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Speech in Adults Treated for Unilateral Cleft Lip and Palate as Rated by Naïve Listeners, Speech-Language Pathologists and Patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.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.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction

Speech may be affected in patients with cleft lip and palate (CLP). Professional listeners, naïve listeners and patients perceive speech differently. The aim of the study was to evaluate speech among adults treated for unilateral CLP as rated by naïve listeners, speech language pathologists (SLPs) and patients.

Methods All patients with complete unilateral CLP (UCLP) treated at Uppsala University Hospital, Uppsala, Sweden, between 1960 and 1987 were invited. A total of 73 of 109 patients (67%) participated with a mean time of 35 years since initiation of treatment. The non-cleft control group consisted of 55 volunteers. All participants filled out a questionnaire for self-rating of speech and their speech was audio-recorded digitally. Fourteen naïve listeners and four SLPs rated the speech individually from blinded recordings.

Results

There were more speech abnormalities among patients compared to controls according to the ratings of naïve listeners and SLPs[Office1] . The patients were less satisfied with their speech and rated themselves to have more speech abnormalities than controls (p < 0.001, Mann Whitney U test). There were positive correlations between the 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, Spearman).

Conclusion

In general, adult patients treated for UCLP during childhood consider their speech as fairly good. However, they were less satisfied than non-cleft controls. The agreement between ratings by naïve listeners and SLPs were good while the agreement between these ratings and self-assessment of speech varied widely. When assessing treatment outcomes in adult patients treated for UCLP, differences in perception of speech abnormalities by professionals, laymen and patients should be taken into account.  

Keywords [en]
Adult, Humans, Speech, Cleft Lip-Palate, Nonsyndromic Self-Assessment, Statistics, Nonparametric Control Groups, Hospitals, University, Speech-Language Pathology, Auditory Perception, Treatment Outcome
National Category
Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
URN: urn:nbn:se:uu:diva-340124OAI: oai:DiVA.org:uu-340124DiVA, id: diva2:1177866
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-01-26
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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