Development and Resolution of Nasal Fricatives in a Child with Repaired Bilateral Cleft Lip and Palate: A Case Report

This case report describes the development, characteristics, and resolution of anterior nasal fricatives (ANFs) - a learned maladaptive articulation error - in a young girl with repaired bilateral cleft lip and palate.

The girl was observed every two months from 12 to 24 months of age with follow-ups at 36, 48, and 67 months of age.

At 12 months of age, the girl nasalized /b/ inconsistently and had mild conductive hearing loss. At 18 months of age, she exhibited audible nasal air emission on some plosives and used ANFs to replace /s/ and /z/, often with a nasal grimace. At 24 months of age, the child continued to experience mild conductive hearing loss, obligatory nasal air emission, and ANFs for /s/ and /z/. At 36 months of age, pressure-flow testing documented significant velopharyngeal (VP) dysfunction. The girl then used ANFs for /f/ and /s/, phonetically marked by different oral stops. At 48 months of age, although VP impairment continued, speech therapy largely eliminated ANFs. By 67 months of age, VP closure was nearly normal.

Multiple factors including VP dysfunction, audible nasal air emission, and conductive hearing loss contributed to the development of ANFs. Clinical and etiological implications are discussed.