Evaluation of Speech Outcomes in Children with Cleft Palate Following Primary Single-Stage Palatoplasty

OBJECTIVE: To evaluate speech outcomes in children with cleft palate following single-stage closure of the soft and hard palate. DESIGN: A retrospective cohort study. SETTING: Tertiary cleft care center at Maastricht University Medical Center+ (MUMC+), the Netherlands. PATIENTS, PARTICIPANTS: A total of 47 children with cleft palate or cleft lip and palate who underwent single-stage palatal closure between 2011 and 2018. Children with syndromes associated with significant cognitive or developmental impairment precluding valid speech assessment were excluded. INTERVENTIONS: Primary palatal repair using two-flap palatoplasty, Furlow double-opposing Z-plasty, or von Langenbeck technique. MAIN OUTCOME MEASURES: Speech was assessed using the Dutch Cleft Speech Evaluation Test (DCSET) and the Dutch version of the Cleft Audit Protocol for Speech - Augmented (CAPS-A). Secondary outcomes included prevalence of otitis media with effusion (OME) and tympanostomy tube placement. RESULTS: Speech intelligibility improved significantly at the final assessment (median score 2 to 1; P<0.001). No significant changes were found in voice, hypernasality, hyponasality, nasal emission, nasal turbulence, or grimace. CAPS-A analysis showed resolution of palatalisation errors, but increased dentalisation/interdentalisation, likely reflecting temporary compensatory articulation. OME was present in 90.7% of children, and 97.6% required at least one tympanostomy tube. CONCLUSION: Single-stage palatal closure leads to improved speech intelligibility with stable outcomes across other speech parameters. High prevalence of middle ear disease underscores the need for multidisciplinary follow-up.