Cleft Lip and Palate

Speech, language and hearing with a cleft

A child born with a cleft palate is more likely to experience problems with speech development than other children. These problems are mostly related to the structure of the palate and the way it closes with the walls of the throat and can also be due to other structural differences such as missing teeth or the position of the upper and lower jaws. Another factor can be reduced hearing which affects most children with a cleft palate at some point. A child born with a cleft palate will have regular hearing checks with an audiologist and will receive appropriate treatment as necessary.

Depending on the cause of speech difficulties, further surgery may be appropriate and/or a Speech and Language Therapist (SALT) will be able to help your child with the pronunciation of words by giving them speech exercises during clinic sessions which can be practised at home. Sometimes the clinic sessions are provided within the school environment, but most families have to travel for speech and language therapy.
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One of the most common reasons for hearing loss is ‘glue ear’ which results from an overproduction of mucus in the middle ear. This occurs because the Eustachian tube (the tube that connects the middle ear to the throat) does not work as well in children with cleft palate and so mucus can build up in the middle ear. It is common for children suffering from glue ear to have grommets fitted through surgery – the excess mucus is first removed and then small ventilation tubes known as grommets are fitted in the ear drum, which help keep the middle ear aerated. An alternative treatment for hearing loss caused by glue ear is hearing aids.
Most parents we spoke to who had a child born with a cleft palate had taken their child for speech therapy. Speech therapy can take place from the age of 3 normally and may continue for some time. If speech and language therapy alone does not encourage sufficient improvements for a child born with a cleft palate further surgery may be needed. This might include a re-repair of the palate, a ‘Furlow’ repair which also lengthens the palate or a “pharyngoplasty” which can alter the shape of the throat to help speech. Speech is assessed following all surgical procedures and further therapy might be required if the child has orthognathic (jaw) surgery. Opportunities for speech therapy will be available through the ‘Cleft treatment pathway’
The child’s speech development was very important to the parents we spoke to particularly with regard to social relationships with other people. It was considered to be as important as the child’s physical looks.
Last reviewed June 2017.

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