Speech and Endoscopic Characteristics of Occult Submucous Cleft Palate

Lee, Eun Kyung; Son, Young Ik

Abstract

BACKGROUND AND OBJECTIVES
Since occult submucous cleft is a defect in the velum that is not apparent on the oral side, it is not infrequently misdiagnosed and an appropriate therapy is often delayed. We aimed to evaluate the speech characteristics and nasopharyngeal endoscopic findings in patients with occult submucous cleft to provide aid to timely diagnosis. SUBJECTS AND METHOD: We reviewed medical records of 10 Korean occult submucous cleft patients who did not present classic stigma of submucous cleft. Their age ranged 3.6 to 63 years. All subjects received perceptual resonance/articulation evaluation, nasometry and nasopharyngoscopy by a speech pathologist and a laryngologist. RESULTS: Eight patients presented with apparent hypernasal speech and their nasalance scores were significantly higher than reference values. Five had compensatory articulation errors: glottal stop for velar plosives, tense alveolar fricatives and/or palatal affricatives. Two patients had only a weak oral consonants and the other produced nasal cognates for their plosives. Nasopharyngeal endoscopic evaluation revealed an overt central groove, slight notch or flattening in the area of the velar eminence. Incomplete velopharyngeal closure with central gap was observed in most of the patients except in two who had a complete velopharyngeal or velo-adenoidal sealing. CONCLUSION: Marked hypernasality and frequent association with compensatory articulation errors warrant a suspicion and vigilant evaluation to find out occult submucous cleft. To provide an appropriate and timely therapy for patients with occult submucous cleft, thorough perceptual, acoustic and endoscopic evaluation is mandatory for the patients with hypernasality.