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Voice quality in adults treated for unilateral cleft lip and palate: Long-term Follow-up After 1- or 2-Stage Palate Repair
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery. Otorhinolaryngology, Uppsala University Hospital.ORCID iD: 0000-0002-9885-3364
Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
2018 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 55, no 5, p. 758-768Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of the current study was to assess voice quality among adults treated for unilateral cleft lip and palate (UCLP), after 1- or 2-stage palate closure, and compare it to a noncleft control group.

Study Design: Cross-sectional study in UCLP patients with long-term follow-up and noncleft controls.

Participants: UCLP patients born 1960-1987, treated at Uppsala University Hospital, Sweden, were examined (n = 73) at a mean of 35 years after primary surgery. Forty-seven patients (64%) had been treated with 1-stage palate closure and 26 with 2-stage closure (36%). The noncleft control group consisted of 63 age-matched volunteers.

Main Outcome Measure(s): Ratings of perceptual voice characteristics from blinded voice recordings with Swedish Voice Evaluation Approach (SVEA) method. Acoustic voice analysis including pitch and spectral measures.

Results: Among the patients, the mean values for the 12 evaluated variables on a VAS scale (0 = no abnormality, 100 = maximal abnormality) ranged between 1 and 22 and the mean for all was 6 mm. Voice variables were similar between patients and controls except the total mean of all the perceptual voice variables, as well as “vocal fry”—both slightly lower among patients (P = .018 and P = .009). There was no difference in any variable between patients treated with 1-stage and 2-stage palate closure. No clear relationship was found between VPI and dysphonia.

Conclusion: The voice characteristics among adults treated for UCLP in childhood are not different from those of individuals without cleft.

Place, publisher, year, edition, pages
2018. Vol. 55, no 5, p. 758-768
Keywords [en]
unilateral cleft lip and palate, adult, long-term, voice, palate repair
National Category
Otorhinolaryngology Surgery
Research subject
Oto-Rhino-Laryngology
Identifiers
URN: urn:nbn:se:uu:diva-340092DOI: 10.1177/1055665618754946ISI: 000430340500018PubMedID: 29461876OAI: oai:DiVA.org:uu-340092DiVA, id: diva2:1177855
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-06-19Bibliographically approved
In thesis
1. Unilateral Cleft Lip and Palate: Speech, Voice and Nasal Function in Adults
Open this publication in new window or tab >>Unilateral Cleft Lip and Palate: Speech, Voice and Nasal Function in Adults
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cleft lip and palate (CLP) is the most common craniofacial malformation. Even after repair of the cleft there may be persistent symptoms affecting speech, voice, nasal breathing, dentition, appearance and quality of life. The aims of the thesis were to: (I) investigate subjective nasal function and nasal airway at clinical examination, (II) evaluate speech by perceptual evaluation, (III) assess voice quality by perceptual evaluation and acoustic analysis and (IV) compare ratings of speech by naïve listeners, speech-language pathologists (SLPs) and patients.

All consecutive patients with complete  unilateral CLP, born 1960-1987, and treated at Uppsala University Hospital were invited. A total of 83 (76%) (I) and 73 (67%) (II, III, IV) of the 109 eligible patients and non-cleft controls (n=63) participated. Patients had been treated in childhood with one- or two-stage palate closure. The participants underwent clinical examination, recording of speech and filled in questionnaires.

The results showed that: (I) Patients earlier treated for UCLP suffer from more nasal symptoms than controls. However, nasal symptoms were not associated with clinical findings or method of palate closure. (II) Seven patients (10%) presented with hypernasality, 12 (16%) had audible nasal emission and/or nasal turbulence, five (7%) had consonant production errors, one (2%) had glottal reinforcements/substitutions, and one had reduced intelligibility. Controls had no quantifiable problems with speech. (III) Among patients, the mean values for the 12 perceptual voice variables on a visual analogue scale (0 = no abnormality, 100 = maximal abnormality) ranged between 1 and 22 and the mean for all was 6 mm. Voice variables were similar between patients and controls except “vocal fry”; this and total mean of all the perceptual voice variables were slightly lower among patients (p = 0.009 and p = 0.018 ). No clear association was found between velopharyngeal insufficiency and dysphonia. (IV). There were positive correlations between speech ratings by naïve listeners and SLPs (r =0.44 to 0.69, p always < 0.001, Spearman). The correlations between ratings of any of these groups and the patients’ self-ratings were weaker (r < 0.40). The patients were less satisfied with their speech and rated themselves to have more speech abnormalities than controls (p < 0.001). There were no statistically significant differences in any of the variables regarding speech, voice or nose between patients treated with one-stage and two-stage palate closure in any of the studies.

This thesis shows that adults treated for unilateral CLP have more nasal symptoms and cleft related speech abnormalities compared to the controls, however the prevalence of speech abnormalities are relatively low. Voice quality is not affected. Speech quality is rated differently by naïve listeners, SLPs and patients.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 89
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1423
Keywords
Adult, Cleft Lip, Cleft Palate, Cross-Sectional Studies, Control Groups, Dysphonia, Follow-Up Studies, Humans, Nasal Obstruction, Nose Deformities, Otolaryngology, Quality of Life, Reconstructive Surgical Procedures/methods, Retrospective Studies, Treatment Outcome, Voice Quality, Acoustic
National Category
Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:uu:diva-340153 (URN)978-91-513-0224-9 (ISBN)
Public defence
2018-03-16, Skoogsalen, Akademiska sjukhuset, ing 79, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-02-22 Created: 2018-01-26 Last updated: 2018-03-07

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Morén, StaffanMani, Maria

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