification of hypernasality individually, with the gold standard evaluation, before and after this training.
Methods
Three inexperienced speech-language pathologists used a four-point scale to assess 24 high-pressure speech samples from individuals with cleft lip and palate, before and after auditory-perceptual training. The speech samples corresponded to six samples of each degree of hypernasality. The speech-language pathologists received auditory-perceptual training during the assessments. They had access to anchor samples and immediate feedback of correct answers regarding the degree of hypernasality in training.
Results
There was no significant difference in the overall percentage of correct answers when comparing before and after the auditory-perceptual training. There was a significant association and agreement of the three evaluators with a gold standard evaluation after training, with an increase in agreement for a single evaluator for absent and mild degrees of hypernasality. The dichotomous analysis of the data showed an increase in the Kappa Index of Agreement of this evaluator. Although there was an increase in the Index of Agreement between evaluators for absent, mild, and severe hypernasality, this increase did not reach statistical significance.
Conclusion
The auditory-perceptual training provided did not result in a significant improvement in the hypernasality classification for the inexperienced speech-language pathologists, even though the individual data analysis showed that the training favored one of the evaluators. Further studies involving gradual and more extensive auditory-perceptual training may favor the classification of hypernasality by inexperienced SLPs.
Keywords:
Cleft Palate; Velopharyngeal Insufficiency; Speech Disorders; Speech Perception; Speech
... Speech assessment is best done perceptually and confirmed instrumentally. 19,20 According to the American Cleft Palate-Craniofacial Association recommendations, the assessment of outcomes of VPI surgeries must at least involve one of the following instrumental methods: NPE, VF, nasometry, and the pressure-flow technique. 21 The decisions made based on the preoperative assessment can be altered intraoperatively. ...
Objective
The aim of this study was to review current literature regarding the speech outcome of different techniques of surgical treatment of VPD in cleft patients, in an attempt to reach a treatment algorithm.
Design: A systematic review was done, by searching Pubmed, Scopus and Web of Science electronic databases, following the PRISMA guidelines.
Participants: Articles reporting speech assessment results of secondary VPI surgeries on non- syndromic patients with CP.
Interventions: surgical techniques were categorized into two groups; palatal and pharyngeal surgeries.
Main outcome: Raw data was extracted to compare speech outcome and complication of each technique, with special emphasis on the factors affecting, the patients’ selection for each technique.
Results
Our results showed comparable success and complication rates among these techniques. However, the factors governing selection of each technique, were identified and taken into consideration to reach a preliminary algorithm.
Conclusion
A preliminary treatment algorithm is described based on the results of our review; the most important factors affecting the technique choice are: VP gap size, LVP position, palatal mobility, palatal scarring, VP closure pattern and age of the patient.
... 33 It is also possible that reduced intelligibility-especially in connected speech-could affect auditory perceptual evaluations and nasometry measures differently. Considering the high prevalence of both specific articulation errors and reduced intelligibility in children with cleft palate, [60][61][62] it is important that the influence of these factors on the relationship between nasometry and auditory-perceptual measures be clarified. ...
To investigate the relationship between auditory-perceptual ratings of resonance and nasometry scores in children with cleft palate. Factors which may impact this relationship were examined including articulation, intelligibility, dysphonia, sex, and cleft-related diagnosis. Retrospective, observational cohort study. Outpatient pediatric cranio-facial anomalies clinic. Four hundred patients <18 years of age identified with CP ± L, seen for auditory-perceptual and nasometry evaluations of hypernasality as well as assessments of articulation and voice. Relationship between auditory-perceptual ratings of resonance and nasometry scores. Pearson's correlations indicated that auditory-perceptual resonance ratings and nasometry scores were significantly correlated across oral-sound stimuli on the picture-cued portion of the MacKay-Kummer SNAP-R Test (r values .69 to.72) and the zoo reading passage (r = .72). Linear regression indicated that intelligibility (p ≤ .001) and dysphonia (p = .009) significantly impacted the relationship between perceptual and objective assessments of resonance on the Zoo passage. Moderation analyses indicated that the relationship between auditory-perceptual and nasometry values weakened as severity of speech intelligibility increased (P < .001) and when children presented with moderate dysphonia (p ≤ .001). No significant impact of articulation testing or sex were observed. Speech intelligibility and dysphonia alter the relationship between auditory-perceptual and nasometry assessments of hypernasality in children with cleft palate. SLPs should be aware of potential sources of auditory-perceptual bias and shortcomings of the Nasometer when following patients with limited intelligibility or moderate dysphonia. Future study may identify the mechanisms by which intelligibility and dysphonia affect auditory-perceptual and nasometry evaluations.
... Clinical evaluation All children with a history of cleft lip and/or palate should be seen by a speech-language pathologist (SLP) for a clinical evaluation of speech and resonance around the age of three years (or sooner if there are language issues). The purpose of the evaluation is to determine if the child demonstrates the characteristics of a speech and/or resonance disorder and to determine the probable cause (Kuehn and Henne 2003;Smith and Kuehn 2007;Kummer 2011Kummer , 2014Kummer , 2018Kummer , 2020d. ...
... Finally, the SLP determines if there is a normal balance of oral and nasal resonance, or if there is a resonance disorder. Although severity ratings of abnormal resonance are often used by SLPs, treatment decisions are based on the type of resonance, not its severity (Kummer 2011(Kummer , 2014(Kummer , 2020c. ...
Children with cleft palate, which is associated with a craniofacial syndrome, may have apraxia, language disorders, global developmental delays, and other neurological conditions. This chapter describes how speech is produced and what can be expected with normal speech and language development. It describes the speech and resonance disorders that can occur due to clefts of the primary and/or secondary palate. The chapter reviews the management of speech and resonance disorders in patients with orofacial clefts, including evaluation procedures and the role of speech therapy in treatment. Whereas speech is the physical component of verbal communication, language is the cognitive component. Speech sound disorders are characterized by consonant phoneme substitutions, omissions, and distortions. Children with clefts of the secondary palate are at risk for speech disorders due to velopharyngeal dysfunction, which is a general term indicating leakage of sound and/or airflow into the nasal cavity during oral speech sound production.
