ANNALS OF IBADAN POSTGRADUATE MEDICINE
A.A. Olusanya1, A.I. Michael2, and O.I. Oketade1
The occurrence of cleft lip and palate anomaly can impact on an affected individual’s quality of life. Cleft of the palate particularly significantly affects the production of speech. This article aims to describe the speech errors following palatoplasty procedures observed from cleft centres within Nigeria. Ability to produce high pressure sounds, frequencies of speech errors and speech intelligibility were analysed from data collated from five cleft centres. The speech services in these centres were provided in partnership with Smile Train, a nongovernmental organization based in the United States of America. Glottal stop was the commonest speech error while the speech intelligibility was considered mild in the majority of cases. This report serves as a form of preliminary overview of the speech pattern of individuals with repaired cleft palate in our environment.
Keywords: Cleft palate, Speech outcome, Nigeria.
Dr. A.A. Olusanya
Dept. of Oral and Maxillofacial Surgery,
University College Hospital,
Cleft lip and or palate (CL/P) anomaly, the commonest craniofacial congenital anomaly, is an anomaly that can be seen, heard and felt. Its occurrence can, therefore, significantly impact an individual’s quality of life. Cleft of the palate especially poses two major challenges to the affected individual; feeding (particularly in the early phase of life) and speech. An affected individual can somewhat adapt to his/her the feeding challenges if the individual survives to adulthood but the speech difficulty remains unless an intervention is done. Speech is a universal means of communication and affectation of this ability can impair the social wellbeing of an affected individual such that integration among peers and into the society as a whole becomes a challenge.
Speech errors associated with individuals with CL/P can be categorized as errors of omission; when a challenging sound is skipped, substitution; when a challenging sound is replaced with a less challenging one such as ‘m’ sound for ‘p’ or ‘b’ sound and distortions; when some other sounds are made in place of challenging sounds such as a glottal or pharyngeal sound for challenging high pressure sound like ‘k’1. These errors have been known to persist in some individuals even after primary palatoplasty. This study aims to describe the type of speech errors observed in Nigerian individuals with repaired CL/P and compare findings with reports from other parts of the globe.
Data of individuals with repaired CL/P receiving sponsored speech therapy in various centres in Nigeria was pooled from February 2015 to May 2019. The sponsorship of the speech therapy services was provided by the centres’ partnership with Smile Train, a nongovernmental organization based in the United States of America and the data was pooled with their permission. Frequency distributions of the centres, number of individuals assessed for speech errors and their gender, type and extent of cleft anomaly, ability to make high pressure sounds /p/, /b/, /t/, /d/, / k/, /g/, /s/ and /f/, type of speech errors and speech intelligibility were collated and analyzed. The determination of speech errors and speech intelligibility were based on descriptions by Henningson2. For speech intelligibility: normal speech was regarded as speech that was always easy to understand by non-family members, mild speech impairment as speech that was occasionally hard to understand by non-family members, moderate speech impairment as speech that was often hard to understand by non-family members and severe speech impairment as speech that was hard to understand most of the time by non-family members.
The cleft anomalies were classified according to the classification by the American Cleft Palate-Craniofacial Association Classification3. The speech intelligibility was cross-tabulated against gender, the type of cleft, presence or absence of fistula and extent of the cleft. Pearson Chi-Square test was used when the expected cell count was adequate and the Fisher’s exact test was used when the expected cell count was less than 5 to test for statistical significance. This was set at p<0.05.