Having a cleft palate can affect both hearing and speech, and these will be closely monitored throughout your child’s early years (as well as at 5 and 10 years old) by the Cleft Team to ensure that any developing problems are dealt with appropriately.
If your child has a cleft palate, they will have been regularly assessed for any hearing issues from a young age by the Audiologist or Ear Nose and Throat (ENT) consultant with the Cleft Team. However, as the kind of hearing issues associated with cleft palate usually come and go, it could be that your child develops these issues again at a later age, so it’s important to watch out for this as they grow up.
Glue Ear (Otitis Media with Effusion, or OME) is a common condition in children with a cleft palate. This happens when the Eustachian tube (which connects the middle ear to the back of the throat) becomes blocked, meaning air can’t get into the tube, so the middle ear produces a liquid that thickens and makes it hard for children to hear, as well as making them prone to earaches. This can make it especially difficult to hear quieter sounds, and can also affect a child’s speech development as they won’t be able to correct their own speech properly. Glue ear is often temporary and can get better on its own, but sometimes treatment is needed.
Grommets are tiny plastic tubes placed in the eardrum. They aren’t noticeable by others, and can help stop earaches. Sometimes this is done at the same time as cleft palate repair surgery. Grommets often fall out as the eardrum heals (after around six months), and if the Glue Ear comes back another procedure to replace the grommets may be necessary.
Hearing aids come in several different kinds, and the most suitable one for your child will be recommended by the Audiologist or ENT consultant. These are a more long-term solution to hearing issues, but unlike grommets these require maintenance, do not stop earaches and are visible.
Other treatments can include using decongestants or nasal sprays to clear out the middle ears. In the majority of cases, hearing problems caused by a cleft palate clear up by around 6-8 years old, but occasionally they can lead to longer-term hearing issues which will be managed by your Cleft Team.
Children with a cleft that affects their soft palate (the part towards the back of the throat) may have problems with speech that include sounding nasal or not being able to make certain consonant sounds such as p, t and d. This is caused by the soft palate not being able to properly close off the mouth from the nose while speaking and therefore letting air escape through the nose. This is known as velopharyngeal dysfunction.
Around half of all children with a cleft palate will need Speech and Language Therapy (SLT) at some point, and any speech issues your child has should already be being managed by the Cleft Team. The aim is for children to have good quality, intelligible (understandable) speech by age 5-6 so that they can start school already able to participate fully in class and communicate with their peers. However, some children will need support for speech issues into their teenage years and beyond. How much, and how this is delivered, will depend on the needs of the child in question – talk to the SLT if you have concerns.
Some children may need additional surgery to reduce the amount of air escaping through their nose when they speak.
Hearing, Speech and School
Any hearing loss, temporary or otherwise, can make it very difficult for a child to hear what a teacher says or to cope during noisy break times. A child who does not seem to be paying attention or following instructions may in fact be having hearing problems.
Sounding ‘different’ can make a child feel very self-conscious about speaking. This could affect class participation and how a child behaves with other children.
“I think during my early childhood my parents and grandparents tried to shield me from my ‘difference’. I distinctly remember them ‘interpreting’ for me or ‘speaking for me’ and feeling extremely frustrated and embarrassed – after all, I could speak, I knew what I wanted to say, and in MY head I sounded just fine, thank you!
As school progressed I realised that my peers and other adults did not always understand me. I became quiet within the classroom….after all, why bother to contribute if you are not understood, or worse, laughed at? I still did well academically, I had a small group of friends and they always said that I was worth listening to. Some said that they always understood me, once they’d gotten used to my speech. I am forever grateful to those friends – some of which I still have today.”
– An adult born with a cleft palate