Development of Stop Consonants in Children with Repaired Cleft Palate

腭裂修复儿童塞音的发展

• 批准号: 8506473
• 负责人: DAVID J ZAJAC
• 金额: $ 66.26万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-04 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8506473
• 关键词: 4 year old; Accounting; Age; Age-Months; Behavior Therapy; Behavioral; Child; Cleaved cell; Cleft Palate; Clinical; Conductive hearing loss; Congenital Abnormality; Data; Development; Early Intervention; Eustachian Tube; Exhibits; Face; Functional disorder; Infant; Intervention; Judgment; Language; Life; Logistic Regressions; Measures; Modeling; Nose; Operative Surgical Procedures; Oral; Otitis Media with Effusion; Outcome; Play; Procedures; Production; Regression Analysis; Relative (related person); Reporting; Research; Severities; Speech; Speech Development; Structure; Subgroup; Surgical Management; Techniques; Testing; Time; Tympanometry; United States; Work; base; follow-up; middle ear; middle ear disorder; novel; palatal surgery; palate repair; pressure; public health relevance; repaired; sex; theories

DESCRIPTION (provided by applicant): Cleft palate is the most frequently occurring facial birth defect in the United States. Although infants typically undergo surgery to repair the palate by 10 months of age, most will exhibit delayed production of stop consonants well into the second year of life. The reasons for such delays are not entirely known. It is known, however, that even after the emergence of stop consonants, approximately 20% to 30% of infants with repaired cleft palate will eventually require secondary palatal surgery to achieve adequate velopharyngeal function for normal speech production. Typically, objective assessment of velopharyngeal function is not possible until children are 3 to 4 years of age and cooperative for clinical and instrumental techniques. The specific aims of the proposed project are to determine 1) the time course and factors - middle ear status, symbolic language, cleft type, and sex - that account for the emergence of stop consonants in children with cleft palate following surgical repair, 2) the time course and factors that account for consistent velopharyngeal closure for stop consonants in children with and without repaired cleft palate, and 3) if a novel aerodynamic measure of velopharyngeal closure for stop consonants at 24 months of age predicts velopharyngeal function at 36 and 48 months of age. Thirty-six infants with repaired cleft palate, 18 typically-developing infants without cleft palate, and 18 infants without cleft palate but with middle ear disease will be followed at two-month intervals from approximately 10 to 24 months of age. Symbolic language ability will be assessed through unstructured and structured play. Middle ear function will be assessed by tympanometry. Nasal ram pressure will be obtained as an indicator of velopharyngeal closure for stop consonants elicited during play. At 36 and 48 months, additional measures of velopharyngeal function will be obtained via nasal airflow and direct magnitude estimation of perceived hypernasality. Developmental trajectories of children relative to stop emergence and velopharyngeal closure for stops will be described using discrete-time survival and binomial logistic regression analyses. Covariates will be included in the models to determine the relative effects of middle ear status, language ability, cleft type, an sex. It is anticipated that the results will a) identify the cause(s) of delayed emergence of stops in children with repaired cleft palate, b) provide developmental data to optimize the timing of either behavioral and/or secondary surgical interventions, and c) further validate a novel and relatively simple assessment procedure to determine velopharyngeal closure of stop consonants in young children.

描述（由申请人提供）：腭裂是美国最常见的面部出生缺陷。尽管婴儿通常在 10 个月大时接受上颚修复手术，但大多数婴儿在出生后的第二年都会表现出塞音的延迟产生。这种延误的原因尚不完全清楚。然而，众所周知，即使在塞音出现后，大约 20% 至 30% 的腭裂修复婴儿最终仍需要进行二次腭部手术，以获得正常言语产生所需的足够的腭咽功能。通常，直到儿童 3 至 4 岁并且能够配合临床和仪器技术时，才能对腭咽功能进行客观评估。该项目的具体目标是确定 1) 导致腭裂儿童在手术修复后出现塞音的时间过程和因素 - 中耳状态、符号语言、裂口类型和性别，2)考虑有或没有修复腭裂的儿童中塞音一致的腭咽闭合的时间过程和因素，以及 3) 是否有一种新的用于塞音的腭咽闭合的空气动力学措施24 个月时的辅音可预测 36 个月和 48 个月时的腭咽功能。 36 名已修复腭裂的婴儿、18 名正常发育的无腭裂婴儿和 18 名无腭裂但患有中耳疾病的婴儿将从大约 10 至 24 个月大时每两个月进行一次随访。符号语言能力将通过非结构化和结构化游戏进行评估。中耳功能将通过鼓室导抗测试进行评估。鼻塞压力将作为演奏过程中引发的停止辅音的腭咽闭合的指标。在 36 个月和 48 个月时，将通过鼻气流和对感知鼻过度的直接幅度估计来获得腭咽功能的额外测量。将使用离散时间生存和二项式逻辑回归分析来描述儿童相对于停止出现和停止时腭咽闭合的发育轨迹。模型中将包含协变量，以确定中耳状态、语言能力、裂隙类型和性别的相对影响。预计结果将 a) 确定延迟出现停车的原因 在腭裂修复儿童中，b) 提供发育数据以优化行为和/或二次手术干预的时机，c) 进一步验证一种新颖且相对简单的评估程序，以确定幼儿塞音辅音的腭咽闭合情况。