title: Blinded speech evaluation following pharyngeal flap surgery by speech pathologists and lay people in children with cleft palate.
abstract: METHODS
  In order to assess intermediate-term speech outcome after pharyngeal flap surgery for velopharyngeal dysfunction in children with cleft palate between 1980 and 1998, their pre- and postoperative speech performance was analyzed in a blinded fashion by speech pathologists and adult lay people. Speech was evaluated on the basis of tape recordings with regard to resonance, intelligibility, articulation, voice and secondary speech disorders.
  
  
  RESULTS
  Twenty-three patients could be evaluated. Both lay assessors and speech pathologists noted a significant improvement in speech performance after pharyngeal flap surgery. The percentage of children who improved was 83% (19/23, 95% confidence interval: 0.68-0.98, p = 0.002) when rated by lay people, and 87% (20/23, CI 0.73-1.01, p < 0.0001) when rated by professionals. Rated on a 5-point scale, the mean improvement per speech characteristic was 0.52 +/- 0.32 scale points when judged by lay people, and 0.75 +/- 0.8 points when judged by experts. Experts considered none of the children to have normal speech after surgery. Agreement with regard to outcome between lay people and speech pathologists occurred in 87% of the patients.
  
  
  CONCLUSIONS
  The cranially based pharyngeal flap can improve speech performance in cleft palate children with chronic velopharyngeal insufficiency. However, it cannot be expected that this type of surgery will result in normal speech.
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital, Bern, Switzerland. martin.toenz@insel.ch
authors.forename: Martin
authors.initials: M
authors.lastname: Tönz
authors.forename: Iris
authors.initials: I
authors.lastname: Schmid
authors.forename: Maja
authors.initials: M
authors.lastname: Graf
authors.forename: Regula
authors.initials: R
authors.lastname: Mischler-Heeb
authors.forename: Josef
authors.initials: J
authors.lastname: Weissen
authors.forename: Georges
authors.initials: G
authors.lastname: Kaiser
mesh_terms: D002648:Child; D002972:Cleft Palate / Q000150:complications / Q000601:surgery*; D004311:Double-Blind Method; D006801:Humans; D015588:Observer Variation; D010609:Pharyngeal Muscles / Q000637:transplantation*; D011897:Random Allocation; D012720:Severity of Illness Index; D013060:Speech; D013064:Speech Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D013065:Speech Intelligibility; D013524:Surgical Flaps