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Sasikumar AV, Hariharan SV, Vittal N, Ahuja PM. Management of Speech and Hearing in Low-Income and Middle-Income Countries: Current Conditions, Problems, Future Directions. J Craniofac Surg 2024:00001665-990000000-01783. [PMID: 39078135 DOI: 10.1097/scs.0000000000010391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 07/31/2024] Open
Abstract
Management of speech and hearing issues in low-income and middle-income countries (LMICs) has been challenging, considering the population size and availability of resources. There is a need to investigate the depth of these challenges and explore the efficacy of strategies to overcome them. This review aimed to delineate the speech and hearing issues in individuals with cleft lip and palate and how they have been managed in the context of LMICs. Keywords were developed based on the objectives of the study to search for literature published during the period 2010 to 2023. Articles from PubMed, Google Scholar, Science Direct, and ProQuest databases were retrieved using appropriate keyword searches. The titles and abstracts were screened to delete the unsuitable articles. Relevant gray literature and hand-searched articles published were also included. The findings are summarized under the following heads in the context of LMICs: incidence and severity of speech and hearing issues, challenges, and barriers in providing speech and hearing services, methods of developing manpower and training, methods of assessing speech and hearing outcomes, service delivery models employed, and the recent advances relating to management of speech and hearing. A wide range of topics revolving around managing speech and hearing issues in individuals with cleft lip and palate has been researched in the context of LMICs. Scattered and fragmented solutions have been provided to overcome the varied challenges in LMICs. The gaps in the literature and the future directions for research have been identified.
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Affiliation(s)
- Aparna V Sasikumar
- SmileTrain Cleft Leadership Center, Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka
| | | | - Namratha Vittal
- SmileTrain Cleft Leadership Center, Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka
| | - Payal M Ahuja
- Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Bettens K, Alighieri C, Bruneel L, D'haeseleer E, Luyten A, Sseremba D, Musasizib D, Ojok I, Hodges A, Galiwango G, Vermeersch H, Van Lierde K. Better speech outcomes after very early palatal repair?-A longitudinal case-control study in Ugandan children with cleft palate. JOURNAL OF COMMUNICATION DISORDERS 2022; 96:106198. [PMID: 35217335 DOI: 10.1016/j.jcomdis.2022.106198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/11/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Children born with cleft palate with or without cleft lip (CP±L) tend to use less oral pressure consonants and more glottal sounds in their babbling. The purpose of very early palatal repair (i.e., one-stage palatal closure prior to 6 months of age) is to make the palate functional before the onset of speech acquisition to reduce the anchoring of wrong patterns in the child's developing phonological system. As a result, less compensatory articulation errors are expected to be present. Currently, no detailed longitudinal speech outcomes after very early palatal closure are available. This study aimed to provide longitudinal speech outcomes in Ugandan children with CP±L who received palatal closure prior to the age of 6 months. METHODS Ten children with CP±L were assessed at a mean age of 5 and 10 years old. Speech understandability, speech acceptability, resonance, nasal airflow and articulation were perceptually rated by two experienced speech-language pathologists. Velopharyngeal function was estimated using the velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary (speech) surgery was collected. The outcomes were compared with the longitudinal outcomes of an age- and gender-matched control group of 10 Ugandan children without CP±L. RESULTS Speech understandability and acceptability improved significantly over time in the group with CP±L (all p's ≤ 0.05, all Z's > -2.43). At both test dates, significantly worse judgments were found for the group with CP±L compared to the control group for these variables and variables related to passive speech errors (all p's ≤ 0.05, all Z's > 2.49). A statistically significant difference with the control group was found for the presence of compensatory articulation errors at the age of 5 years but not at the age of 10 years, indicating a catch up by the children with CP±L. CONCLUSION Whether a one-stage palatal closure prior to the age of 6 months is more favorable for speech outcomes compared to one-stage palatal closure at 12 months is still not clear. Speech of the children with CP±L improved over time, but significantly differed from the control group at the age of 5 and 10 years old. Limited access to health care facilities and possible influence of malnutrition on wound healing need to be considered when interpreting the results. Whether palatal closure prior to the age of 6 months is transferable to other countries is subject for further research, including both longitudinal and prospective designs with larger samples.
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Affiliation(s)
- Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium.
