Laryngeal Aerodynamics, Acoustics, and Hypernasality in Children With Cleft Palate

The objective of this study was to examine the relationship between laryngeal aerodynamics, acoustics, and hypernasality in children with cleft palate with or without lip (CP ± L).

This study used a prospectively performed cross-sectional design. Fifty-six children between the ages of 6 and 17 years with CP ± L participated (M_age= 11.7, SD = 3.4; male = 32, female = 24). Children were separated into four groups based on auditory-perceptual ratings of hypernasality made using the Cleft Audit Protocol for Speech-Augmented-Americleft Modification protocol. Laryngeal aerodynamic measures including subglottal pressure, transglottal airflow, laryngeal aerodynamic resistance (LAR), and phonation threshold pressure were collected. Acoustic measures of smoothed cepstral peak prominence (CPP) and low-to-high ratio on sustained vowels and connected speech were also considered. Analyses controlled for age, sex, auditory-perceptual ratings of voice quality, and speech intelligibility.

Children with minimally or mildly hypernasal resonance demonstrated significantly increased subglottal pressure, reduced transglottal airflow, and increased LAR, when compared with children with balanced or moderately hypernasal resonance. CPP on sustained vowel was significantly lower for children with moderate hypernasality when compared with all other groups-suggesting poorer voice quality. Other acoustic measures were in or near normative pediatric range.

Children with CP ± L and minimal or mildly hypernasal resonance demonstrated aerodynamic voice measures indicative of vocal hyperfunction. These findings suggest that children with CP ± L may compensate for velopharyngeal dysfunction on a laryngeal level, thus increasing the risk of laryngeal pathology. Future study should explore the relationship between laryngeal function and velopharyngeal port closure and consider how voice problems can be prevented or mitigated in children with CP ± L.