腭裂患者语音清晰度多学科评估标准指南

Multidisciplinary assessment criteria and guidelines for speech intelligibility in patients with cleft palate

周海燕;陈仁吉;时秀娟;周晖;张天虹;蒋莉萍;宋涛;张文婧;李霄;辛凤;徐志恒;马田雨;张青;唐丽华;郭伟光;刘美姣;杨雯雯;张苏苏;关明;吕萌;魏嘉宁;钟灿;郭瑞华;胡雯茜;张婉露

1:哈尔滨医科大学附属第一医院哈尔滨医科大学口腔医学院

2:中国康复医学会言语康复委员会首都医科大学附属北京口腔医院言语康复治疗中心

3:山东大学外国语学院山东大学临床神经语言学研究中心

4:四川大学华西第二医院

摘要
<正>世界卫生组织(World Health Organization,WHO)发布的关于口腔卫生的报道中提出:颌面及唇腭裂是口腔颌面部最常见的先天性发育畸形,全球患病率为1/1 500~1/1 000(颌面及唇腭裂患者/被观察总人口),我国唇腭裂的发病率约1.82‰~([1]),术后由于腭咽闭合不全(velopharyngeal insufficiency,VPI)导致语音障碍的发病率为25.00%~50.00%,神经生理调控障碍中因中枢神经系统异常出现运动失调型语音障碍的发生率为15.00%~([2]),而合并语言障碍的发生率为28.00%~([3]),唇腭裂儿童更容易被诊断为精神、智力、语言障碍。研究显示腭裂患者中88.38%存在中重度听力损失,且未经治疗的中耳炎是导致听力损失的重要因素~([4])。嗓音障碍的发病率约为6.60%,其中腭裂儿童约占40.00%~60.00%~([5])。中国腭裂青少年患有心理疾病的概率更高且生活质量更差,抑郁程度也更严重,具有更多的行为与情绪问题~([6]),腭裂语音清晰度低下则是引起心理障碍的主要因素。腭裂语音清晰度是评估沟通障碍严重程度和治疗效果的关键指标~([7])。
关键词
基金项目(Foundation):
黑龙江省残疾人福利基金会横向课题(2022IIT141);; 四川省科技厅基金(24ZDYF0141);; 黑龙江省语言文字委员会科研项目(G2025Q003)
作者
周海燕;陈仁吉;时秀娟;周晖;张天虹;蒋莉萍;宋涛;张文婧;李霄;辛凤;徐志恒;马田雨;张青;唐丽华;郭伟光;刘美姣;杨雯雯;张苏苏;关明;吕萌;魏嘉宁;钟灿;郭瑞华;胡雯茜;张婉露
参考文献

[1]陈仁吉.我国言语障碍康复治疗发展历程与现状[J].中国听力语言康复科学杂志,2025,23(4):348-351.

[2]THOPPIL M G,KUMAR C S,KUMAR A,et al.Speech signal analysis and pattern recognition in diagnosis of dysarthria[J].Ann Indian Acad Neurol,2017,20(4):352-357.

[3]刘雪曼.儿童语言障碍与语言评估[J].中国听力语言康复科学杂志,2019,17(3):161-165.

[4]娄群,朱洪平,罗奕,等.腭裂术后患者的中耳功能及听力状况分析[J].实用口腔医学杂志,2018,34(3):377-379.

[5]张春光,赵志宇,么远,等.腭裂术后语音障碍患儿的语音清晰度及言语康复治疗效果分析[J].口腔颌面外科杂志,2021,31(5):314-318.

[6]ZONG Y,CHENG X,XIA W,et al.The correlation between osa-related quality of life and two mental statuses in adolescent chinese patients with cleft palate:a comprehensive study[J].Front Pediatr,2022,10:985375.

[7]陈仁吉.语言康复指南[M].北京:人民卫生出版社,2023:154-154.

[8]陈耀龙,杨克虎,王小钦,等.中国制订/修订临床诊疗指南的指导原则(2022版)[J].中华医学杂志,2022,102(10):697-703.

[9]TILLMAN K K,HAKELIUS M,H?IJER J,et al.Increased risk for neurodevelopmental disorders in children with orofacial clefts[J].J Am Acad Child Adolesc Psychiatry,2018,57(11):876-883.

