The long-term speech outcome in Flemish young adults after two different types of palatoplasty.

Objective: The success of cleft palate surgery is specifically determined by the subsequent speech characteristics. There are several types of surgical techniques to repair the palate. The surgeon chooses his or her own technique according to the principles (s)he have established based on experience. The main purpose of this study is to determine and to compare the long-term speech outcome (18 years after surgery) regarding overall intelligibility, articulation, resonance, and voice after one-stage Wardill-Kilner palatoplasty or two-stage Furlow palatoplasty. The authors hypothesized that a decreased overall intelligibility, more compensatory articulation disorders, higher nasalance values and more nasality disorders would occur in the two-stage Furlow palatoplasty. Moreover, an increased risk for dysphonic symptoms, caused by the more intensive vocal tract activities, were expected in subjects with higher nasalance scores. An additional objective of this study was to compare the speech and voice characteristics with the age related normative data. Significant differences between the resonance and voice characteristics of the two techniques of palatoplasty and the normative data were hypothesized.

Methods: Objective as well as subjective assessment techniques were used. The evaluation of the articulation included a phonetic inventory and a relational analysis in which the consonant and vowel productions were compared with target productions and analyzed for error types at the segmental level. The speech samples were perceptually judged for intelligibility and nasality. The Nasometer was used for the objective measurement of the nasalance values. The assessment of the voice included a perceptual evaluation and a determination of the Dysphonia Severity Index.

Results: The subjects who received a two-stage Furlow palatoplasty showed statistically more hypernasality and higher nasalance scores in comparison with the one-stage Wardill-Kilner palatoplasty. No major differences regarding articulation and voice characteristics were found. As expected, significant differences were found between the speech intelligibility and resonance characteristics in subjects who received a palatoplasty and the normative data.

Conclusion: Since the subjects who received a one-stage Wardill-Kilner palatoplasty had a significantly better speech outcome it was decided in the craniofacial team of the University Hospital of Ghent that a two-stage palatoplasty would no longer be performed.