Speech therapy only versus speech therapy combined with Furlow palatoplasty for the treatment of velopharyngeal insufficiency in submucous cleft palate: A systematic review and meta-analysis

Abstract

Objective: The purpose of this review is to investigate the speech outcomes of speech therapy only versus speech therapy in combination with Furlow palatoplasty for the treatment of velopharyngeal insufficiency (VPI) in submucous cleft palate (SMCP).

Design: Systematic review and 2 meta-analyses of speech therapy only and speech therapy in combination with Furlow palatoplasty in the treatment of VPI in SMCP.

Setting: Secondary and tertiary care centres in 10 different countries spread over 6 continents.

Patients, participants: Articles were selected after an elaborate literature search using PubMed, Embase and the Cochrane Library.

Interventions: Speech therapy only and speech therapy in combination with Furlow palatoplasty MAIN OUTCOME MEASURE: The primary outcome measure of this study is the reduction of VPI-associated speech difficulties after treatment.

Results: Speech therapy only showed a risk difference (RD) of 0.015 to 0.036 for the presence of hypernasality; 0.045 for the presence of nasal emission; 0.015 for the presence of compensatory articulation and 0.089 for the presence of unintelligible speech. Speech therapy in combination with Furlow palatoplasty showed RDs of 0.46; 0.29 and 0.37 for the presence of hypernasality, clinically relevant hypernasality and nasal emission, respectively.

Conclusion: Both speech therapy only and speech therapy in combination with Furlow palatoplasty demonstrate a decrease in VPI-associated speech difficulties in SMCP. According to the current findings, speech therapy should accompany surgical correction by Furlow for the treatment of SMCP. However, larger prospective studies are required to investigate the precise role of speech therapy as a standalone intervention in mild cases of SMCP.

Keywords: Furlow palatoplasty; Hypernasality; Nasal emission; Speech therapy; Submucous cleft palate (SMCP); Velopharyngeal insufficiency (VPI).