Vol. 13 No. 2 (2021): Archives of Public Health
Public Health

Changes in voice quality of the children with cleft/lip in relation to children without anomaly

Mira Jovanovska
Institute for Rehabilitation of Hearing, Speech and Voice , Skopje, Republic of North Macedonia
Mirjana Petrovikj-Lazikj
University of Belgrade, Faculty of Special Education and Rehabilitation, Serbia
Vesna Lazarovska
Institute for Rehabilitation of Hearing, Speech and Voice, Skopje, Repiblic of North Macedonia

Published 2021-11-20


  • voice,
  • cleft palate/lip,
  • changes in voice quality,
  • speech

How to Cite

Jovanovska M, Petrovikj-Lazikj M, Lazarovska V. Changes in voice quality of the children with cleft/lip in relation to children without anomaly. Arch Pub Health [Internet]. 2021 Nov. 20 [cited 2022 Dec. 7];13(2):30-8. Available from: https://id-press.eu/aph/article/view/6005


Children with cleft palate/lip are exposed to risk for verbal communication disorders that include resonance, articulation, voice disorders, and expressive language. The aim of this paper was to evaluate the changes in the voice quality of the children with cleft palate in relation to children without anomaly. The study included 52 participants, 26 with previously corrected cleft palate / lip, and 26 respondents without anomaly who are between 3 and 6 years old. Subjective assessment of voice quality was performed by using the GRBAS scale. Perceptual scales are important in assessing the voice quality, determining the degree and severity of voice disturbance, and deciding on further clinical procedures. Although the instrumental approach to voice examination is relevant because it provides objectivity, the subjective impression in assessing voice quality is crucial. Statistical processing was performed by groups, group structure (gender and age), a certain highest value, as well as percentage participations. The results showed that 50% of the participants were diagnosed with certain changes in the voice. Children aged 3-5 years have a 2.25 times higher incidence of voice changes than children aged 6-8 years. The largest number of participants belong to group 0 - There is no change in voice quality which represents as much as 50% of the total number of patients in the first group. While "3 - Pronounced changes in the voice" were not identified in the respondents aged 3-5 years. In 50% of the total number of participants there is no change in voice quality and these are located in girls aged 3-5 years.


Download data is not yet available.


