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Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages

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The Cleft Care UK study. Part 4: perceptual speech outcomes.

D Sell¹, S Mildinhall², L Albery³

¹Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK.

Orthodontics & Craniofacial Research

|November 17, 2015

Summary

Centralized cleft care in the UK improved speech outcomes for children with unilateral cleft lip and palate. However, some children still experience significant speech difficulties at school entry.

Keywords:

cleft lip cleft palate speech treatment outcome

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Area of Science:

Craniofacial anomalies
Speech-language pathology
Pediatric healthcare outcomes

Background:

The Clinical Standards Advisory Group (CSAG) audit in 1998 established baseline speech outcomes for children with cleft lip and palate in the UK.
The Cleft Care UK (CCUK) study aimed to assess current speech outcomes following changes in service delivery.

Purpose of the Study:

To evaluate perceptual speech outcomes in children with complete unilateral cleft lip and palate.
To compare these outcomes with historical data from the 1998 CSAG audit.
To investigate the impact of centralized cleft care on speech development.

Main Methods:

A cross-sectional study involving 248 children (born 2005-2007) with complete unilateral cleft lip and palate.
Speech audio-video recordings were collected by specialist speech and language therapists.
Perceptual analysis was performed by two independent listeners using the CAPS-A Audit tool, with reliability testing.

Main Results:

Significant improvements were observed in intelligibility, hypernasality, palatalization, velar/uvular articulation, glottal articulation, and nasal consonant realization in CCUK children compared to CSAG children.
Speech parameters that did not show improvement included nasal emission, nasal turbulence, hyponasality, and lateralization.
The study identified specific areas of speech that benefited from the updated care model.

Conclusions:

Centralization of cleft care into high-volume centers in the UK has led to better speech outcomes for children with unilateral cleft lip and palate.
The development of a specialized workforce may contribute to these improved outcomes.
A subset of children continues to face considerable speech challenges upon entering school, indicating a need for ongoing specialized support.