The combined role of Speech Therapy and Audiologic-Phoniatric assessment in enhancing speech outcomes for patients with Cleft Palate

Patients with craniofacial malformations, and in particular with cleft lip and palate, require audiological and phoniatrics assessment. This approach is mandatory, as malformative conditions may affect hearing through conductive or sensorineural hearing losses, related to craniofacial malformations or syndromic conditions. Swallowing impairments may also be present, leading to nasal regurgitation, penetration, or aspiration. Moreover, vocal effort can be detected in this population, due to patients’ compensation need for nasal air escape. This condition results in kissing nodules or a hyperkinetic vocal pattern. Analysing speech, cleft palate surgery restores anatomical integrity, but postoperative speech outcomes often vary widely. In order to investigate speech performances, a retrospective study was conducted on 100 patients treated for cleft palate at the Phoniatric Clinic of Città della Salute e della Scienza Hospital, Turin. A three-year dataset was analysed, comparing phonemic tests before and after speech therapy. Patients were classified by severity of the cleft (mild, moderate, severe). Statistical analysis included Shapiro-Wilk, Wilcoxon signed-rank test, Kruskal-Wallis test, and linear and multiple regression models. Speech therapy significantly improved speech disorder scores (Wilcoxon p < 0.001). The greatest benefit was found in moderately impaired patients; severe cases showed limited progress. Regression analyses indicated that the number of therapy hours alone did not directly predict improvement, suggesting other influential factors such as surgical outcome and age. Speech therapy is fundamental in postoperative cleft palate rehabilitation. Tailored approaches are required to maximize outcomes in patients with severe deficits.