Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 5. Speech outcomes in 5-year-olds - consonant proficiency and errors

• Published in: Journal of plastic surgery and hand surgery Vol. 51; no. 1; pp. 38 - 51
• Main Authors: Willadsen, Elisabeth, Lohmander, Anette, Persson, Christina, Lundeborg, Inger, Alaluusua, Suvi, Aukner, Ragnhild, Bau, Anja, Boers, Maria, Bowden, Melanie, Davies, Julie, Emborg, Berit, Havstam, Christina, Hayden, Christine, Henningsson, Gunilla, Holmefjord, Anders, Hölttä, Elina, Kisling-Møller, Mia, Kjøll, Lillian, Lundberg, Maria, McAleer, Eilish, Nyberg, Jill, Paaso, Marjukka, Pedersen, Nina Helen, Rasmussen, Therese, Reisæter, Sigvor, Andersen, Helene Søgaard, Schöps, Antje, Tørdal, Inger-Beate, Semb, Gunvor
• Format: Journal Article
• Language: English
• Published: Sweden Taylor & Francis 01.01.2017
• Subjects: Articulation Disorders - etiology; Articulation Disorders - therapy; Child, Preschool; Cleft Lip - diagnosis; Cleft Lip - surgery; Cleft Palate - diagnosis; Cleft Palate - surgery; cleft speech characteristics; consonant proficiency; Female; Follow-Up Studies; Humans; Infant; Internationality; Male; Medicin och hälsovetenskap; Oto-rino-laryngologi; Otorhinolaryngology; Primary palatal repair; randomised clinical trial; Randomized Controlled Trials as Topic; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Recovery of Function; Speech Disorders - etiology; Speech Disorders - therapy; Speech Production Measurement; Speech Therapy - methods; Statistics, Nonparametric; Time Factors; Treatment Outcome; unilateral cleft lip and palate; cleft speech characteristics; consonant proficiency; unilateral cleft lip and palate; randomised clinical trial; Primary palatal repair
• ISSN: 2000-656X; 2000-6764; 2000-6764
• DOI: 10.1080/2000656X.2016.1254647

Background and aim: Normal articulation before school start is a main objective in cleft palate treatment. The aim was to investigate if differences exist in consonant proficiency at age 5 years between children with unilateral cleft lip and palate (UCLP) randomised to different surgical protocols for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. Design: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Norway, Sweden, and the UK. Methods: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with non-syndromic UCLP. Speech audio- and video-recordings of 391 children (136 girls and 255 boys) were available and transcribed phonetically. The main outcome measure was Percent Consonants Correct (PCC) from blinded assessments. Results: In Trial 1, arm A showed statistically significant higher PCC scores (82%) than arm B (78%) (p = .045). No significant differences were found between prevalences in Trial 2, A: 79%, C: 82%; or Trial 3, A: 80%, D: 85%. Across all trials, girls achieved better PCC scores, excluding s-errors, than boys (91.0% and 87.5%, respectively) (p = .01). Conclusions: PCC scores were higher in arm A than B in Trial 1, whereas no differences were found between arms in Trials 2 or 3. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed. Trial registration: ISRCTN29932826.