Investigating the Impact of Patient-Related Factors on Speech Outcomes at 5 Years of Age in Children With a Cleft Palate

• Published in: The Cleft palate-craniofacial journal 2023-12, Vol.60 (12), p.1578-1590
• Main Authors: Butterworth, Sophie, Fitzsimons, Kate J, Medina, Jibby, Britton, Lorraine, Van Eeden, Stephanie, Wahedally, Hussain, Park, Min Hae, van Der Muelen, Jan, Russell, Craig J H
• Format: Article
• Language: English
• Subjects: Birth defects; Speech
• ISSN: 1055-6656; 1545-1569
• DOI: 10.1177/10556656221110094

Objective To investigate the relationship between patient-related factors (sex, cleft type, cleft extent, and Robin Sequence [RS]) and speech outcome at 5 years of age for children born with a cleft palate ±  lip (CP ± L). Participants 3157 Children (1426 female:1731 male) with a nonsyndromic CP ± L, born between 2006 and 2014 in England, Wales, and Northern Ireland. Outcome Measure Perceptual speech analysis utilized the Cleft Audit Protocol for Speech–Augmented (CAPS-A) rating and UK National Speech Outcome Standards: Speech Standard 1 (SS1)—speech within the normal range, SS2a—no structurally related speech difficulties or history of speech surgery, and SS3—speech without significant cleft-related articulation difficulties. Results Odds of achieving SS1 were lower among boys (aOR 0.771 [CI 0.660-0.901]), those with clefts involving the lip and palate (vs palate only) (UCLP—aOR 0.719 [CI 0.591-0.875]; BCLP—aOR 0.360 [CI 0.279-0.463]), and clefts involving the hard palate (incomplete—aOR 0.701 [CI 0.540-0.909]; complete—aOR 0.393 [CI 0.308-0.501]). Similar relationships with these patient factors were observed for SS3. SS2 was affected by the extent of hard palate involvement (complete; aOR 0.449 [CI 0.348-0.580]). Although those with CP and RS were less likely to meet all 3 standards than those without RS, odds ratios were not significant when adjusting for sex and cleft extent. Conclusion Sex, cleft type, and extent of hard palate involvement have a significant impact on speech outcome at 5 years of age. Incorporating these factors into risk-adjustment models for service-level outcome reporting is recommended.