RESUMEN
Management of speech and hearing issues in low-income and middle-income countries (LMICs) has been challenging, considering the population size and availability of resources. There is a need to investigate the depth of these challenges and explore the efficacy of strategies to overcome them. This review aimed to delineate the speech and hearing issues in individuals with cleft lip and palate and how they have been managed in the context of LMICs. Keywords were developed based on the objectives of the study to search for literature published during the period 2010 to 2023. Articles from PubMed, Google Scholar, Science Direct, and ProQuest databases were retrieved using appropriate keyword searches. The titles and abstracts were screened to delete the unsuitable articles. Relevant gray literature and hand-searched articles published were also included. The findings are summarized under the following heads in the context of LMICs: incidence and severity of speech and hearing issues, challenges, and barriers in providing speech and hearing services, methods of developing manpower and training, methods of assessing speech and hearing outcomes, service delivery models employed, and the recent advances relating to management of speech and hearing. A wide range of topics revolving around managing speech and hearing issues in individuals with cleft lip and palate has been researched in the context of LMICs. Scattered and fragmented solutions have been provided to overcome the varied challenges in LMICs. The gaps in the literature and the future directions for research have been identified.
RESUMEN
OBJECTIVE: The Furlow palatoplasty is a proven procedure in the management of secondary velopharyngeal dysfunction in patients with cleft palate. But the selection of cases, the degree of clinical success, and the preoperative predictors of the same are less established. This study is an effort to retrospectively look at outcomes, in a large series of velopharyngeal dysfunction cases treated with the Furlow palatoplasty alone. DESIGN: Retrospective analysis of preoperative and postoperative speech and videofluoroscopic data. SETTING: Tertiary care center. PATIENTS/PARTICIPANTS: Ninety-two patients who were diagnosed with velopharyngeal dysfunction post primary cleft palate repair. INTERVENTIONS: Furlow palatoplasty for velopharyngeal dysfunction post primary cleft palate repair. MAIN OUTCOME MEASURES: Variables analyzed were perceptual speech parameters and, closure ratios obtained from lateral video-fluoroscopic images. RESULTS: Overall, 81.5% had postoperative improvements in their lateral video-fluoroscopic parameters, 63% improved their nasality scores, and 65.2% had improved speech intelligibility. A simple linear regression was done to predict the postoperative closure ratio. Preoperative closure ratio, hypernasality (moderate and severe), and audible nasal air emission are predictors for postoperative closure ratio. CONCLUSIONS: The Furlow palatoplasty alone led to complete resolution, or significant improvement of velopharyngeal dysfunction in a majority of patients, despite the cohort having a wide range of severity in terms of degree of dysfunction. The predictive formula will be validated in a further study.