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Anke Luyten
- Speech Pathology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Daniel Sseremba
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Duncan Musasizib
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Isaac Ojok
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Andrew Hodges
- Department of Plastic and Reconstructive Surgery, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - George Galiwango
- Department of Plastic and Reconstructive Surgery, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Hubert Vermeersch
- Department of Head and Skin, Ghent University, Ghent, Belgium; Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium; Department of Speech-Language Therapy and Audiology, University of Pretoria, Pretoria, South-Africa
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Nachmani A, Masalha M, Kassem F. Phonological Profile of Patients With Velopharyngeal Dysfunction and Palatal Anomalies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4649-4663. [PMID: 34739332 DOI: 10.1044/2021_jslhr-20-00652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This purpose of this study was to assess the frequency and types of phonological process errors in patients with velopharyngeal dysfunction (VPD) and the different types of palatal anomalies. METHOD A total of 808 nonsyndromic patients with VPD, who underwent follow-up at the Center for Cleft Palate and Craniofacial Anomalies, from 2000 to 2016 were included. Patients were stratified into four age groups and five subphenotypes of palatal anomalies: cleft lip and palate (CLP), cleft palate (CP), submucous cleft palate (SMCP), occult submucous cleft palate (OSMCP), and non-CP. Phonological processes were compared among groups. RESULTS The 808 patients ranged in age from 3 to 29 years, and 439 (54.3%) were male. Overall, 262/808 patients (32.4%) had phonological process errors; 80 (59.7%) ages 3-4 years, 98 (40, 0%) ages 4.1-6 years, 48 (24.7%) 6.1-9 years, and 36 (15.3%) 9.1-29 years. Devoicing was the most prevalent phonological process error, found in 97 patients (12%), followed by cluster reduction in 82 (10.1%), fronting in 66 (8.2%), stopping in 45 (5.6%), final consonant deletion in 43 (5.3%), backing in 30 (3.7%), and syllable deletion and onset deletion in 13 (1.6%) patients. No differences were found in devoicing errors between palatal anomalies, even with increasing age. Phonological processes were found in 61/138 (44.20%) with CP, 46/118 (38.1%) with SMCP, 61/188 (32.4%) with non-CP, 70/268 (26.1%) with OSMCP, and 25/96 (26.2%) with CLP. Phonological process errors were most frequent with CP and least with OSMCP (p = .001). CONCLUSIONS Phonological process errors in nonsyndromic VPD patients remained relatively high in all age groups up to adulthood, regardless of the type of palatal anomaly. Our findings regarding the phonological skills of patients with palatal anomalies can help clarify the etiology of speech and sound disorders in VPD patients, and contribute to general phonetic and phonological studies.
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Affiliation(s)
- Ariela Nachmani
- Communication Disorders Faculty, Hadassah Academic College, Jerusalem, Israel
- Communication Disorders Faculty, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Muhamed Masalha
- Department of Otolaryngology, Head and Neck Surgery, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport School of Medicine, Technion - Israel Institute of Technology, Haifa
| | - Firas Kassem
- Department of Otolaryngology - Head and Neck Surgery, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
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Bettens K, Bruneel L, Alighieri C, Sseremba D, Musasizib D, Ojok I, Hodges A, Galiwango G, Adriaansen A, D'haeseleer E, Vermeersch H, Van Lierde K. Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients With Cleft Palate. Cleft Palate Craniofac J 2020; 58:999-1011. [PMID: 33380217 DOI: 10.1177/1055665620980249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To provide speech outcomes of English-speaking Ugandan patients with a cleft palate with or without cleft lip (CP±L). DESIGN Prospective case-control study. SETTING Referral hospital for patients with cleft lip and palate in Uganda. PARTICIPANTS Twenty-four English-speaking Ugandan children with a CP±L (15 boys, 9 girls, mean 8.4 years) who received palatal closure prior to 6 months of age and an age- and gender-matched control group of Ugandan children without cleft palate. INTERVENTIONS Comparison of speech outcomes of the patient and control group. MAIN OUTCOME MEASURES Perceptual speech outcomes including articulation, resonance, speech understandability and acceptability, and velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary surgery. RESULTS Normal speech understandability was observed in 42% of the patients, and 38% were judged with normal speech acceptability. Only 16% showed compensatory articulation. Acceptable resonance was found in 71%, and 75% of the patients were judged perceptually to present with competent velopharyngeal function based on the VPC-sum. Additional speech intervention was recommended in 25% of the patients. Statistically significant differences for all these variables were still observed with the control children (P < .05). CONCLUSIONS Overall, acceptable speech outcomes were found after early primary palatal closure. Comparable or even better results were found in comparison with international benchmarks, especially regarding the presence of compensatory articulation. Whether this approach is transferable to Western countries is the subject for further research.
