Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Unilateral Cleft Lip and Palate: Speech, Voice and Nasal Function in Adults
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
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 [en]
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: urn:nbn:se:uu:diva-340153ISBN: 978-91-513-0224-9 (print)OAI: oai:DiVA.org:uu-340153DiVA, id: diva2:1177903
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
List of papers
1. Nasal symptoms and clinical findings in adult patients treated for unilateral cleft lip and palate
Open this publication in new window or tab >>Nasal symptoms and clinical findings in adult patients treated for unilateral cleft lip and palate
2013 (English)In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 47, no 5, p. 383-389Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to investigate self-experienced nasal symptoms among adults treated for UCLP and the association to clinical findings, and to evaluate whether palate closure in one-stage or two-stages affected the symptoms or clinical findings. All people with UCLP born between 1960-1987, treated at Uppsala University Hospital, were considered for participation in this cross-sectional population study with long-term follow-up. Eighty-three patients (76% participation rate) participated, a mean of 37 years after the first operation. Fifty-two patients were treated with one-stage palate closure and 31 with two-stage palate closure. An age-matched group of 67 non-cleft controls completed the same study protocol, which included a questionnaire regarding nasal symptoms, nasal inspection, anterior rhinoscopy, and nasal endoscopy. Patients reported a higher frequency of nasal symptoms compared with the control group, e.g., nasal obstruction (81% compared with 60%) and mouth breathing (20% compared with 5%). Patients also rated their nasal symptoms as having a more negative impact on their daily life and physical activities than controls. Nasal examination revealed higher frequencies of nasal deformities among patients. No positive correlation was found between nasal symptoms and severity of findings at nasal examination. No differences were identified between patients treated with one-stage and two-stage palate closure regarding symptoms or nasal findings. Adult patients treated for UCLP suffer from more nasal symptoms than controls. However, symptoms are not associated with findings at clinical nasal examination or method of palate closure.

Keywords
Unilateral cleft lip and palate, nasal function, nasal obstruction, olfactory function, clinical examination, adult, surgical protocols
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-209465 (URN)10.3109/2000656X.2013.771583 (DOI)000324533400009 ()
Available from: 2013-10-24 Created: 2013-10-21 Last updated: 2018-01-26Bibliographically approved
2. Speech in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair
Open this publication in new window or tab >>Speech in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair
Show others...
2017 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 54, no 6, p. 639-649Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate speech in adults treated for unilateral cleft lip and palate with one-stage or two-stage palate closure and compare the speech of the patients with that of a noncleft control group.

DESIGN: Cross-sectional study with long-term follow-up.

PARTICIPANTS/SETTING: All unilateral cleft lip and palate patients born from 1960 to 1987 and treated at Uppsala University Hospital, Sweden, were invited (n = 109). Participation rate was 67% (n = 73) at a mean of 35 years after primary surgery. Forty-seven had been treated according to one-stage palate closure and 26 according to two-stage palate closure. Pharyngeal flap surgery had been performed in 11 of the 73 patients (15%). The noncleft control group consisted of 63 age-matched volunteers.

MAIN OUTCOME MEASURE(S): Speech-language pathologists rated perceptual speech characteristics from blinded audio recordings.

RESULTS: Among patients, seven (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 (2%) had reduced intelligibility. Controls had no audible signs of velopharyngeal insufficiency and no quantifiable problems with the other speech production variables. No significant differences were identified between patients treated with one-stage and two-stage palate closure for any of the variables.

CONCLUSIONS: The prevalence of speech outcome indicative of velopharyngeal insufficiency among adult patients treated for unilateral cleft lip and palate was low but higher compared with individuals without cleft. Whether palatal closure is performed in one or two stages does not seem to affect the speech outcome at a mean age of 35 years.

Keywords
adult, cross-sectional, long-term, one-stage repair, speech outcome, two-stage repair, unilateral cleft lip and palate
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-317289 (URN)10.1597/15-037 (DOI)000413110600003 ()28140670 (PubMedID)
Available from: 2017-03-13 Created: 2017-03-13 Last updated: 2018-01-26Bibliographically approved
3. Voice quality in adults treated for unilateral cleft lip and palate: Long-term Follow-up After 1- or 2-Stage Palate Repair
Open this publication in new window or tab >>Voice quality in adults treated for unilateral cleft lip and palate: Long-term Follow-up After 1- or 2-Stage Palate Repair
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.

Keywords
unilateral cleft lip and palate, adult, long-term, voice, palate repair
National Category
Otorhinolaryngology Surgery
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:uu:diva-340092 (URN)10.1177/1055665618754946 (DOI)000430340500018 ()29461876 (PubMedID)
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-06-19Bibliographically approved
4. Speech in Adults Treated for Unilateral Cleft Lip and Palate as Rated by Naïve Listeners, Speech-Language Pathologists and Patients
Open this publication in new window or tab >>Speech in Adults Treated for Unilateral Cleft Lip and Palate as Rated by Naïve Listeners, Speech-Language Pathologists and Patients
Show others...
(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
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:nbn:se:uu:diva-340124 (URN)
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-01-26

Open Access in DiVA

fulltext(3361 kB)90 downloads
File information
File name FULLTEXT01.pdfFile size 3361 kBChecksum SHA-512
7186fb0b869e9c1f39ff964e29436c922bf7fea6ace907f545a96587f772164d61bffe5a2c743d840a015005d4c7c387be2ecd559f4fb0ad1f5415002d631f4e
Type fulltextMimetype application/pdf
Buy this publication >>

Search in DiVA

By author/editor
Morén, Staffan
By organisation
Otolaryngology and Head and Neck Surgery
Otorhinolaryngology

Search outside of DiVA

GoogleGoogle Scholar
Total: 90 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 487 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf