Cleft Palate & Speech

Question 1

What are the etiologies of cleft palate?

Answer 1

• Genetics (explains 20% to 50% of cleft)
• external factors, gene/environmental interactions, external agents (smoking, alcohol, too much vitamin A, and drugs)
• maternal conditions (diabetes, obesity, and malnutrition).

Question 2

What is the importance of an SLP when an individual has a cleft palate?

Answer 2

Feeding and speech may be affected in individuals with cleft palate.

Palate repair, but still have habits, so go to speech therapy to rid of habits.

Question 3

Cleft palate errors in speech

Answer 3

nasal emission, glottal stop, pharyngeal stop, pharyngeal fricatives, pharyngeal affricates, nasal fricatives, mid-dorsum palatal stop

Question 4

Cleft palate and resonance

Answer 4

Hypernasality is common: too much sound resonating in the nasal cavity during speech, usually due to velopharyngeal dysfunction or an oronasal fistula.

Question 5

What is a submucous cleft palate?

Answer 5

A submucous cleft of the hard palate is defined as a bony defect in the midline or center of the bony palate. This can sometimes be felt as a notch or depression in the hard palate.

Question 6

What are some signs of a submucous cleft palate?

Answer 6

• Hypernasality
• Zona pellucida: a bluish tint to the tissue along the midline of the soft palate
• “Tenting” of the velum or inverted v, especially during phonation
• Bifid Uvula: 2 pendulums, a uvula with an indentation, or an underdeveloped uvula.

Question 7

What is a cleft palate?

Answer 7

An opening or split in the palate that occurs when developing facial structures in an unborn baby don’t close completely by 12 weeks.

A cleft palate can occur with or without a cleft lip.

Question 8

What is a cleft lip?

Answer 8

An opening or split in the upper lip that occurs when developing facial structures in an unborn baby don’t close completely

A cleft lip can occur with or without a cleft palate

Question 9

What type of cleft lip is this?

Answer 9

Unilateral incomplete cleft lip

Question 10

What kind of cleft lip is this?

Answer 10

Unilateral complete cleft lip

Question 11

What kind of cleft lip is this?

Answer 11

Bilateral complete cleft lip

Question 12

What condition is this?

Answer 12

Cleft palate

Question 13

What sounds do individuals with cleft palate not have trouble making?

Answer 13

Nasals: “m”, “n,” “-ng”

Question 14

What sounds can individuals with cleft palate usually make, even if not perfectly.

Answer 14

Low pressure sounds: glides and liquids, and
/w/, /r/, /l/, /j/, /h/

Question 15

What sounds can individuals with cleft palate not make?

Answer 15

High pressure sounds: Stops, fricatives, affricates
“p”, “b”, “t”, “d”, “k”, “g”, f, v, s, z, sh, ch, th, and dg

Question 16

Why can individuals with cleft palates not make high pressure sounds?

Answer 16

They cannot “close the door”
The velum needs to raise up, and the back and side pharyngeal walls must meet/seal with it.
This is not possible for individuals with cleft palates.

If the palate is open or short, it is not closing off the nasal cavity, and the air leaks through the nose when they are supposed to come out of the mouth.

Question 17

Why do individuals with cleft palate often display hypernasality?

Answer 17

Those with cleft palate or fistula have a lot of air escaping up to their nasal cavity, therefore – hypernasality.

Question 18

What is hypernasality?

Answer 18

Too much sound resonating in the nasal cavity during speech

Voiced oral sounds become nasalized (b, m, d, n, ng, g) which are obligatory distortions

Other phoneme-specific consonants may be substituted by nasals (e.g. s → n)

Severity depends on the size of the opening, the etiology, and even articulation

Question 19

How do you assess for hypernasality?

Answer 19

Assess with oral-only sentences (no nasals), loaded with high vowels and low pressure voiced consonants

Question 20

What is hyponasality?

Answer 20

Not enough resonance on nasal sounds (m, n, ng)

Nasal sounds become oral sounds

Can sound like when you have a cold and your nose is stuffy.

Nasal sounds end up sounding similar to their oral cognates (m→ b, n → d, -ng→ g)

Can also be present on vowels.

Question 21

What causes hyponasality?

Answer 21

Due to blockage in the nasopharynx from cold, swollen adenoids, or swollen tonsils.

Apraxia of Speech: the velum may not lower fast enough for nasal phonemes once it has been raised for oral sounds.

Question 22

How do you distinguish hypernasality from hyponasality?

Answer 22

1. Kummer test
   If an m sounds like a b, it is hyponasal
   If a b sounds like an m, it is hypernasal.

Question 23

What is mixed resonance?

Answer 23

When Hyper and Hypo nasality occur together.

This can occur when there is velopharyngeal dysfunction in a significant airway or nasal cavity blockage

Hypernasality is present when producing oral sounds, but hyponasality during production of nasal consonants.

Question 24

What is cul-de-sac resonance?

Answer 24

This occurs when transmission of acoustical energy is trapped in a blind pouch with an entrance, but there’s no outlet.

“Potato in the mouth” – sound is trapped in a cavity

Look for a shift in resonance or decrease in nasal air emissions when the nose is occluded.

Can happen with microstomia – small mouth opening. Like mumbling – not opening mouth wide enough.

This can only be resolved through surgery.