A retrospective study of hearing, speech and language function in childrenwith clefts following palatoplasty and veloplasty procedures at 18-24 months of age

Many cleft palate teams currently schedule palatoplasty and veloplasty with in the child's first year of life. At Hannover Medical School, palatoplasty and veloplasty are performed at similar to 18-24 months of age. It was que stioned which speech and language outcome was achieved and whether it may b e influenced by: (1) type and extent of the clefts; (2) velopharyngeal inad equacy; and (3) hearing disorders. A retrospective evaluation of data colle cted from 1985 to 1993 was performed summarizing receptive and expressive s peech and language skills of 370 children aged 4.5 years. Cleft types were unilateral cleft lip and palate (UCLP, 30.0%), bilateral cleft lip and pala te (BCLP, 28.7%), cleft hard and soft palate (CP, 21.6%), cleft soft palate (cleft velum, CV, 10.8%), cleft lip and alveolus (CLA, 5.8%) and submucous clefts (SUB, 3.2%). n = 86 had constant normal hearing, and n = 284 had co nductive hearing loss > 20 dB (500-4000 Hz). Severe developmental phonology errors were found in 30-50% of children with repaired cleft palate and in less than 8% of patients with CLA and SUB. Posterior compensatory misarticu lation was below 15% in the groups UCLP, BCLP, CP, CV and SUB. Nasal resona nce and air emission was nearly normal in CLA; but was increased in 27% to 38% of the other cleft types. Children with conductive hearing loss had sig nificantly more and severely affected phonology, morphology, syntax, vocabu lary, language comprehension, and auditory perception than normal hearing c hildren. Findings indicated that speech and language function in CLP patien ts were predominantly related to the hearing status. (C) 1999 Elsevier Scie nce Ireland Ltd. All rights reserved.