Palate Re-Repair for Velopharyngeal Insufficiency Treatment: A Long-Term Auditory-Perceptual Assessment of Speech

Abstract

Purpose: The purpose of this study was to assess the effectiveness of the palate re-repair by the auditory-perceptual assessment of speech. Method: Nonsyndromic individuals with operated cleft palate ± lip and velopharyngeal insufficiency (VPI), aged 6–22 years (10 men and 10 women), were referred to secondary palate surgery by the Sommerlad technique. Speech characteristics related to velopharyngeal function (VPF) were analyzed by auditory-perceptual assessment using digital audio recording 5 days before and 13 months after the palate re-repair, on average. Hypernasality, global impression of VPF, and active speech symptoms were scored and blindly rated by three experienced speech-language pathologists before and after surgery. The effect of age and the type of cleft on the outcomes was also analyzed. Results: Surgical success, interpreted as the elimination or reduction of hypernasality, was observed in 13 of the 20 patients analyzed (65%). Adequate nasality was observed in 55% of the patients, and the degree of hypernasality decreased from moderate to mild in 10% of the patients. Postoperative normal nasality was only seen among the children (73%). There was a tendency for better outcomes in patients with unilateral cleft lip and palate. Conclusions: The auditory-perceptual assessment of speech showed that re-repairs were effective in eliminating hypernasality and normalizing VPF in the majority of children analyzed, but not among the adults. In view of these results, the Sommerlad surgery should be prioritized in children as a secondary intervention in order to eliminate VPI.