Speech Outcome in Cleft Palate

The Scandcleft Trials project, which started in 1997, consists of three concurrent randomized trials of primary surgery for infants born with complete unilateral cleft lip and palate (UCLP). The project was developed and executed by 10 North European cleft teams: Århus/Copenhagen (Denmark), Helsinki (Finland), Bergen/Oslo (Norway), Gothenburg/Linköping/ Stockholm (Sweden), and Manchester/Belfast (UK). One surgical protocol was defined to serve as a common method in each trial, against which a local protocol was compared. Recruitment of 448 infants took place over a 9-year period, with high subsequent retention of participants in each trial. The 5- and 10-year outcome has been published. Longitudinal analyses are ongoing as well as follow-up at young adulthood. 

Trial registration number ISRCTN29932826.

PI Speech: Anette Lohmander 2001 – 2016, Christina Persson 2017 –

The primary objective of the TOPS-trial is to determine whether surgery for cleft palate performed at 6 or 12 months of age is most beneficial for speech outcomes. Approximately 550 children from five countries (all centres Denmark, Norway and Sweden, the Bauru center in Brazil and around 10 in the UK).

The primary outcome is perceived velopharyngeal function at 5 years of age. Secondary outcomes at 12 and 36 months of age will be reported as well.

Trial registration number NCT00993551.

PI Stockholm Center:  Anette Lohmander.

Fluctuating hearing loss due to otitis media with effusion (OME) is very common in children born with cleft palate (CP±L). In the TUTH project, early development of speech and hearing is studied in a controlled group study of children with CP±L and children with OME, respectively. 

Subprojects include hearing, perception and production of consonant sounds, consonant inventory and proficiency, velopharyngeal function, intelligibility, vocabulary and language comprehension up to 3 years of age.

PI: Anette Lohmander
Postdoc-project: Åsa Okhiria

In Sweden, children born with cleft palate are operated on at 6 different university hospitals. There are mainly two methods of cleft palate surgery that are used; closure in one session at 9-12 months of age or closure in two sessions where the soft palate is closed at around 6 months and the cleft in the hard palate at around 2 years of age (earlier in preschool or early school age). The evidence regarding the speech result after various surgical methods has been insufficient both in terms of a specific age and longitudinally. The purpose of a series of projects is partly to contribute generally to the basis for choosing a surgical treatment method by evaluating how speech develops in children born with LKG cleft, and partly to specifically investigate the impact of speech abnormalities on the environment's perception of the individual's speech and communication. Three project parts have been completed:

• Speech outcome in children born with cleft lip and palate: aspects of function and environment (doctoral student Jill Nyberg, 2016, PhD).
• Orofacial function, articulation proficiency and intelligibility in 5-year old children born with cleft lip and palate (doctoral student Ann Malmenholt, 2020: PhD)
• Speech outcome and self-reported communicative ability in young adults born with unilateral cleft lip and palate: comparing long-term results after two different surgical methods for palatal repair (doctoral student Petra Peterson, 2022; PhD)

The speech of a group of children born with UCLP and treated with a two-stage palate repair are examined longitudinally from 1-7 years and is compared with the results in a previous group treated with one-stage palate repair. Age-relevant speech variables are assessed perceptually, and the results are compared between the groups. Both studies include measures of intelligibility, that is, how well the environment perceives / understands the speech, and the individuals' own perception of their speech.

Doctoral student: Emilie Hagberg

Speech disorders in children born with cleft palate are treated with speech therapy, but treatment studies of speech disorders related to cleft palate are still few and with great methodological variation. The project includes a systematic review and meta-analysis.

Furthermore, two treatment studies where both are controlled case series (Controlled single subject series design) in collaboration with speech and language pathologists in the Stockholm Region. In the second, distance treatment is planned.

Postdoctoral project: Anders Sand
Doctoral student project: Emilie Hagberg