Instrumental Assessment of Velopharyngeal Closure for Speech

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: sensitivity = 0.85, specificity = 0.84, negative predictive power = 0.68, relative risk = 5.4.[18]