  1. Petrović-Lazić, M., Kosanović, R. Vokalna rehabilitacija glasa. Beograd: Nova naučna 2008
  2. Bolfan Stošić, N, Zorić, A. Higiena dečjeg glasa – Uputstva za rad kod kuće i razvijanje higijene dečjeg glasa. Zagreb: Hrvatsko logopedsko društvo 1997.
  3. Boone DR, McFarlane SC. The voice and voice therapy, 6th edition. Needham Heights: Pearson Education Co. 2000.
  4. Dembitz A. Glasinje gove promjene. Znanstveno-stručni simpozij – Logopedija: jučer, danas,sutra. Zagreb: Hrvatsko logopedsko društvo 2012.
  5. Parčina, M. Poremećaji glasa predškolskog uzrasta – dječja promuklost, U: Hrvatsko logopedsko društvo – Podružnica Splitsko-dalmatinske županije, Logopedski vodič Splitsko- dalmatinske županije (11-13). Split: HLD 2019
  6. Peterson-Falzone S, Hardin-Jones M, Karnell M.. Cleft Palate Speech (3rd ed.) St. Louis (M): Mosby, Inc. 2001.
  7. Brøndsted K, Liisberg WB, Orsted A, Prytz S, Fogh-Andersen P. Surgical and speech results following palatopharyngoplasty operations in Denmark 1959-1977. Cleft Palate J 1984;21(3):170-179.
  8. Timmons MJ, Wyatt RA, Murphy T. Speech after repair of isolated cleft palate and cleft lip and palate. Br J Plast Surg 2011;54(5):377-384.- DOI: https://doi.org/10.1054/bjps.2000.3599
  9. Hocevar-Boltezar I, Jarc A, Kozelj V. Ear, nose and voice problems in children with orofacial clefts. J Laryngol Otol 2006;120(4):276-281. DOI: https://doi.org/10.1017/S0022215106000454
  10. McWilliams BJ, Lavorato AS, Bluestone CD. Vocal cord abnormalities in children with velopharyngeal valving problems. Laryngoscope 1973;83(11):1745- 1753. DOI: https://doi.org/10.1002/lary.5540831101
  11. Seyfer AE, Simon CD. Long-term results following the repair of palatal clefts: a comparison of three different techniques. Plast Reconstr Surg 1989;83(5): 785-792. DOI: https://doi.org/10.1097/00006534-198905000-00003
  12. Van Lierde KM, Claeys S, De Bodt M, Van Cauwenberge P. Vocal quality characteristics in children with cleft palate: a multiparameter approach. J Voice 2004; 18(3):354-362. DOI: https://doi.org/10.1016/j.jvoice.2003.12.006
  13. Lewis JR, Andreassen ML, Leeper HA, Macrae DL, Thomas J. Vocal characteristics of children with cleft lip/palate and associated velopharyngeal incompetence. J Otolaryngol 1993;22(2):113-117.
  14. Grunwell P, Brondsted K, Henningsson G, et al. A six-centre international study of the outcome of treatment in patients with clefts of the lip and palate: the results of a cross-linguistic investigation of cleft palate speech. Scand J Plast Reconstr Surg Hand Surg 2000; 34(3):219-229. DOI: https://doi.org/10.1080/02844310050159792
  15. D’Antonio LL, Muntz HR, Province MA, Marsh JL. Laryngeal/voice findings in patients with velopharyngeal dysfunction. Laryngoscope 1988; 98(4):432- 438. DOI: https://doi.org/10.1288/00005537-198804000-00016
  16. Leder SB, Lerman JW. Some acoustic evidence for vocal abuse in adult speakers with repaired cleft palate. Laryngoscope 1985; 95(7, pt 1):837-840. DOI: https://doi.org/10.1288/00005537-198507000-00017
  17. Hamming KK, Finkelstein M, Sidman JD. Hoarseness in children with cleft palate. Otolaryngol Head Neck Surg 2009;140(6):902-906. DOI: https://doi.org/10.1016/j.otohns.2009.01.036
  18. Webb AL, Carding PN, Deary IJ, MacKenzie K. The reliability of three perceptual evaluation scales for dysphonia. European Archives of Otorhinolaryngology 2004; 261:429-434 DOI: https://doi.org/10.1007/s00405-003-0707-7
  19. Villafuerte-Gonzalez R, Valadez-Jimenez VM, Hernandez-Lopez X, Ysunza PA. Acoustic analysis of voice in children with cleft palate and velopharyngeal insufficiency. Int J Pediatr Otorhinolaryngol 2015; 79(7):1073-6. DOI: https://doi.org/10.1016/j.ijporl.2015.04.030
  20. Bonetti A. Perceptivna procjena glasa. Hrvatska revija za rehabilitacijska istraživanja 2011; 47(1), 64-71
  21. Chan K. & Yiu E M L. A comparison of two perceptual voice evaluation training programs for naive listeners. Journal of Voice 2006; 20(2): 229–241. DOI: https://doi.org/10.1016/j.jvoice.2005.03.007
  22. De Bodt MS, Wuyts FL, Van de Heyning PH, Croux C. Test-retest study of the GRBAS scale: influence of experience and professional background on perceptual rating of voice quality. J Voice 1997;11(1):74-80. DOI: https://doi.org/10.1016/S0892-1997(97)80026-4
  23. Zraick RI, Kempster GB, Connor NP, et al. Establishing validity of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Am J Speech Lang Pathol 2011;20(1):14–22. DOI: https://doi.org/10.1044/1058-0360(2010/09-0105)
  24. Baylor C R, Yorkston K M, Eadie T L, Strand E A, Duffy J. A systematic review of outcome measurement in unilateral vocal fold paralysis. Journal of Medical Speech-Language Pathology 2006; 14(1), 1–33.
  25. Kreiman J, Gerratt B. Reconsidering the Nature of Voice. In: Frühholz S, Belin P, editors. The Oxford Handbook of Voice Perception. Oxford University Press; 2019. DOI: https://doi.org/10.1093/oxfordhb/9780198743187.013.8