Speech characteristics after palatal closure in subjects with isolated clefts : an exploration in Uganda

Cleft lip and/or palate (CL/P) is a congenital craniofacial defect that arises on average in 1.7 per 1000 live births. This anomaly causes atypical facial appearance, hearing problems, malocclusions and speech disorders. Outcomes in terms of speech are influenced by timing of surgical cleft closure. In the Comprehensive Rehabilitation Services in Uganda (CoRSU) hospital, closure of the entire cleft during a single surgery prior to the age of 6 months is preferred in view of reducing default rates for second surgery and decreasing risks for malnutrition and death. However, some patients arrive the first time at the hospital in later childhood, youth or adulthood. No information about satisfaction and speech outcome was yet available for these Ugandan patients. Moreover, only few, if any studies systematically assessed satisfaction and speech following similar surgical timing protocols. Therefore, in view of searching for the optimal surgical treatment for patients with CL/P, the general aim of the current doctoral thesis was to verify satisfaction and speech in Ugandan patients with CL/P repaired in CoRSU by one experienced surgeon using the Sommerlad technique for palatal closure. In view of clinics and further research, normative nasalance values were first obtained in Ugandan English-speaking males and females (age: 2;7 to 13;5 years) without craniofacial anomalies. No significant age and gender differences were observed. Second, parental satisfaction was studied in Ugandan children with unilateral or bilateral cleft lip and palate (CLP) following synchronous lip and palatal closure. Overall high levels of satisfaction were noted for appearance of lip, nose and face, despite lower satisfaction levels for teeth appearance and speech. Comparison with an age- and gender-matched non-cleft control group revealed significant higher parental dissatisfaction for speech and appearance of teeth and nose in Ugandan patients with CLP. Third, articulation and resonance characteristics of Ugandan patients with early synchronous closure of C(L)P (≤ 6 months) were assessed. Comparison with an age- and gender-matched non-cleft control group revealed various deviations from normal speech development. The Ugandan CP group showed significantly smaller consonant inventories as well as significantly more phonetic disorders, phonological processes and nasal emission/turbulence compared to the control group. In addition, Ugandan patients with C(L)P were compared to a Belgian CP group (matched for cleft type, age and gender) who underwent palatal repair after the age of 6 months. A Ugandan and Belgian age- and gender-matched non-cleft control group was included to control for language, culture and other environmental factors. Comparison of the Ugandan and Belgian CP group revealed at least similar articulation and resonance characteristics. No significant group differences were obtained for perceptual evaluation of resonance, mean nasalance values of oral speech samples, consonant inventories and most phonetic errors and phonological processes. However, the Belgian CP group showed significantly more distortions due to higher occurrence frequencies for (inter)dental articulation of apico-alveolar consonants. Finally, articulation and resonance characteristics as well as patients’ satisfaction with speech were verified in Ugandan patients following delayed one-stage soft and hard palatal closure (≥ 8 years). Comparison with an age- and gender-matched non-cleft control group revealed overall low satisfaction with speech and severely disordered articulation and resonance. The patient group showed significantly smaller consonant inventories, more phonetic and phonological disorders, more hypernasality and nasal emission/turbulence as well as higher mean nasalance values for oral and oronasal speech samples compared to the control group. When findings of the current doctoral thesis are placed within a broader framework, early closure of the entire cleft during a single surgery seems to be an appropriate surgical timing protocol for resource-poor countries. However, prior to application in northern countries, more information on maxillofacial growth disturbances is required. Furthermore, when youngsters and adults present with untreated clefts, delayed cleft repair might be of value, although speech outcomes are poor

Oral strength in subjects with unilateral cleft lip and palate

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Voice symptoms and risk factors for developing voice disorders in future musical actors

Musical theater students follow an intensive program of singing, acting and physical excercises (dancing) and are expected to participate in long rehearsals and full performances. As they are absolutely depending on their vocal quality and vocal capacities for their studies and their future profession, an optimal voice coaching is very important. The purpose of this study was to determine the voice quality, voice symptoms and the risk factors for developing voice problems in future elite vocal performers (musical theater performers). Thirty-one Musical students (7 men and 24 women) with a mean age of 20 years participated to the study. To determine the objective voice quality aerodynamic measurements, voice range profile, acoustic analysis and Dysphonia Severity Index were used. To inventory the voice symptoms and the risk factors for developing voice disorders the Dutch version of the checklists (De Bodt et al. 2008) of Russel et al. (2000) were used. The questionnaires investigate the presence and the frequency (never, daily, weekly, monthly) of voice symptoms and risk factors (vocal abuse, vocal misuse) as reported by the subjects. Psychosocial impact of a voice disorder was investigated using the the Voice Handicap Index and Singing Voice Handicap Index. The mean DSI in male and female Musical theater students was respectively 3.9 and 5.6, both corresponding with an overall good vocal quality. The results of the VHI showed no important psychosocial impact on the speaking voice. Despite the overall good vocal quality, more than 40% experienced voice symptoms on a regular basis. Vocal misuse and abuse was also frequently reported. Videolaryngostroboscopy revealed a high presence of organic and functional voice disorders. Note: The objective vocal quality in this group was presented in a poster at the voice conference in Philadelphia in 2015. This presentation focuses on new data regarding the symptoms and risk factors reported by the subjects

Spraakkarakteristieken na palatoplastiek bij Oegandese schisispatiënten

Het tijdstip waarop de chirurgische sluiting van de gespleten structuren bij schisispatiënten wordt uitgevoerd, is nog steeds controversieel. Hoewel sommigen een vroege palatale sluiting aanraden om een betere spraak te bewerkstelligen, waarschuwen anderen voor mogelijke verstoringen van de maxillofaciale groei. Desondanks gaat in ontwikkelingslanden de voorkeur uit naar een simultane sluiting van de lip en het verhemelte op een zeer jonge leeftijd, omwille van verschillende redenen zoals het risico op malnutritie en sterven. Het doel van deze studie bestond bijgevolg uit het onderzoeken van de nasale resonantie en articulatie bij Oegandese patiënten met een (cheilognato)palatoschisis na een chirurgische sluiting voor de leeftijd van zes maanden. Vijftien Oegandese patiënten met (cheilognato)palatoschisis (3 jongens, 12 meisjes; mediane leeftijd 4;8 jaar) waarbij een simultane sluiting van de schisis werd uitgevoerd op een gemiddelde leeftijd van 3.5 maanden, werden opgenomen in deze studie. Een statistische vergelijking werd gemaakt met een controlegroep bestaande uit 15 normaalontwikkelende Oegandese kinderen zonder schisis gematched volgends geslacht en leeftijd (mediane leeftijd: 4.10 jaar). Subjectief (hypernasaliteitstest en nasale emissietest van Bzoch) en objectief (nasometrie) onderzoek van de nasale resonantie werd uitgevoerd, evenals een articulatieonderzoek (Photo Articulation Test 3). Een fonetisch inventaris werd opgesteld en de fonetische en fonologische articulatiekenmerken werden geanalyseerd. Het merendeel van de Oegandese patiënten met (cheilognato)palatoschisis vertoonde een aanvaardbare nasale resonantie. Desondanks kwamen bij deze patiënten meer fonetische (vb. glottale plosief, faryngale fricatief) en fonologische (vb. backing) articulatieproblemen voor in vergelijking met de normaalontwikkelende Oegandese kinderen. Voorzichtigheid is echter geboden bij de interpretatie van deze resultaten, gezien het beperkt aantal proefpersonen

Spraakkarakteristieken na palatoplastiek bij Oegandese schisispatiënten

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