Evaluation of speech disorders in children with cleft lip and palate.
BACKGROUND
We investigated the reliability of nasopharyngoscopy and auditory perception, two common clinical methods employed in examining the speech pathology of children with cleft lip and palate.


METHODS
Nasopharyngoscopy was performed to assess velopharyngeal closure function and nasopharyngeal morphology. The auditory examination evaluated nasality and other speech disorders such as articulatory tension, shift in articulation, and sigmatism. The study was based on the audio and video recordings of twelve patients (9.5 +/- 0.5 years) after surgical rehabilitation of their cleft lip and palate. The speech sample consisted of reading a standardized sequence of words. The recordings were analyzed by several examiners with different experience in the evaluation procedure at two time-points. Inter-rater and intra-rater reliability was determined by Cohen's Kappa coefficient and by estimation of the 95% intervals of confidence.


RESULTS
Analysis of the visual and auditory-perceptual findings by the experienced raters was highly reliable. However, the less experienced raters' results showed greater variability, as did morphological evaluation in both groups. Comparison between visual and auditory evaluations concerning hypernasality resulted in little correlation.


CONCLUSIONS
These two subjective methods of evaluation are recommended because of their high reliability with experienced raters. Our results suggest that "experience" is an essential criterion in determining the structural quality of the morphological and functional assessment of typical speech pathologies in children with cleft lip and palate. In addition, the data demonstrate the necessity of special multidisciplinary rehabilitation teams in so-called cleft centers.
Paal
Sonja
S
Department of Phoniatrics and Pediatric Audiology, University of Erlangen, 91054 Erlangen, Germany.
Reulbach
Udo
U
Strobel-Schwarthoff
Karin
K
Nkenke
Emeka
E
Schuster
Maria
M
D002648:Child; D002971:Cleft Lip / Q000150:complications* / Q000175:diagnosis; D002972:Cleft Palate / Q000150:complications* / Q000175:diagnosis; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009305:Nasopharynx / Q000473:pathology*; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013064:Speech Disorders / Q000175:diagnosis* / Q000209:etiology*; D013068:Speech Production Measurement / Q000379:methods*