Speech

Around half of all children with a cleft palate will need some form of Speech and Language Therapy, usually up until the age of 7. Some adults with a cleft may still have issues with their speech, whether or not they received Speech and Language Therapy when they were younger.

How does a cleft palate affect speech?

The soft palate (the part towards your throat) moves upwards and backwards when you talk. This is part of how your nose is separated from your mouth – your soft palate moves to make sure no air escapes through your nose when you make certain sounds. The palate moves up and back for sounds like p, t, g, sh, and ch. It lowers to let air pass through the nose for letters like m and n.

If your palate doesn’t work as well as it should because of a cleft, your speech can be affected in two main ways:

1. Sounding nasal – this is caused by the palate not properly separating the mouth from the nose and letting air escape through the nose while speaking.
2. Sounds not forming properly – again this is caused by too much air escaping through the nose, meaning there isn’t enough left in the mouth for some sounds to be made clearly.

These are examples of velopharyngeal dysfunction, which means the mechanism to separate the nose and the mouth (in this case, the soft palate) isn’t working properly.

Sometimes speech can be affected in other ways. For example, you might have learnt to use your voice box in a different way to compensate or adjust for problems caused by your cleft, and this can affect how you sound.

Adults with a cleft may have speech issues even if they received Speech and Language Therapy as children.

Problems with speech can be because of a learned problem where they have learned to make sounds in the wrong way growing up or a structural problem where there is something wrong with the mouth or palate.

How can you get help

A Speech and Language Therapist (SLT) can help to figure out what kind of problem is causing any speech issues you have, and can ensure you receive the relevant treatment. The specialist SLT with your Cleft Team will be able to tell if the way your mouth and palate is at the moment will allow you to improve your speech with professional help such as breathing exercises, or if you need physical treatment such as surgery.

Surgery is more likely if you have developed a fistula (small hole in the palate), or if your mouth has grown and changed in a certain way since your cleft repair.

Two examples of velopharyngeal surgery are the pharyngeal flap and the pharyngoplasty surgery, both of which aim to help block excess air from going into the nose while still allowing you to breathe normally. We go through what these surgeries involve in our Teenagers section.

Getting a clear and careful evaluation from a Cleft Specialist is an important step before considering any further treatments.

If you are not already under a Cleft Team, find out how to return to treatment.

“Every day I speak to literally hundreds of people. Yes, there is often someone who fails to understand me. I simply repeat myself. I remind myself they might have not heard me, they might not have been listening, or they might not have understood me….and that is simply life!”

FAQs

Why might I want speech therapy?

• You may wish to visit a Speech Language Therapist for a number of different concerns in adulthood, such as:
  • Hypernasality: too much air coming through the nose when you speak
  • Hyponasality: too little air coming through the nose on certain sounds
  • Articulation disorders: difficulties making specific sounds
  • Voice – e.g. breathiness or vocal nodules.
• Sometimes these concerns can be resolved with speech and language therapy, surgery, or both.
• You may be referred onto your community Speech Language Therapist for treatment closer to where you live.

 What can I do at home to improve my speech?

• There are often exercises that you can practice at home which your speech and language therapist will be able to show you.
• Sometimes, Speech Language Therapy alone won’t not be able to result in significant change. In these cases, surgery or physical appliances (such as a ‘speech plate’) may be suggested as a potential way of addressing speech concerns.

What support is available if I’m having difficulties with my hearing?

• Talk to your Cleft Team if you think you might be having difficulties with your hearing.
• You can talk to your GP to arrange a hearing test, or talk to the Audiologist on the Cleft Team.
• You may also talk to the Clinical Psychologist within your Cleft Team if you have any concerns you’d like to talk through, for example, if you feel self-conscious about wearing hearing aids.
• Even if you think your hearing difficulties are not to do with your cleft, it is still advisable to let your Cleft Team know and to seek their advice. This is because some of the routine treatments for hearing difficulties (e.g. getting your ears syringed) might not be appropriate for people who were born with a cleft.