Cleft Palate & Speech Flashcards
What are the etiologies of cleft palate?
- 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).
What is the importance of an SLP when an individual has a cleft palate?
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.
Cleft palate errors in speech
nasal emission, glottal stop, pharyngeal stop, pharyngeal fricatives, pharyngeal affricates, nasal fricatives, mid-dorsum palatal stop
Cleft palate and resonance
Hypernasality is common: too much sound resonating in the nasal cavity during speech, usually due to velopharyngeal dysfunction or an oronasal fistula.
What is a submucous cleft palate?
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.
What are some signs of a submucous cleft palate?
- 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.
What is a cleft palate?
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.
What is a cleft lip?
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
What type of cleft lip is this?
Unilateral incomplete cleft lip
What kind of cleft lip is this?
Unilateral complete cleft lip
What kind of cleft lip is this?
Bilateral complete cleft lip
What condition is this?
Cleft palate
What sounds do individuals with cleft palate not have trouble making?
Nasals: “m”, “n,” “-ng”
What sounds can individuals with cleft palate usually make, even if not perfectly.
Low pressure sounds: glides and liquids, and
/w/, /r/, /l/, /j/, /h/
What sounds can individuals with cleft palate not make?
High pressure sounds: Stops, fricatives, affricates
“p”, “b”, “t”, “d”, “k”, “g”, f, v, s, z, sh, ch, th, and dg
Why can individuals with cleft palates not make high pressure sounds?
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.
Why do individuals with cleft palate often display hypernasality?
Those with cleft palate or fistula have a lot of air escaping up to their nasal cavity, therefore – hypernasality.
What is hypernasality?
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
How do you assess for hypernasality?
Assess with oral-only sentences (no nasals), loaded with high vowels and low pressure voiced consonants
What is hyponasality?
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.
What causes hyponasality?
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.
How do you distinguish hypernasality from hyponasality?
- Kummer test
If an m sounds like a b, it is hyponasal
If a b sounds like an m, it is hypernasal.
What is mixed resonance?
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.
What is cul-de-sac resonance?
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.
