Speech Outcomes of a National Cohort of Children with Orofacial Cleft at 5 and 10 Years of age

Abstract

Objective To assess speech outcomes at five and ten years of age in a nationwide study of children with orofacial cleft. Design Prospective study. Participants Children born with orofacial cleft and having primary surgery in New Zealand. Speech samples were available for 151 five-year-old, and 163 ten-year-old children. Main outcome measures Intelligibility, Acceptability, Velopharyngeal function, Hypernasality, Hyponasality, severity of airflow evaluated by perceptual speech assessment (using the standardised Rhinocleft assessment), and overall assessment of requirement for clinical intervention. Results A large proportion of five-year-old children had speech that was considered to be not completely intelligible, was not acceptable, and had inadequate velopharyngeal function. The noted deficiencies led to a clinical judgement that further speech and/or surgical intervention was required in 85% with cleft lip and palate, 65% with cleft palate and 26% with cleft lip. The proportion of children with poor speech outcomes in the ten-year-old children was lower, though of clinical importance, further intervention required for 25% with CLP, 15% with CP and 3% with CL. The number of sound production errors in both age groups followed the same pattern with fewest in those with CL and most in those with CLP. Conclusions A significant proportion of children with orofacial cleft were found to have poor speech outcomes requiring further treatment. The outcomes are poor compared to centres reported in the UK and Scandinavia. New Zealand requires a review of the current services for individuals born with cleft to improve speech outcomes and interdisciplinary care.

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Speech proficiency at 10 years of age

“…It is also important to follow the effect of time, as speech is expected to improve with increasing age (Lohmander, 2011). A few studies have reported speech outcomes at 10 years of age (Brunnegård & Lohmander, 2007; Feragen et al., 2017; Havstam et al., 2011; Lohmander et al., 2006, 2012; Morrison et al., 2022; Nyberg et al., 2014), one at 11–14 years (Grunwell et al., 2000), and one at 12 years (Sell et al., 2001). This age is often chosen as children have spent some years in school and, depending on the school system, they are often about to start secondary school, giving a higher demand on their speech.…”

Auckland Regional Cleft Palate Service: service accessibility and speech outcomes

“…As a whole cohort, Auckland Regional Cleft Service speech outcomes are better than the national reported outcomes for Aotearoa New Zealand, where 85% required further speech and/ or surgical intervention at age 5 years. 26 However, internationally, it is widely accepted and reported that 20% of children born with orofacial cleft may have persistent speech disorder at the age of 5 years [2][3][4] in comparison to our 30% (VPI) and 30% (CSCs).…”

“…Morrison et al 26 recently published Aotearoa New Zealand's first speech outcomes for children with orofacial cleft at 5-10 years of age. This study looked at speech outcomes across the nation and included five cleft centres.…”

Speech in 7- and 10-year-olds born with a unilateral cleft lip and palate: a continued prospective Swedish intercentre study

“…In a previous Swedish study of 69 children born with unilateral cleft lip and palate, 93% had competent velopharyngeal function at 10 years of age [21], which is a somewhat lower proportion than in this study (98%). In the nationwide study of 56 10-year-olds born with complete cleft lip and palate treated in New Zealand, 66% had adequate velopharyngeal function and 25% were in need for further investigation or therapy [12]. In their study, bilateral and unilateral complete clefts were not separated, which complicates the comparison with our data.…”

“…At 10 years of age, the results indicated that children treated with two-stage closure with hard palate closure at 36 months had lower PCC than children treated with simultaneous hard and soft palate closure at 12 months of age, whereas the proportion of children with primary VPC (without secondary surgery to improve function) was higher in the group with delayed hard palate closure [11]. A national survey from New Zealand included 56 children with cleft lip and palate at 10 years of age and found adequate velopharyngeal function in 66% and a need for further investigation or therapy in 25% [12].…”