ABSTRACT
The presence of a palatal cleft at birth should not prevent good speech production
in most children provided they have (1) appropriate surgical intervention to close
the palate at or around the child's first birthday, (2) careful monitoring of speech
development throughout childhood, (3) speech therapy when needed, and (4) secondary
surgical or speech-prosthetic intervention when needed. When managed carefully by
an experienced, well-prepared multidisciplinary team that applies the criteria listed
above, ~70% of children with nonsyndromic palatal clefts will have no significant
difficulties with speech intelligibility or speech quality due to velopharyngeal insufficiency
by the time they enter elementary school. Speech assessment is the first step toward
comprehensive team management of children with cleft palate. The purpose of this chapter
is to describe the use of instrumentation in the evaluation of speech of children
with palatal clefts, within the context of a multidisciplinary team. The focus of
this article is on instruments that are used to supplement the perceptual assessment
to document current speech status and plan management strategies.
KEYWORDS
Cleft palate - velopharyngeal insufficiency - nasometry - speech videofluoroscopy
- nasendoscopy - nasopharyngoscopy
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1 After 1133 nasometry tests documented with perceptual ratings of nasal resonance
by the author, indices of predictive utility of nasalance measures were as follows:
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Michael P KarnellPh.D.
Department of Otolaryngology-Head and Neck Surgery, Department of Communication Sciences
and Disorders, University of Iowa
200 Hawkins Drive, Iowa City, IA 52242-1602
Email: michael-karnell@uiowa.edu
