Cleft palate is the most frequently occurring facial birth defect in the United States. Even following palate repair, many children will experience delayed speech and language well into the second year of life. Findings from our current R01 project show that greater than 40% of children with repaired cleft palate do not achieve emergence of stop consonants by 16 months of age (4 to 6 months following palate repair) and approximately 20% do not by 20 months of age (8 to 10 months following palate repair). By school age, 20% to 30% of children with repaired cleft palate will require secondary palatal surgery for obligatory symptoms of velopharyngeal dysfunction and 60% to 70% will require speech therapy for articulation. One of the most common errors is backed (palatalized) production of alveolar targets.
The specific aims of this proposed renewal are to determine: 1) if a novel aerodynamic measure of velopharyngeal closure for stop consonants at 24 months of age predicts velopharyngeal function at 3, 4, and 5 years of age in children with repaired cleft palate, 2) age-related changes in obligatory symptoms of velopharyngeal dysfunction ? hypernasality and audible nasal air escape ? of children with repaired cleft palate from 5 to 8 years of age, and 3) the effects of cleft type and hearing status on the development and intelligibility of alveolar stop and fricative targets in children with repaired cleft palate from 5 to 8 years of age. We will continue to follow three currently enrolled cohorts of children: 1) with repaired cleft palate (approximately 60), 2) without cleft palate but with history of early otitis media with effusion (approximately 30), and 3) typically-developing without cleft palate or history of otitis media with effusion (approximately 30). We will also enroll additional 2 and 5 year-old children to offset attrition and maintain adequate sample sizes. We will use nasal ram pressure, standard pressure-flow procedures, perceptual ratings, single-word intelligibility testing, and spectral moment analyses to accomplish the specific aims. We will evaluate the first specific aim using binomial regression and sensitivity/specificity analyses. We will evaluate the second and third specific aims using one-way analysis of variance and linear mixed models with and without cleft type and hearing status as covariates. It is anticipated that the results will a) further validate a novel and relatively simple procedure to evaluate velopharyngeal function in young children with repaired cleft palate, b) provide longitudinal data on obligatory symptoms and articulation of older children with repaired cleft palate, and c) contribute to theories of early speech development of children with structural anomalies. Such information will be instrumental to optimize the timing of secondary surgeries and provide evidence-based strategies for behavioral interventions that will improve oral communication and quality of life.

Public Health Relevance

This research aims to determine the clinical usefulness of a novel procedure to evaluate velopharyngeal function of young children with repaired cleft palate. The children will be followed over time to determine changes in speech and resonance as a function of age. The study will provide longitudinal data that may help to optimize the timing of either behavioral interventions and/or secondary surgical management in children with cleft palate.

Agency
National Institute of Health (NIH)
Institute
National Institute of Dental & Craniofacial Research (NIDCR)
Type
Research Project (R01)
Project #
2R01DE022566-06A1
Application #
9738275
Study Section
Motor Function, Speech and Rehabilitation Study Section (MFSR)
Program Officer
Fischer, Dena
Project Start
2013-04-04
Project End
2024-03-31
Budget Start
2019-04-01
Budget End
2020-03-31
Support Year
6
Fiscal Year
2019
Total Cost
Indirect Cost
Name
University of North Carolina Chapel Hill
Department
Dentistry
Type
Schools of Dentistry/Oral Hygn
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599