Speech Outcome in Cleft Palate

Cleft lip and palate (CLP) occurs in Sweden in about one child per 500 born. However, children with CLP are a heterogeneous group with several subgroups and differences between them. This applies to the type of cleft, size and cooccurrence of other malformations or disabilities.

Illustration by May Johansson

Introduction

Primary surgical repair of the cleft palate is primarily to provide the best conditions for speech development, occlusion and appearance. The treatment is multidisciplinary and also includes the speech and and palatal function, the function of the ear and hearing, which are important contributing components for speech and language development, as well as dental development and growth in the face, which are important contributing components for appearance.

Early identification of children who are at risk of being delayed or deviating in speech development is necessary to be able to develop care programs and routines to prevent poor health in terms of speech disorders that make speech different and difficult to understand and that affect the ability for communicative activity and participation.

Today there is rather good knowledge of the occurrence of deviations related to cleft palate as well as about differences depending on the type of column. International studies show relatively consistent results, although these vary, partly due to differences in surgical treatment, and partly methodological ambiguities. Furthermore, the results are mainly based on retrospective cross-sectional studies carried out at different ages.

In summary, up to 50 percent still seem to have speech and / or nasality problems in preschool or early school age. Furthermore, that peers perceive deviations in speech which could have a negative impact on participation. Data on ear and hearing problems are still scarce, but provide support for the fact that otitis media with effusion (OME) with associated fluctuating mild hearing loss occurs in virtually all children with cleft palate. However, there is still no support for any particular surgical method or timing of palatal surgery to providing the best conditions for speech development. In addition, there is insufficient knowledge of people's own perception of their speech and the need for and effect of speech intervention.

The group investigates the effect of the method for surgery of the cleft palate in children born with cleft lip, jaw and / or cleft palate (LKG) on how speech develops, how people perceive their speech and the effect of speech therapy.

The following projects are included

The Scanclceft Trials

consisting of three concurrent randomised 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 were compared. Recruitment of 448 infants took place over a 9-year period, with high subsequent retention of participants in each trial. The 5 year outcome has been published. An follow-up analysis at 10 years of age is ongoing. 

Trial registration number ISRCTN29932826.

TOPS - Timing of primary surgery in cleft palate

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 funtion 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 Lohmander9.

Speech outcome and self-reported communicative ability in individuals born with UCLP - comparing results after two methods for palatal repair

Early closure (about 6 months) of the soft palate seems to provide good conditions for palate function and early speech development even if the cleft in hard the palate is closed later (after 2 years) and better than if the entire cleft palate is closed at about 1-1.5 years. This is examined with regard to the final results of treatment and follow-up, that is, at the age of 19-21 years, with one group having received surgery in Gothenburg and one in Stockholm.

In another study, 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 project Petra Peterson, Emilie Hagberg). (Anette Lohmander, Jill Nyberg).

Early Development of Speech and Hearing - TUTH

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).(Traci Flynn, Liisi Raud Westberg, Birgitta Tengroth).

Effect of speech therapy of LKG-related speech disorders

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). (Anette Lohmander, Jill Nyberg).