Effects of preoperative speech therapy on the speech intelligibility of patients with velopharyngeal incompetence
The Egyptian Journal of Otolaryngology volume 29, pages 269–276 (2013)
Improved articulatory placement through speech therapy may eliminate compensatory errors, improve velopharyngeal function, minimize perception of hypernasality, and improve speech intelligibility.
The aim of this work was to study the effect of preoperative speech therapy on the speech intelligibility in patients with residual velopharyngeal insufficiency in order to provide a better speech outcome in such patients.
Patients and methods
This study included 41 patients diagnosed with residual velopharyngeal insufficiency after cleft palate repair. Patients were divided into two groups: group I included 22 patients scheduled to undergo speech therapy 6 months preoperatively, and group II included 19 patients who did not receive preoperative speech therapy. Both groups underwent speech therapy for 6 months postoperatively. Evaluation was carried out through auditory perceptual assessment (APA) including the type and degree of open nasality, consonant precision, compensatory articulatory mechanisms (glottal articulation and pharyngealization of fricatives), audible nasal emission of air, and overall intelligibility of speech. All these elements are graded along a five-point scale in which 0 is normal and 4 is severe affection. Documentation of APA is performed by high fidelity speech and voice audio recording and endoscopy. Formal speech intelligibility testing was carried out using the Arabic Speech Intelligibility test, which is designed to provide an estimation of the overall speech intelligibility of children by providing a total score in percentage. Nasometry was performed for all patients using a Kay nasometer, which provides the ‘nasalance score’.
On comparing the APA assessment of group I after 6 months of speech therapy postoperatively with the preoperative data, a highly significant decrease with regard to all parameters was revealed; however, in group II, the same comparison revealed a highly significant decrease as regards the degree of open nasality and nasal emission of air and a significant difference in terms of glottal articulation, pharyngealization of fricatives, and overall speech intelligibility. On comparing the two groups postoperatively, a significant difference in glottal articulation, pharyngealization of fricatives, and overall speech intelligibility, being more improved in group I, was revealed. Nasometry showed a significant difference between the postoperative results after speech therapy compared with the preoperative results, with a nonsignificant difference between the two groups postoperatively. In group I, the results of the Arabic Speech Intelligibility test showed a highly significant decrease in the number of patients with unintelligible speech and poor speech intelligibility, a significant decrease in number of patients with fair speech intelligibility, and a highly significant increase in the number of patients with good and excellent speech intelligibility. In group II, there was a significant decrease in the number of patients with unintelligible speech and poor speech intelligibility and a significant increase in the number of patients with fair, good, and excellent speech intelligibility.
Conclusion and recommendations
Speech therapy before surgery for residual velopharyngeal insufficiency can improve the results of postoperative therapy, with a better speech intelligibility outcome. Therefore, it is recommended to schedule a speech therapy program before secondary repair of the velopharyngeal valve in order to attain better speech intelligibility.
Derijcke A, Eerens A, Carels C. The incidence of oral clefts: a review. Br J Oral Maxillofac Surg 1996;34:488–494.
Harding A, Grunwell P. Characteristics of cleft palate speech. Eur J Disord Commun 1996;31:331–357.
Rosanowski F, Eysholdt U. Phoniatric aspects in cleft lip patients. Facial Plast Surg 2002;18:197–203.
Kotby MN. Rehabilitation of the communicatively handicapped. Presented at the 16th Pan Arab Medical Congress, 1980. pp. 1–3.
Kent RD. Speech intelligibility. In: Yoder DE, Kent RD, editors. Decision making in speech language pathology. Philadelphia:Decker; 1988. pp. 140–143.
Lower M. Communications and speech intelligibility. Southampton, UK:University of Southampton, Highfield; 2000.
Van Lierde KM, Claeys S, De Bodt M, Van Cauwenberge P. Vocal quality characteristics in children with cleft palate: a multiparameter approach. J Voice 2004;18:354–362.
Chapman KL, Tecco Graham K, Gooch J, Visconti C. Conversational skills of preschool and school-age children with cleft lip and palate. Cleft Palate Craniofac J 1998;35:503–516.
Millard T, Richman LC. Different cleft conditions, facial appearance and speech: relationship to psychological variables. Cleft Palate Craniofac J 2001;38:68–75.
Van Lierde KM, De Bodt M, Van Borsel J, Wuyts FL, Van Cauwenberge P. Effect of cleft type on overall speech intelligibility and resonance. Folia Phoniatr Logop 2002;54:158–168.
Kamel E. Validity of some diagnostic procedures of velopharyngeal valve incompetence [Unpublished MD Thesis]. Phoniatric Unit, Faculty of Medicine, Ain Shams University, 1995.
Whitehill TL. Assessing intelligibility in speakers with cleft palate: a critical review of the literature. Cleft Palate Craniofac J 2002;39:50–58.
Kummer AW. Cleft palate and craniofacial anomalies: the effects on speech and resonance. 2nd ed. New Albany, NY:Delmar Cengage Learning; 2008.
