Development and Resolution of Nasal Fricatives in a Child with Repaired Bilateral Cleft Lip and Palate: A Case Report.
David J Zajac, Juliana Powell, Margaret McQuillan
PMID 34901443WHAT IT FOUND
In one child with cleft palate, speech therapy eliminated learned nasal fricatives even though velopharyngeal dysfunction persisted.
This prevented unnecessary surgery. Clinicians must distinguish learned errors from structural issues before considering surgical intervention.
Key findings
01Speech therapy eliminated anterior nasal fricatives in a child with persistent velopharyngeal dysfunction, avoiding the need for secondary surgery.
02Differential diagnosis between learned nasal fricatives and obligatory nasal air emission is critical because misdiagnosis can lead to unnecessary surgery or ineffective therapy.
03The child's conductive hearing loss and velopharyngeal dysfunction likely contributed to the development of anterior nasal fricatives through enhanced bone-conducted feedback.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a single case report, so the findings cannot be generalized to all children with cleft palate. The child received multiple concurrent interventions, including early intervention, speech therapy, and occupational therapy, making it difficult to isolate the specific contribution of speech therapy to the resolution of nasal fricatives. The improvement in velopharyngeal function over time may have been due to maturation, therapy, or both, as the authors explicitly state they do not attribute the improvement solely to speech therapy. Details of the specific speech therapy techniques used were not fully documented, relying on parent report and general descriptions.
Declared interests
The authors declared no conflicts of interest. The study was part of an ongoing longitudinal study on stop consonant development in children with repaired cleft palate.
The easy way to misread this
Do not assume that velopharyngeal dysfunction will resolve with speech therapy alone or that nasal fricatives are always compensatory for structural issues. In this case, the child's velopharyngeal function improved significantly, possibly due to maturation, and the nasal fricatives were learned errors rather than obligatory symptoms. Always confirm the nature of the nasal emission before deciding on treatment.