Orofacial clefts are rare congenital anomalies of the upper aerodigestive tube. Approximately 30 children are born with this disorder in Slovenia every year. The important functions of the child are mainly affected by the cleft palate. Knowledge of the relationship between hearing and speech-language development in children with clefts is crucial for successful planning of speech therapy activities in the field of prevention and rehabilitation.
In the theoretical part of the master's thesis we described the anatomy and development of the oral cavity and the ear. We described the types of clefts in the orofacial area, including their epidemiology and aetiology. The functional consequences of orofacial clefts are detailed, focusing on changes in speech and hearing. We also presented the possible causes of speech sound disorders in children with clefts.
In the empirical part, we present the protocol we used for the purpose of conducting the study. In the study, we used the caval non-experimental method and the quantitative research approach for statistical data processing. We wanted to investigate the prevalence of hearing impairment in children with cleft palate (palatoschisis) and unilateral or bilateral cleft lip, mandibular ridge and palate (cheilognathopalatoschisis unilateralis/bilateralis) managed at the ENT and CFK Clinic in Ljubljana. Data were taken from medical records (foniatric, audiology and speech therapy reports). We examined how many children with these orofacial clefts have hearing impairment, how the hearing status of children with clefts is related to speech-language development, hypernasality, compensatory articulation and speech sound disorders in speech.
We included children with cleft palate (30 children) and children with cleft lip, jaw ridge and palate (16 children) born in three consecutive years (2015-2017). We therefore obtained data for 46 children. We found that the presence of a cleft in the orofacial region in our study negatively affected hearing status before palatoplasty in more than two-thirds of cases, meaning that more than one-third of the subjects with a cleft were hearing impaired. Based on the data obtained, we found that almost three quarters of parents of children with clefts and concomitant hearing impairment did not notice that their child was hearing impaired. Hearing impairment was identified by the ENT and CFK Clinic instead of the parents, when a hearing test was also performed at the check-up. The results of the study showed that there was no statistically significant difference between the groups of children with long-term hearing impairment (over 6 months) and without long-term hearing impairment on speech intelligibility (p = 0.494). We also found no statistically significant difference between the two groups of subjects on vocabulary size (p = 0. 867), the presence of a speech-language delay (p = 0.309), the presence of compensatory articulation in speech (p = 0.743) and the presence of speech sound disorders (p = 0.813). We found that hypernasality was present in more than half of the subjects before the start of speech therapy in children with orofacial clefts.
We were also interested in how the group of subjects with syndromes differed from the group without syndromes with regard to the presence of long-term hearing impairment, vocabulary size, speech-language delay, hypernasality, compensatory articulation and speech sound disorders. The results showed that there was no statistically significant difference between the two groups with regard to the prevalence of permanent hearing impairment (p = 0.132). We found that the group of children with syndromes and cleft palate had a reduced vocabulary, frequently present speech-language delay, hypernasality, compensatory articulation and speech sound disorders.
We were limited in our study by the number of children with cleft palate (palatoschisis) and unilateral or bilateral cleft lip, mandibular ridge and palate (cheilognathopalatoschisis unilateralis/bilateralis) born in three consecutive years, so the sample size of our study is relatively small. It would be interesting to repeat a similar study on a larger sample as well as follow the children in the future and monitor their learning and final academic performance. However, the results of the study confirmed that the treatment protocol for children with cleft palate is correct, as regular hearing monitoring and intervention in the event of hearing impairment is the only way to enable a child with cleft palate to develop as normally as possible. Speech therapy for a child with cleft palate should preferably be provided before the cleft palate surgery, and especially after the cleft palate surgery. Thus, the speech therapist, together with active parents, is crucial for the child's speech and general development.
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