Cleft Summit 2022: The Impact of a Unified Voice.

Objective: The inaugural Cleft Summit aimed to unite experts and foster interdisciplinary collaboration, seeking a collective understanding of velopharyngeal insufficiency (VPI) management.

Design: An interactive debate and conversation between a multidisciplinary cleft care team on VPI management.

Setting: A two-hour discussion within a four-day comprehensive cleft care workshop (CCCW).

Ankyloglossia: Typical Characteristics, Effects on Function, and Clinical Implications.

The purpose of this article is to (1) define the diagnostic characteristics of ankyloglossia, (2) identify potential problems associated with ankyloglossia, and (3) discuss treatment options, when treatment is appropriate. This article is based on a review of the literature, including recent systematic reviews, and the author's experience as a cleft and orofacial specialist. Ankyloglossia is a common congenital condition characterized by an anterior attachment of the lingual frenulum on the tongue.

Secretion Bubbling as the Sound Mechanism for Nasal Rustle: A Perceptual Study.

Purpose: Secretion bubbling on the superior aspect of the velopharyngeal (VP) valve typically occurs with a small VP opening during production of oral pressure consonants. The use of high-speed nasopharyngoscopy has shown correlation between the bubbling frequency and the acoustics captured with the nasal microphone of the nasometer. The purpose of this study was to investigate if the sound generated by the bubbling process is perceived as nasal rustle (also known as nasal turbulence).

Nasalance Scores for Normal Speakers of American English Obtained by the Nasometer II Using the MacKay-Kummer SNAP-R Test.

Objective: To establish nasalance score norms for adolescent and young adult native speakers of American English and also determine age-group and gender differences using the Simplified Nasometric Assessment Procedures (SNAP) Test-R and Nasometer II.

Design: Prospective study using a randomly selected sample of participants.

Setting: Greater Cincinnati area and Miami University of Ohio.

Assessment of Intelligibility in Children with Velopharyngeal Insufficiency: The Relationship between Intelligibility in Context Scale and Experimental Measures.

Purpose: The purpose of this study was to investigate the clinical application of the Intelligibility in Context Scale (ICS) instrument in children with velopharyngeal insufficiency (VPI). This study investigated the relationship between clinical speech outcomes and parental reports of speech intelligibility across various communicative partners.

Methods: The ICS was completed by the parents of 20 English-speaking children aged 4-12 years diagnosed with VPI.

Nasal rustle: The retrospective and prospective investigation of effects of bubbling of secretions on speech.

Objective: "Nasal rustle" is a type of nasal emission associated with a small velopharyngeal (VP) gap and distracting loud noise. Currently, the mechanisms behind noise generation are unclear. In this study, we use a combination of retrospective and prospective data to test the hypotheses that bubbling of secretions could be a source of audible noise.

Optimal Outcomes Reporting (OOR): A New Value-Based Metric for Outcome Reporting Following Cleft Palate Repair.

Objective: Palatoplasty outcome measurements vary widely among institutions. A standardized outcome metric would help provide quality benchmarks.

Design: Retrospective review of primary palatoplasty patients from 2007 to 2013.

Nasometric evaluation of resonance disorders: A norm study In Turkish.

Objective: The aim of this study was to adapt the Simplified Nasometric Assessment Procedures-Revised (SNAP-R) [1] to Turkish, gather norms from Turkish speakers, and test the sensitivity and specificity of the adapted test. Finally, this study was designed to determine if there are any differences in average nasalance scores due to age, gender, and vowel content of the passage.

Methods: 240 children without any known speech, language or hearing disorders and 40 children with cleft palate participated in the study.

Protocols for Reporting Speech Outcomes following Palatoplasty or Velopharyngeal Surgery: A Literature Review.

Background: To determine best practices, surgeons who perform cleft palate surgery or surgery for velopharyngeal insufficiency need to be able to compare their outcomes in normalizing the velopharyngeal valve.

Methods: We conducted a comprehensive review of articles that reported speech/resonance outcomes following palatoplasty or surgery for velopharyngeal insufficiency. We analyzed protocols that were used and how the results were reported.

Sustainable Cleft Care Through Education: The First Simulation-Based Comprehensive Workshop in the Middle East and North Africa Region.

Objective: To describe the conduct of the first multidisciplinary simulation-based workshop in the Middle East/North Africa region and evaluate participant satisfaction.

Design: Cross-sectional survey-based evaluation.

Setting: Educational comprehensive multidisciplinary simulation-based cleft care workshop.

Effect of One-Stage versus Two-Stage Palatoplasty on Hypernasality and Fistula Formation in Children with Complete Unilateral Cleft Lip and Palate: A Randomized Controlled Trial.

Background: Is one-stage or two-stage palatoplasty more effective for preventing fistula formation and hypernasality in patients with complete unilateral cleft lip and palate?

Methods: This parallel blocked randomized controlled trial included 100 patients with nonsyndromic complete unilateral cleft lip and palate with a repaired cleft lip, divided into two equal groups. Group A had one-stage palatoplasty patients at age 12 to 13 months while group B had two-stage palatoplasty patients with soft palatoplasty at age 12 to 13 months and hard palatoplasty at age 24 to 25 months. Presence of a fistula was tested clinically at 3 years and speech was tested using nasometry and perceptual analyses at 6 years.

Placement of an antibiotic oral pack on the hard palate after primary cleft palatoplasty: a randomized controlled trial into the effect on fistula rates.

Objective: The objective of this study is to determine whether placement of an antibiotic oral pack on the hard palate reduces fistula rates after primary cleft palatoplasty.