Kotby N, Abdel Haleem EK, Hegazi M, Safe I, Zaki M. Aspects of assessment and management of velopharyngeal dysfunction in developing countries. Folia Phoniatr Logop 1997;49(3–4): 139–146.
Kotby MN, Khairy A, Barakah M, El-Rifaie N, E-Shobary A. Language testing of Arabic speaking children. Proceedings of the XXIII World Congress of the International Association of Logopedics and Phoniatrics, Cairo, 1995; pp. 6–10.
Kotby MN, Bassiouny S, El-Zomor M, Mohsen E. Standardization of an articulation test. Proceedings of the 9th Annual Ain Shams Medical Congress, March 1986.
Abdel Hamid A, Bassiouny S, Hegazi M, Saber A, Nassar G, Ibrahim A. Development of Arabic speech intelligibility test for children. [Unpublished MD Thesis]. Unit of Phoniatrics, Faculty of Medicine, Ain Shams University, 2010.
Terman L, Mernil M. Stanford Binnet Intelligence Scale. Manual of the 3rd revision form L-M. Boston:Houghton Mifflin; 1961.
Golding-Kushner KJ. Therapy techniques for cleft palate speech and related disorders. San Diego, CA:Singular; 2001.
Peterson-Falzone S, Trost-Cardamone J, Karnell M, Hardin-Jones M. The clinician guide to treating cleft palate speech. St Louis, MO:Mosby; 2006.
De Serres LM, Deleyiannis FW, Eblen LE, Gruss JS, Richardson MA, Sie KC. Results with sphincter pharyngoplasty and pharyngeal flap. Int J Pediatr Otorhinolaryngol 1999;48:17–25.
Armour A, Fischbach S, Klaiman P, Fisher DM. Does velopharyngeal closure pattern affect the success of pharyngeal flap pharyngoplasty? Plast Reconstr Surg 2005;115:45–52.
Middag C, Van Nuffelen G, Martens J, De Bodt M. Objective intelligibility assessment of pathological speakers, In 11th International Conference on Spoken Language Processing, 25–28 September 2008. Brisbane, Australia, 2008. pp. 1175–1178.
Kent RD, Miolo G, Bloedel S. The intelligibility of children speech: a review of evaluation procedures. Am J Speech Lang Pathol 1994;3:81–95.
Bernthal JE, Bankson NW. Articulation and phonological disorders. 5th ed. Boston:Pearson/Allyn & Bacon; 2004.
Sell D. Issues in perceptual speech analysis in cleft palate and related disorders: a review. Int J Lang Commun Disord 2005;40:103–121.
Morris H, Ozanne A. Phonetic, phonological, and language skills of children with a cleft palate. Cleft Palate Craniofac J 2003;40:460–470.
McWilliams BJ, Morris HL, Shelton RL. Disorders of phonation and resonance. In: McWilliams BJ, Morris HL, Shelton RL, editors. Cleft palate speech. Philadelphia:BC Decker;1990. pp. 247–268.
Whitehill TL, Chun JC. Intelligibility and acceptability of speakers with cleft palate. In: Windsor F, Kelly ML, Hewlett N, editors. Investigations in clinical phonetics and linguistics. Mahwah, NJ:Lawrence Erlbaum Associates; 2002. pp. 405–415.
Kummer A, Lee L. Evaluation and treatment of resonance disorders. Lang Speech Hear Serv Sch 1996;27:271–281.
Amer AM, Bassiouny SE, Aboul-Saad TA, El-Barbary AS. Selection criteria for managing residual velopharyngeal valve insufficiency following repaired cleft palate patients. [Unpublished MD Thesis]. Faculty of Medicine, Ain Shams University, 2011.
Scherer N, Chapman M, Hardin-Jones M, D’Antonio L. Early assessment and intervention for children with cleft palate. San Diego, California, USA: Presentation at ASHA Convention, November 18–20; 2005.
Riski J 2007 Managing speech disorders: How to develop your non-instrumental clinical skills for assessing velopharyngeal function. Available at: http://www.choa.org [Accessed 12 September 2012].
Maegawa J, Sells RK, David DJ. Speech changes after maxillary advancement in 40 cleft lip and palate patients. J Craniofac Surg 1998;9:177–182 discussion 183–184.
Hardin-Jones Mary, Kathy L. The impact of early intervention on speech and lexical development for toddlers with cleft palate: a retrospective look at outcome. Lang Speech Hear Serv Sch 2008;39:89–96.
Ysunza-Rivera A, Pamplona-Ferreira MC, Toledo-Cortina E. Changes in valvular movements of the velopharyngeal sphincter after speech therapy in children with cleft palate. A videonasopharyngoscopic and videofluoroscopic study of multiple incidence [article in Spanish]. Bol Med Hosp Infant Mex 1991;48:490–501.
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Ghandour, H.H., Kaddah, FA., Abdelhamid, A. et al. Effects of preoperative speech therapy on the speech intelligibility of patients with velopharyngeal incompetence. Egypt J Otolaryngol 29, 269–276 (2013). https://doi.org/10.7123/01.EJO.0000429576.72335.5f
- speech intelligibility
- speech therapy
- velopharyngeal insufficiency