Cleft Lip and Cleft Palate Speech Problems

What speech problems might children with cleft palate have?

A child with a cleft palate may have trouble with:

1.       Speech Sound Development

2.       Velopharyngeal Incompetence

3.       Hearing Loss

1.Speech Sound Development:

      Speech sound development begins in infancy and continues through a child's seventh or eighth year. Children's speech generally gets easier to under as they get older. Children born with a cleft palate may have a delay at the beginning of speech and development of speech sounds. In addition, children with a cleft palate may produce speech errors that are directly related to clefting. These are called compensatory speech errors 

The following is a guideline for the age at which your child is expected to use sounds in words :

2. Velopharyngeal Dysfunction

Velum during nasal breathing

Velum during speech

Velopharyngeal dysfunction (VPD) is a general term. It is used to describe different disorders of the velopharyngeal valve. These include:

Ø  Velopharyngeal insufficiency (VPI)

Ø  Velopharyngeal incompetence (VPI)

Ø  Velopharyngeal mislearning

Ø  Velopharyngeal Insufficiency:

         Velopharyngeal insufficiency is caused by abnormality of the soft palate which does not close tightly against the back of the throat, leaking to air coming out the nose ( characterized by hypernasality and/or nasal air emission) during the speech.

Ø    Velopharyngeal Incompetence:

              Velopharyngeal incompetence is caused by the poor movement of velopharyngeal structures due to a disorder or injury of the brain or cranial nerves.

Ø  Velopharyngeal Mislearning:

         Velopharyngeal mislearning  refers to a situation where the patient has normal anatomy, normal muscle, and nerve function, and can successfully seal off the back of the nose, but leaves the back of the nose open during the production of some speech sounds.

3. Hearing loss

         Children born with a cleft palate commonly experience middle ear problems and associated hearing loss. This happens because the muscles of the palate help in allowing air into the middle ear and also allowing drainage of secretions from the middle ear. When this process is interrupted, fluid can build up (otitis media) in the middle ear. This leads to temporary hearing loss, which is usually mild in severity. In addition to affecting hearing, fluid in the middle ear predisposes the child to frequent middle ear infections. This can require treatment with antibiotics. If left untreated, this can cause permanent hearing loss.