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Affiliation(s)
- Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Daniel Sseremba
- Speech-Language Pathologist, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Duncan Musasizib
- Speech-Language Pathologist, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Isaac Ojok
- Speech-Language Pathologist, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Andrew Hodges
- Plastic and Reconstructive Surgeon, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - George Galiwango
- Plastic and Reconstructive Surgeon, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Anke Adriaansen
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Hubert Vermeersch
- Department of Head and Skin, 26656Ghent University, Ghent, Belgium.,Department of Plastic Surgery, 26656Ghent University Hospital, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
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Baillie L, Sell D. Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique. Cleft Palate Craniofac J 2020; 57:1197-1215. [DOI: 10.1177/1055665620923925] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective: To report speech and velopharyngeal function (VPF) outcomes, and surgical characteristics, at age 5 following early complete palate closure using the Sommerlad protocol. Design: A retrospective, descriptive, cross-sectional consecutive series. Setting: A regional twin site center; a district general hospital and tertiary children’s hospital. Participants: Between 1993 and 2006, 877 participants underwent surgery; 712 (81%) were eligible for inclusion; 391 (55%) were included, 321 (45%) excluded. Thirteen percent had bilateral cleft lip and palate (CLP), 40% unilateral CLP, and 47% isolated cleft palate. Intervention: Lip and vomerine flap repair at 3 months of age (BCLP, UCLP) with soft palate closure using radical muscle dissection and retropositioning at a mean age of 6.6 months, range 4 to 23 months, as described and undertaken by Sommerlad. Outcome Measures: Velopharyngeal Composite (VPC) CAPS-A and articulation summary scores derived from analysis using the Cleft Audit Protocol for Speech-Augmented. Results: A VPC-SUM CAPS-A score of “0” was found in 97% reflecting adequate VPF; 73% had no cleft articulation difficulties. The BCLP group had the poorest articulation. Secondary speech surgery rate was 2.6% and 10.7% had fistula repair. Levator muscle quality and degree of retropositioning was associated with speech outcomes related to VPF. 2.6% had current features of VPI. Conclusions: Complete palate closure by around 6 months of age by the surgeon who described the technique led to excellent perceived VPF and very good speech outcomes at age 5, with less speech therapy and secondary speech surgery than commonly reported. These findings serve as a benchmark for the Sommerlad protocol and technique.
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Affiliation(s)
- Lauren Baillie
- Speech and Language Therapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
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Lancaster HS, Lien KM, Chow JC, Frey JR, Scherer NJ, Kaiser AP. Early Speech and Language Development in Children With Nonsyndromic Cleft Lip and/or Palate: A Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:14-31. [PMID: 31841365 PMCID: PMC7213476 DOI: 10.1044/2019_jslhr-19-00162] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 06/10/2019] [Accepted: 09/08/2019] [Indexed: 05/31/2023]
Abstract
Objective The aim of the study was to conduct a meta-analysis of research examining the early speech and language functioning of young children, birth to age 8;11 (years;months), with nonsyndromic cleft lip and/or palate (NSCL/P) compared to their peers without NSCL/P. Method We conducted a random-effects metaregression using 241 effect sizes from 31 studies comparing 955 young children with NSCL/P to 938 typically developing peers on measures of speech and language functioning. Moderators were sample characteristics (i.e., age, cleft type, publication year, and study location) and measurement characteristics (i.e., speech sample material, language modality and domain, and assessment type). Results Young children with NSCL/P scored significantly lower on measures of speech and language compared to children without NSCL/P. Children with NSCL/P had smaller consonant inventories (standardized mean difference effect size [ESg] = -1.24), less accurate articulation (ESg = -1.13), and more speech errors (ESg = 0.93) than their peers. Additionally, children with NSCL/P had poorer expressive (ESg = -0.57) and receptive (ESg = -0.59) language skills than their peers. Age and assessment type moderated effect sizes for expressive language. As children with NSCL/P aged, their expressive language performance became more similar to their peers. Expressive language effect sizes from parent reports and observational language measures (estimated effect size = -0.74) were significantly lower than those from standardized norm-referenced tests (estimated effect size = -0.45). Conclusions These findings suggest that young children with NSCL/P experience delays relative to their peers across multiple speech and language constructs. Differences between children with NSCL/P and their typically developing peers appear to decrease with age. Supplemental Material https://doi.org/10.23641/asha.11356904.