Subjects And Methods: This study was a parallel blocked randomized controlled trial. The study consisted of two groups of 100 patients each with non-syndromic unilateral complete cleft lip, alveolus, and hard and soft palate that underwent primary palatoplasty.

A Pediatrician's Guide to Communication Disorders Secondary to Cleft Lip/Palate.

This article describes how different types of clefts affect the child's function and, in particular, the child's communication abilities. This article also describes the evaluation process and various options for the treatment of affected speech. Because these children have many complicated needs over their entire growth period, it is important that they are referred by the pediatrician to a cleft palate/craniofacial team for the best care and best ultimate outcomes.

Validity of test stimuli for nasalance measurement in speakers of Jordanian Arabic.

Objective: The objective of the study was to establish the validity of passages for measuring nasalance of Jordanian speakers of Arabic.

Design: Two Arabic text passages were constructed; the Spring Passage is devoid of nasal consonants and the Home Passage contains both oral and nasal consonants. Nasalance was measured for participants while reciting each passage three times.

Evaluation of Speech and Resonance for Children with Craniofacial Anomalies.

Children with craniofacial anomalies often demonstrate disorders of speech and/or resonance. Anomalies that affect speech and resonance are most commonly caused by clefts of the primary palate and secondary palate. This article discusses how speech-language pathologists evaluate the effects of dental and occlusal anomalies on speech production and the effects of velopharyngeal insufficiency on speech sound production and resonance.

Clinical Practice Guideline: Otitis Media with Effusion Executive Summary (Update).

The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the updated "Clinical Practice Guideline: Otitis Media with Effusion." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 18 recommendations developed emphasize diagnostic accuracy, identification of children who are most susceptible to developmental sequelae from otitis media with effusion, and education of clinicians and patients regarding the favorable natural history of most otitis media with effusion and the lack of efficacy for medical therapy (eg, steroids, antihistamines, decongestants).

Clinical Practice Guideline: Otitis Media with Effusion (Update).

Objective: This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME.

Purpose: The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice.

Incidence of velopharyngeal insufficiency and oronasal fistulae after cleft palate repair: A retrospective study of children referred to Isfahan Cleft Care Team between 2005 and 2009.

Objective: The purpose of this study is to determine the incidence of velopharyngeal insufficiency (VPI) and fistulae development in patients seen by the Isfahan Cleft Care Team and also determine the association of gender, age at repair, and cleft type with the incidence of each.

Methods: This retrospective study was completed using records of patients referred to Isfahan Cleft Care Team between 2005 and 2009. One hundred thirty-one patients with a history of cleft palate (with or without cleft lip) who had undergone primary palate repair and were at least 4 years of age at the time of the speech evaluation were included in this review.

Non-cleft causes of velopharyngeal dysfunction: implications for treatment.

Although a history of cleft palate is the most common cause of velopharyngeal dysfunction (VPD), there are other disorders that can also cause hypernasality and/or nasal emission. These include other structural anomalies of the velopharyngeal valve (velopharyngeal insufficiency), neurophysiological disorders that result in inadequate velopharyngeal movement (velopharyngeal incompetence), and even faulty articulation placement in the pharynx (velopharyngeal mislearning). Unfortunately, individuals with non-cleft causes of hypernasality and/or nasal emission do not typically present at a cleft palate/craniofacial center where there are professionals who specialize in the evaluation and treatment of these disorders.

Speech evaluation for patients with cleft palate.

Children with cleft palate are at risk for speech problems, particularly those caused by velopharyngeal insufficiency. There may be an additional risk of speech problems caused by malocclusion. This article describes the speech evaluation for children with cleft palate and how the results of the evaluation are used to make treatment decisions.

Ethics in the practice of speech-language pathology in health care settings.

ETHICS refers to a moral philosophy or a set of moral principles that determine appropriate behavior in a society. Medical ethics includes a set of specific values that are considered in determining appropriate conduct in the practice of medicine or health care. Because the practice of medicine and medical speech-language pathology affects the health, well-being, and quality of life of individuals served, adherence to a code of ethical conduct is critically important in the health care environment.

Speech therapy for errors secondary to cleft palate and velopharyngeal dysfunction.

Individuals with a history of cleft lip/palate or velopharyngeal dysfunction may demonstrate any combination of speech sound errors, hypernasality, and nasal emission. Speech sound distortion can also occur due to other structural anomalies, including malocclusion. Whenever there are structural anomalies, speech can be affected by obligatory distortions or compensatory errors.

Perceptual assessment of resonance and velopharyngeal function.

Cleft lip is an anomaly that primarily affects aesthetics, whereas cleft palate is an anomaly that primarily affects function, particularly speech. In fact, the main reason for repairing the palate is to provide adequate structure and function for normal speech production. Despite undergoing palatoplasty surgery, 20 to 30% of children with repaired cleft palate will demonstrate some degree of velopharyngeal dysfunction, resulting in abnormal speech.

Types and causes of velopharyngeal dysfunction.

The velopharyngeal valve is responsible for production of oral speech sounds. There are three components to normal velopharyngeal function: anatomy, physiology, and learning. velopharyngeal dysfunction (VPD) is a condition where the velopharyngeal valve does not close consistently and completely during the production of oral sounds.

Disorders of resonance and airflow secondary to cleft palate and/or velopharyngeal dysfunction.

The purpose of this article is to help the reader understand what contributes to normal resonance for speech production. In addition, the reader will learn about the types of resonance disorders and their characteristics. The causes of resonance disorders will be described with a guideline on how they should be treated.