[10]GALLAGHER E R,COLLETT B R.Neurodevelopmental and academic outcomes in children with orofacial clefts:a systematic review[J].Pediatrics,2019,144(1):20184027.

[11]COSTA B,WHITE P,KIFF J D,et al.Parent-reported socioemotional and cognitive development in children with a cleft lip and/or palate at 18 months:findings from a uk birth cohort[J].Child Care Health Dev,2021,47(1):31-39.

[12]FERAGEN K B,AUKNER R,S?RVOLD T K,et al.Speech,language,and reading skills in 10-year-old children with palatal clefts:the impact of additional conditions[J].JCommun Disord,2017,66:1-12.

[13]JURADO M R B,CAVALHEIRO M G,DE CASTROCORRêA C,et al.Global and communicative development skills in preschool children with cleft lip and palate[J].Pediatr Investig,2021,5(1):33-37.

[14]DUCKETT K A,POUPORE N S,CARROLL W W,et al.Preoperative imaging in patients with 22q11 deletion syndrome undergoing velopharyngeal surgery[J].Laryngoscope,2023,134(6):2551-2561.

[15]KIMIA R,SOLOT C B,MCCORMACK S M,et al.Speech outcomes following operative management of velopharyngeal dysfunction(VPD)in non-syndromic post-palatoplasty cleft palate patients[J].Cleft Palate Cran J,2023,61(6):1007-1017.

[16]SMETONA J T,NARAN S,FORD M,et al.What's new in cleft palate and velopharyngeal dysfunction management:an update[J].Plast Reconstr Surg,2024,154(2):378-390.

[17]SITZMAN T J,WILLIAMS J L,SINGH D J,et al.Magnetic resonance imaging of the velopharynx:clinical findings in patients with velopharyngeal insufficiency[J].Plast Reconstr Surg,2024,153(6):1155-1168.

[18]WILLIAMS J L,PERRY J L,SNODGRASS T D,et al.Can MRI replace nasopharyngoscopy in the evaluation of velopharyngeal insufficiency?[J].Cleft Palate Craniofac J,2025,62(7):1093-1102.

[19]MANGAL M,KUMAR P,MUNJAL S,et al.Endoscopic evaluation of velopharyngeal function in cleft lip palate patients-a correlation with speech analysis[J].J Plast Reconstr Aesthet Surg,2023,77:170-176.

[20]SULLIVAN S R,TAYLOR H O B,STILES E,et al.Ideofluoroscopy versus nasopharyngoscopy of lateral pharyngeal wall movement for assessment of velopharyngeal insufficiency[J].J Craniofac Surg,2023,34(1):40-44.

[21]SNODGRASS T D,SITZMAN T J,CHEE-WILLIAMS JL,et al.Factors that limit evaluation of velopharyngeal closure during nasopharyngoscopy[J].Cleft Palate Craniofac J,2025,62(2):300-308.

[22]ZHANG S,WANG T,TANG L,et al.Assessment methods and intervention strategies for cleft-related lateral misarticulation in Chinese-speaking children[J].J Craniofac Surg,2024,35(5):1523-1530.

[23]PENCEK M E,LOSEE J E.Cleft palate[J].Clin Plast Surg,2025,52(2):157-177.

[24]SAINSBURY D C G,WILLIAMS C C,BUTTERWORTHS,et al.Patient factors influencing speech outcomes in velopharyngeal function following initial cleft palate repair:a systematic review and meta-analysis[J].Cleft Palate Cran J,2024,61(12):2022-2037.

[25]SULLIVAN N A T,SIJTSEMA V,LACHKAR N,et al.Velopharyngeal insufficiency after cleft palate repair in patients with isolated robin sequence versus isolated cleft palate:a systematic review[J].JPRAS Open,2024,42:58-80.

[26]JEON S,IANG J,HONG Y H,et al.Assessing the impact of palatal fistula formation and cleft width on speech outcomes following double opposing z-plasty in patients with cleft palate[J].J Plast Reconstr Aes,2024,98:103-111.

[27]RAPOSO-AMARAL C E,GIL A,SABBAG A,et al.Speech outcome audit for cleft lip and palate patient population correlated with veau cleft type,surgical repair technique,and patient age[J].J Craniofac Surg,2025,36(3):866-869.

