Longitudinal Speech Performance in Patients with Cleft Palate: Comparisons Based on Secondary Management

Abstract

Speech performance of three groups of speakers with cleft palate was analyzed at two-year intervals from age 4 years through age 16 years. The three groups consisted of: (1) Group A—individuals who score below 20 percent correct on the Iowa Pressure Articulation Test (IPAT) at 4 years of age and who received secondary surgery by 8 years of age; (2) Group B—individuals who scored below 20 percent correct on the Iowa Pressure Articulation Test at 4 years of age, but did not receive secondary management by 8 years of age; and (3) Group C— individuals who scored above 20 percent correct on the Iowa Pressure Articulation Test and who did not receive secondary surgery by 8 years of age. The results demonstrated that Group A performed better on several measures of speech performance at 16 years of age than either of the other groups. Also, speech performance appeared to become slightly worse around 12 years of age for Group B. This may be interpreted as evidence that this group may have been negatively affected by the physiologic changes associated with puberty. The other two groups did not appear to show this effect. The results of this study emphasize the need for careful research regarding patients who, in spite of early poor speech performance, are not considered candidates for early secondary management. Secondary surgical procedures such as pharyn— geal flap and Teflon injection are frequently recommended for speakers with cleft palates in order to improve velopharyngeal function for speech. Such procedures are usually performed after 4 years of age and may be delayed until puberty or later if the patient's prospect for non— surgical improvement is not well understood.