The first study of voice and resonance related treatment outcomes of Estonian cleft palate children
Date
2023-09-12
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Abstract
Huule-suulaelõhe (HSL) on üks sagedasemaid kaasasündinud väärarenguid. Suulaelõhega sündinud lastel esineb sageli mitmeid kaasuvaid probleeme, sh neelamis- ja söömisraskused, probleemid kõnearenguga, mille peamiseks põhjuseks on resonantsiprobleemid, häälehäired, kolju- ja näopiirkonna kasvu ning arengu kõrvalekalded, ortodontilised probleemid, kuulmislangus, keelelise arengu probleemid ning õpiraskused. Uuringud näitavad, et kõige enam mõjutavad HSL-iga lapse psühhosotsiaalset toimetulekut tema välimus ja kõne kvaliteet. Eestis sünnib aastas umbes 20 HSL-iga last. Oma töös (1) koostasime optimaalsed kõnestiimulid Nasometer II-le ning arvutasime nasaleerituse piirväärtused; (2) töötasime välja kõnestiimulid velofarüngeaalse funktsiooni hindamiseks; (3) kirjeldasime HSL-iga sündinud laste häälekvaliteeti – teostasime videostroboskoopia kõri ja häälepaelte liikuvuse visualiseerimiseks ning morfoloogia hindamiseks, viisime läbi hääle akustiliste parameetrite mõõtmise ja hindasime häälehäire mõju laste elukvaliteedile, (4) määrasime kindlaks näokolju parameetrid, mis võivad mõjutada kõne kvaliteeti. Leidsime, et eesti HSL-lastel esinevad resonantsi ja häälehäired üsna väljendunult. Kõri piirkonna morfoloogilisi muutusi, eriti muutusi häälepaeltel, esines oluliselt sagedamini võrreldes tavapopulatsiooniga. Kõrvalekalded kraniofatsiaalses arengus võivad mõjutada kõne kvaliteeti. Selgus, et resonants on tundlikum pehmesuulae ja kõvasuulae pikkuse muutustele, keeleluu ja kolmanda kaelalüli vahelisele kaugusele ning ülalõualuu ja alalõualuu omavahelisele suhtele. Käesolevas uuringus ei võetud kõnekvaliteedi hindamisel arvesse logopeedilise teraapia kestust ega sagedust, mis samuti võib laste kõne kvaliteeti oluliselt mõjutada. Edaspidi on vajalik uurida logopeedilise sekkumise tõhusust, hinnata kirurgilise ja ortodontilise ravi kättesaadavuse ja ravi õigeaegsuse mõju laste kõnele. Uurimistööga pandi alus Eesti HSL-iga sündinud laste riikliku registri loomisele.
Oral clefts are the second most common birth defect. Children born with any type of non-syndromic cleft often demonstrate multiple problems such as early swallowing and feeding difficulties, abnormal articulation, resonance, voice disorders, craniofacial growth deviance and orthodontic abnormalities, hearing loss and poor language acquisition skills, psychosocial issues and learning difficulties at school. Research shows that lower satisfaction with appearance and speech seems to be mostly associated with increased emotional and social difficulties. In Estonia, about 20 CP±L children are born every year. This study is the first attempt to d methodologically research resonance in speech and voice disorders in the Estonian cleft palate children, and to set measurable standards for treatment outcomes. We aimed to develop specific assessment protocols tailored to the Estonian language: (1) developed Estonian-specific optimised speech stimuli for Nasometer II and established normative nasalance scores, (2) developed Estonian specific optimised speech stimuli for videonasoendoscopy, (3) performed videolaryngostroboscopy, acoustic analysis of voice, and measured voice related quality of life, (4) determined the cephalometric parameters that predominantly relate to resonance disorders. We found that Estonian cleft palate children exhibit both resonance and voice disorders quite expressively. Based on our findings, changes in craniofacial growth, especially in the length of soft and hard palate, the distance between the hyoid bone and the third cervical vertebra, and the angle formed by the maxilla and mandible are more sensitive to resonance. These results are of practical use to multidisciplinary CP±L teams, especially orthodontists and surgeons. Further studies are needed to evaluate the effectiveness of speech therapy and of orthodontic and surgical intervention. The research work laid the foundation for the creation of a national register of children born with CP±L in Estonia.
Oral clefts are the second most common birth defect. Children born with any type of non-syndromic cleft often demonstrate multiple problems such as early swallowing and feeding difficulties, abnormal articulation, resonance, voice disorders, craniofacial growth deviance and orthodontic abnormalities, hearing loss and poor language acquisition skills, psychosocial issues and learning difficulties at school. Research shows that lower satisfaction with appearance and speech seems to be mostly associated with increased emotional and social difficulties. In Estonia, about 20 CP±L children are born every year. This study is the first attempt to d methodologically research resonance in speech and voice disorders in the Estonian cleft palate children, and to set measurable standards for treatment outcomes. We aimed to develop specific assessment protocols tailored to the Estonian language: (1) developed Estonian-specific optimised speech stimuli for Nasometer II and established normative nasalance scores, (2) developed Estonian specific optimised speech stimuli for videonasoendoscopy, (3) performed videolaryngostroboscopy, acoustic analysis of voice, and measured voice related quality of life, (4) determined the cephalometric parameters that predominantly relate to resonance disorders. We found that Estonian cleft palate children exhibit both resonance and voice disorders quite expressively. Based on our findings, changes in craniofacial growth, especially in the length of soft and hard palate, the distance between the hyoid bone and the third cervical vertebra, and the angle formed by the maxilla and mandible are more sensitive to resonance. These results are of practical use to multidisciplinary CP±L teams, especially orthodontists and surgeons. Further studies are needed to evaluate the effectiveness of speech therapy and of orthodontic and surgical intervention. The research work laid the foundation for the creation of a national register of children born with CP±L in Estonia.
Description
Väitekirja elektrooniline versioon ei sisalda publikatsioone
Keywords
children, cleft palate, cleft lip, speech disorders, articulation disorders, voice, resonance, rehabilitation, speech therapy, results of treatment, Estonia