[28]GARG S P,CHWA E S,REDDY N K,et al.Distribution of specialties providing surgical management of cleft-related speech disorders in children 3years of age and older:2004to 2021[J].J Craniofac Surg,2025,36(1):61-65.

[29]SITZMAN T J,BAYLIS A L,PERRY J L,et al.Protocol for a prospective observational study of revision palatoplasty versus pharyngoplasty for treatment of velopharyngeal insufficiency following cleft palate repair[J].Cleft Palate Craniofac J,2024,61(5):870-881.

[30]彭兆伟,钟天航,韩剑丽,等.头颅定位侧位片与鼻咽纤维镜评价腭咽闭合不全的效果评价[J].中国口腔颌面外科杂志,2020,18(3):245-249.

[31]BOWER C,REILLY B K,RICHERSON J,et al.Hearing assessment in infants,children,and adolescents:recommendations beyond neonatal screening[J].Pediatrics,2023,152(3):2023063288.

[32]国家卫生和计划生育委员会新生儿疾病筛查听力诊断治疗组.婴幼儿听力损失诊断与干预指南[J].中华耳鼻咽喉头颈外科杂志,2018,53(3):181-188.

[33]YANCEY K L,CHEROMEI L J,MUHANDO J,et al.Pediatric hearing screening in low-resource settings:incorporation of video-otoscopy and an electronic medical record[J].Int J Pediatr Otorhinolaryngol,2019,126:109633.

[34]LIPSCHITZ N,KOHLBERG G D,SCOTT M,et al.Imaging findings in pediatric single-sided deafness and asymmetric hearing loss[J].Laryngoscope,2020,130(4):1007-1010.

[35]SORGE I,HIRSCH F W,FUCHS M,et al.Imaging in children with hearing loss[J].Rofo,2023,195(10):896-904.

[36]ALMAKADMA H,AITHAL S,AITHAL V,et al.Use of wideband acoustic immittance in neonates and infants[J].Semin Hear,2023,44(1):29-45.

[37]REYNARD P,MONTERO M,ALHAMWI A,et al.Contribution of bone conduction click-evoked auditory brainstem responses to diagnosis of hearing loss in infants in France[J].Eur Ann Otorhinolaryngol Head Neck Dis,2021,138(3):159-162.

[38]ORMUNDO D D S,LEWIS D R.Auditory brainstem response with click and CE-Chirp?level specific stimuli in hearing infants[J].Int J Pediatr Otorhinolaryngol,2021,147:110819.DOI:10.1016/j.ijporl.2021.110819

[39]RANCE G,TOMLIN D,GRAYDON K.Tone-burst elicited auditory brainstem responses in full-term and pre-term infants[J].Int J Audiol,2025,64(4):384-391.

[40]KOCO'NS,SKóRKIEWICZ K,STR K P,et al.Stability of ABR wave V threshold in early hearing diagnostics in children from selected groups at risk of congenital hearing loss[J].Otolaryngol Pol,2020,75(1):7-15.

[41]周佳霖,刘大波,黄振云,等.极重度感音神经性听力损失婴幼儿短纯音听性脑干反应与CE-Chirp听觉稳态反应的对比研究[J].中华耳鼻咽喉头颈外科杂志,2015,50(7):551-555.

[42]EHRMANN-MüLLER D,SHEHATA-DIELER W,ALZOUBI A,et al.Using assr with narrow-band chirps to evaluate hearing in children and adults[J].Eur Arch Otorhinolaryngol,2021,278(1):49-56.

[43]ROSE J,FLAHERTY M,BROWNING J,et al.Puretone frequency discrimination in preschoolers,young school-age children,and adults[J].J Speech Lang Hear Res,2018,61(9):2440-2445.

[44]SKOLOUDIK L,MEJZLIK J,JANOUCH M,et al.Hearing screenings for preschool children:a comparison between whispered voice and pure tone audiogram tests[J].Int J Pediatr Otorhinolaryngol,2020,130:109798.DOI:10.1016/j.ijporl.2019.109798

[45]COUDERT A,REILLY K T,TRUY E,et al.A new tool for the assessment of speech understanding and spatial hearing difficulties in children:the kid-SSQ questionnaire[J].Eur Arch Otorhinolaryngol,2023,280(8):3557-3566.