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Affiliation(s)
- Hope Sparks Lancaster
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Kari M. Lien
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Jason C. Chow
- Department of Counseling and Special Education, Virginia Commonwealth University, Richmond
| | - Jennifer R. Frey
- Department of Special Education & Disability Studies, The George Washington University, Washington, DC
| | - Nancy J. Scherer
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Ann P. Kaiser
- Department of Special Education, Peabody College of Vanderbilt University, Nashville, TN
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Sell D, Seselgyte R, Prendeville N, Sadri A, Pinkstone M. Letter comments on: Time course of improvement after re-repair procedure for VPI management. J Plast Reconstr Aesthet Surg 2019; 72:2064-2094. [PMID: 31607595 DOI: 10.1016/j.bjps.2019.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Debbie Sell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID).
| | | | | | - Amir Sadri
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom
| | - Marie Pinkstone
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom
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Bruneel L, Bettens K, De Bodt M, Roche N, Bonte K, Van Lierde K. Speech outcomes following Sommerlad primary palatoplasty: Results of the Ghent University Hospital. JOURNAL OF COMMUNICATION DISORDERS 2018; 72:111-121. [PMID: 29397063 DOI: 10.1016/j.jcomdis.2018.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/08/2018] [Accepted: 01/22/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE AND SUBJECTS Speech outcomes were described for 16 patients with cleft palate (mean age: 5.4 years) following Sommerlad primary palatoplasty performed by a single surgeon of the Ghent University Hospital. These speech outcomes were compared with those of an age and gender matched control group without cleft palate (mean age: 5.3 years). METHODS Speech intelligibility/distinctiveness, resonance, nasal airflow and articulation, were perceptually evaluated. Additionally, nasalance values and the NSI 2.0 were determined. RESULTS In seven patients, speech intelligibility/distinctiveness was disordered. Hypernasality was present in twelve participants, whereas nasal emission and nasal turbulence were perceived in thirteen and five patients respectively. Both perceptual and instrumental speech evaluations were significantly poorer in the patient group in comparison to the control group. CONCLUSIONS Patients still present with both obligatory and compensatory speech disorders following Sommerlad's palatoplasty. In the future, a Dutch speech assessment protocol will be developed in order to standardize follow-up of these patients and to allow for within-center and inter-center comparisons.
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Affiliation(s)
- Laura Bruneel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Kim Bettens
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Marc De Bodt
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium; Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Edegem, Belgium
| | - Nathalie Roche
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien Bonte
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Pathology and Audiology, University Of Pretoria, Pretoria, South Africa
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Klintö K, Lohmander A. Phonology in Swedish-speaking 3-year-olds born with unilateral cleft lip and palate treated with palatal closure in one or two stages. J Plast Surg Hand Surg 2016; 51:112-117. [DOI: 10.1080/2000656x.2016.1194280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kristina Klintö
- Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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The impact of palatal repair before and after 6 months of age on speech characteristics. Int J Pediatr Otorhinolaryngol 2014; 78:787-98. [PMID: 24630984 DOI: 10.1016/j.ijporl.2014.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Optimal timing of palatal repair is still subject of discussion. Although literature provides some evidence that palatal closure prior to 6 months positively influence speech outcome in children with clefts, only few studies verified this hypothesis. The purpose of this study was to describe and compare articulation and resonance characteristics following early (≤6 months) and later (>6 months) palatal repair, performed using the Sommerlad technique. METHODS Comparison was made between 12 Ugandan children with isolated cleft (lip and) palate following early palatal repair (mean age: 3.3 m) and 12 Belgian patients with later palatal repair (mean age: 11.1 m), matched for cleft type, age and gender. A Ugandan and Belgian age- and gender-matched control group without clefts was included to control for language, culture and other environmental factors. Articulation assessments consisted of consonant inventories and phonetic and phonological analyses that were based on consensus transcriptions. In addition, resonance was evaluated by perceptual consensus ratings and objective mean nasalance values. RESULTS The Belgian and Ugandan control groups were comparable for the majority of the variables. Comparison of cleft palate groups revealed no clinically relevant significant group differences for consonant inventory or phonological processes. Phonetic analysis showed significantly more distortions in the Belgian cleft palate group due to higher occurrence frequencies for (inter)dental productions of apico-alveolar consonants. Neither perceptual consensus ratings of hypernasality, hyponasality, cul-de-sac resonance and nasal emission/turbulence, nor objective mean nasalance values for oral speech samples revealed significant group differences (p>0.05). CONCLUSION Articulation and resonance characteristics of young children following palatal repair before and after 6 months of age seem to be at least comparable.
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