Speech Outcomes Audit for Unilateral Cleft lip and Palate After 2-Stage Palate Repair: Preliminary Results.

Primary cleft lip and palate surgeries can interfere with speech status, facial appearance, maxillary growth, and psychosocial and academic development. Therefore, different surgical protocols and techniques have been proposed, and adequate velopharyngeal function and speech is the main goal for the treatment success. The present study aimed to report preliminary speech results of the 2-stage palate repair of children with unilateral cleft lip and palate. One hundred seventy nonsyndromic patients with unilateral cleft lip and palate were included in this report, 35% males and 65% females, submitted to the 2-stage palatoplasty protocol, composed by lip, nasal ala, and hard palate repair at 3 to 6 m (stage 1) and soft palate repair at 12 to 18 m (stage 2). The target age range for speech recording was 5 to 10 years, and the speech material included repetition of Brazilian Portuguese sentences. These samples were obtained over 5 years and assessed by 3 of 14 experienced speech pathologists. When discordant, the majority rate was adopted. Average velopharyngeal dysfunction (VPD) rates were 19,5%, varying according to the soft palate technique, with better results when the Sommerlad technique was performed (VPD=11%), followed by Braithwaite (VPD=15%) and then Von Langenbeck (VPD=25%). Passive errors were observed in 32% and active errors in 25%. Speech results reflect the outcomes of an interdisciplinary team's work, where facial growth and nasolabial appearance must also be considered. Further analysis and a wider casuistic are recommended. Hence outcomes audit needs to be a permanent process, providing solid and updated evidence for optimal cleft care.

Frontonasal dysplasia: clinical evaluation on audiological and brainstem electrophysiological profiles.

UNLABELLED: Frontonasal dysplasia (FND) is a rare malformative complex affecting the frontal portion of the face, the eyes and the nose; it may occur singly or associated with other clinical signs. No systematic studies describing hearing in this condition were found. AIM: To evaluate hearing sensitivity and sound stimulus conduction from cochlea to brainstem in patients with clinical signs of FND. METHODS: 21 patients with isolated or syndromic FND were submitted to a clinical (otological/vestibular antecedents and otoscopy) and instrumental (pure tone and speech audiometry, tympanometry and brainstem auditory evoked response) hearing evaluation. DESIGN: A clinical, cross-sectional observational prospective study. RESULTS: Hearing thresholds were normal in 15 (70%) patients, abnormal in 5 (25%), mostly with conductive hearing loss; one patient did not cooperate with testing. The tympanometric curve was type A in 30 (72%) ears, type C in 5 (12%), type As in 4 (9%) and type B in 3 (7%). The auditory brainstem response (ABR) showed no abnormalities. CONCLUSION: Patients with FND showed no abnormalities in the auditory system from cochlea to brainstem in this study. Mild conductive hearing loss found in some is probably related to cleft palate. Further evaluation of hearing pathways at higher levels is recommended.

Frontonasal dysplasia: clinical evaluation on audiological and brainstem electrophysiological profiles / Displasia frontonasal: avaliação clínica e eletrofisiológica da audição

Frontonasal dysplasia (FND) is a rare malformative complex affecting the frontal portion of the face, the eyes and the nose; it may occur singly or associated with other clinical signs. No systematic studies describing hearing in this condition were found. AIM: To evaluate hearing sensitivity and sound stimulus conduction from cochlea to brainstem in patients with clinical signs of FND. METHODS: 21 patients with isolated or syndromic FND were submitted to a clinical (otological/vestibular antecedents and otoscopy) and instrumental (pure tone and speech audiometry, tympanometry and brainstem auditory evoked response) hearing evaluation. DESIGN: A clinical, cross-sectional observational prospective study. RESULTS: Hearing thresholds were normal in 15 (70 percent) patients, abnormal in 5 (25 percent), mostly with conductive hearing loss; one patient did not cooperate with testing. The tympanometric curve was type A in 30 (72 percent) ears, type C in 5 (12 percent), type As in 4 (9 percent) and type B in 3 (7 percent). The auditory brainstem response (ABR) showed no abnormalities. CONCLUSION: Patients with FND showed no abnormalities in the auditory system from cochlea to brainstem in this study. Mild conductive hearing loss found in some is probably related to cleft palate. Further evaluation of hearing pathways at higher levels is recommended.

A displasia frontonasal (DFN) representa um complexo malformativo que afeta os olhos, o nariz e a região frontal da face. Estudos específicos com o objetivo de estudar a audição na DFN não foram encontrados na literatura. OBJETIVO: Avaliar o sistema auditivo em indivíduos com DFN quanto à acuidade e condução do estímulo sonoro até o tronco encefálico. MATERIAL E MÉTODO: 21 pacientes na faixa etária de 7 a 42 anos, sendo 14 do sexo feminino e 7 do sexo masculino, com DFN isolada ou sindrômica, foram submetidos à anamnese, meatoscopia, imitanciometria, audiometria tonal liminar e potenciais evocados auditivos de tronco encefálico (PEATE). FORMA DE ESTUDO: Estudo de série clínico prospectivo. RESULTADOS: Limiares audiométricos normais em 15 (70 por cento) indivíduos e alterados em 5 (25 por cento), sendo perda auditiva condutiva na maior parte. Na timpanometria, 30 orelhas (72 por cento) apresentaram curva tipo A, 5 (12 por cento) tipo C, 4 (9 por cento) tipo Ar e 3 (7 por cento) tipo B. Os valores das latências absolutas e interpicos do PEATE foram normais. CONCLUSÕES: Não foram encontradas alterações na via auditiva até o tronco encefálico. As alterações condutivas são provavelmente relacionadas às patologias de orelha média decorrentes da fissura de palato. Sugerimos a avaliação de níveis mais altos dentro do sistema auditivo.