[46]刘莎,董瑞娟.小儿行为测听(3)[J].听力学及言语疾病杂志,2017,25(1):109-110.

[47]刘莎,董瑞娟.小儿行为测听(5)[J].听力学及言语疾病杂志,2017,25(3):331-332.

[48]刘莎,董瑞娟.小儿行为测听(7)[J].听力学及言语疾病杂志,2017,25(5):555-556.

[49]林少莲,林有辉,舒博,等.不同程度感音神经性听力损失儿童ASSR、click-ABR反应阈与行为听阈的相关性[J].听力学及言语疾病杂志,2022,30(1):46-49.

[50]STACHLER R J,FRANCIS D O,SCHWARTZ S R,et al.Clinical practice guideline:hoarseness (dysphonia)(update)[J].Otolaryngol Head Neck Surg,2018,158:1-42.

[51]YAGCIOGLU D,AYDINLI F E,ASLAN G,et al.Development,validation,and reliability of the teacher-reported pediatric voice handicap index[J].Lang Speech Hear Serv Sch,2022,53(1):69-87.

[52]刘恒鑫,王华,郝建萍,等.儿童嗓音障碍行为学干预的研究进展[J].听力学及言语疾病杂志,2024,32(2):176-181.

[53]PAN Z,QIU Z,MA T,et al.Parents'perceptions of and attitudes toward voice therapy[J].J Voice,2023.DOI:10.1016/j.jvoice.2023.05.015.

[54]刘思维,邵骏.嗓音声学分析方法的研究现状[J].临床耳鼻咽喉头颈外科杂志,2022,36(12):966-970,976.

[55]FANTINI M,CIRAVEGNA G,KOUDOUNAS A,et al.The rapidly evolving scenario of acoustic voice analysis in otolaryngology[J].Cureus,2024,16(11):73491.DOI:10.7759/cureus.73491.

[56]INCEBAY?,K?SE A,ESEN AYDINLI F,et al.The effects of age and gender on laryngeal aerodynamics in the children population[J].J Voice,2020,34(2):300.27-300.46.

[57]陈宇翔,黄群,闫怡轩,等.569例唇腭裂规范化序列治疗推广效果追踪评价[J].武汉大学学报(医学版),2022,43(5):817-821.

[58]LIMA S L,RIBEIRO S G,AQUINO D N S,et al.Prevalence of depressive symptoms in patients with cleft lip and palate[J].Brazilian Journal of Otorhinolaryngology,2015,81(2):177-183.

[59]刘华,庞允婷,陈涌,等.65例7~15岁唇腭裂儿童心理状况调查[J].昆明医科大学学报,2018,39(3):81-84.

[60]COOK B,VAN BOCKSTAEKE S,CROW S B,et al.Neurodevelopmental disorders in children with cleft lip and palate:a systematic review[J].Eur Child Adolesc Psychiatry,2025,34(6):1731-1738.

[61]KIM D H,JEONG J W,KANG D,et al.Usefulness of automatic speech recognition assessment of children with speech sound disorders:validation study[J].J Med Internet Res,2025,27:60520.

[62]LINDEBORG M M,SHAKYA P,RAI S M,et al.Optimizing speech outcomes for cleft palate[J].Curr Opin Otolaryngol Head Neck Surg,2020,28(4):206-211.

[63]闵志云,李峰,徐丽娜,等.腭裂术后塞音构音障碍患者的语音特点及康复训练[J].听力学及言语疾病杂志,2019,27(5):472-476.

[64]古力孜巴·艾海提,张鹏鑫,齐佳,等.腭裂术后腭咽闭合不全患者面部扭曲行为与腭咽闭合程度的关系[J].口腔医学研究,2023,39(8):696-700.

[65]艾皮孜古丽·亚库普,亚尔肯·阿吉,吴言辉,等.腭裂术后患者发音时表情扭曲与构音的关系研究[J].国际口腔医学杂志,2021,48(3):263-268.

[66]李杨,尹恒.腭裂语音评估与治疗[M].北京:人民军医出版社,2015:110-112.

[67]LANCASTER H S,LIEN K M,CHOW J C,et al.Early speech and language development in children with nonsyndromic cleft lip and/or palate:a meta-analysis[J].J Speech Lang Hear Res,2019,63(1):14-31.