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Pediatric Otolaryngology

Longitudinal Speech Changes in Velopharyngeal Function in Submucous Cleft Palate

Tuesday, October 3, 2023
3:42 PM - 3:48 PM East Coast USA Time
Location: 207CD

    Presenting Author(s)

  • Soukaina Eljamri, BA

    Medical Student
    University of Pittsburgh School of Medicine
    Pittsburgh, PA, United States

    • Co-Author(s)

  • Randall J. Harley, MD, MS

    Medical Resident
    University of Pennsylvania
    Philadelphia, PA, United States

    • Senior Author(s)

  • Noel Jabbour, MD

    Associate Professor of Otolaryngology; Residency Program Director
    Department of Otolaryngology - Head and Neck Surgery, UPMC Pittsburgh
    Pittsburgh, PA, United States

Disclosure(s):
Noel Jabbour, MD: No relevant relationships to disclose.
Introduction: Velopharyngeal dysfunction (VPD) describes the inadequate closure of the soft palate and pharynx to separate the oral and nasal cavities. It is often repaired surgically to allow for normal speech development within a critical window. This study aims to evaluate changes in speech production in the setting of submucous cleft palate (SMCP) and VPD in children receiving Furlow Palatoplasty and those not undergoing surgery.

Methods: This is a retrospective analysis from a single tertiary academic center between 2002 and 2008, of children with a diagnosis of SMCP and VPD, and a follow-up period of at least 2 years. The primary outcome was speech evaluation using the validated Pittsburgh Weighted Speech Score (PWSS). The scoring guidelines are as follows: 1–2 = borderline competence, 3–6 = borderline incompetence, and >7 velopharyngeal incompetence. In our multilevel mixed-effects model, we examined the association between surgical correction and longitudinal speech score trajectories using the interaction between surgical status and time in study. We adjusted for age at diagnosis, sex, race, and SMCP severity.

Results: We included 204 children (mean [SD] age, 4.9 [3.1] years; 124 [60.8%] Male; 114 [55.9%] Furlow Palatoplasty). Our non-surgical group had a baseline PWSS of 14 (Intercept [β_0], 14.4; 95% Confidence Interval [95% CI], 12 to 16.7), which improved by close to one point each year (coefficient [β], -0.89; 95% CI, -1.14 to -0.64). Our model predicts that it takes eight years for speech scores to improve to < 7. Our surgical group had a postoperative baseline PWSS of 0.6 (β_0, 0.58; 95% CI, -1.85 to 3.01), which worsened slightly each year following surgical intervention (β, 0.23; 95% CI, 0.06 to 0.4). Our model predicts that it would take close to 30 years to reach a score in the VPD range.

Conclusions: We found that speech production can improve over time without surgical intervention, but would not be expected to do so before the critical window for speech development closes. While speech scores tend to increase slightly over time following Furlow palatoplasty, these would not be expected to increase into the abnormal range.