Speech problems in an adult with an untreated, partial cleft palate?

Jack Judah · Jun 2, 2017

Howdy all,

I need some help. My current WIP is an historical set in Ancient Egypt. My MC is known to have had a speech impediment. Sources don't mention what kind, or how severe, or even if it was a lifelong problem, but in the course of my research I've discovered that at least one of his closest relatives suffered from, among a distressingly long list of other congenital issues, a partial cleft palate. I'm told this can run in the genes, and so seems to be a likely explanation for my MC's impediment (I think the genetics line up, though I could be wrong). Now I just have to figure out how to write it.

I've been trying to research what sort of speech problems an adult with an untreated partial cleft palate might have. There's plenty of info out there, but most of it is just technical enough I find myself drowning in a sea of jargon.

So, questions:

1) What sort of problems could my MC expect from a fairly minor partial cleft palate? I'm told there are resonance issues and pronunciation issues. Told in wonderfully precise terms that I'm sure mean volumes for those initiated to their mysteries. But for a schlub like me, I'm lost.

2)What could his family (with no concept of speech therapy) do to alleviate said problems.

3) And finally, I'd like to hear them for myself. I've tried finding videos or at least audio of patients with similar circumstances (because it's hard to write dialogue for something you've never heard), but finding recordings of subjects who haven't had the benefit of at least some surgery or speech therapy is proving challenging.

neandermagnon · Jun 3, 2017

I'm concerned whether there'd be additional problems besides the speech. I just had a quick look and feeding problems in infancy (difficulty suckling) and frequent ear infections, possibly leading to deafness, are common complications of a cleft palate. Set in the time period you're talking about, there's a high likelihood of a child with a cleft palate dying in infancy or early childhood.

That's not to say it's a foregone conclusion that the child would die. An upright feeding posture may help with suckling, albeit that this advice probably comes from formula fed babies, as breastfeeding relies on squeezing the nipple against the roof of the mouth. A mild cleft palate may not result in so much difficulty feeding (presumably so long as there's enough mouth roof there to squash the nipple enough to stimulate milk production, and the milk then goes down the throat rather than into the nose (which will probably eventually find its way to the stomach, but its presence in the nose will increase the risk of ear infection).

Babies who can't suckle will die in early infancy, albeit in ancient Egypt they had agriculture so could have poured animal milk down the kid's throat to stop him or her dying. So it's not implausible that a child could survive with a fairly minor clerft palate.

The Wikipedia page on cleft lip and cleft palate has a lot of info, including with regards to speech sounds, in case you haven't come across it already https://en.wikipedia.org/wiki/Cleft_lip_and_cleft_palate

My 2nd cousin had a medical condition that was similar to this but involved a while load of abnormalities due to the midline not joining properly during embryonic development (same way cleft palate happens, but involving much more of the body). This was a genetic condition and he was affected in more ways than just midline development abnormalities. It's a very rare condition and not listed on the Wikipedia page.

I've heard the speech of someone who has a cleft palate and it sounds very nasal. The whole resonance of the speech is different. It's hard to describe. My 2nd cousin had severe speech issues, somewhat due to the physical problems but much more due to mental handicap, as his condition affected the development of the brain. The resonance of his voice was very different to other children and you could recognise his voice on a crowded street without being able to see him, because it was unique.

Jack Judah · Jun 3, 2017

neandermagnon said:
Babies who can't suckle will die in early infancy, albeit in ancient Egypt they had agriculture so could have poured animal milk down the kid's throat to stop him or her dying. So it's not implausible that a child could survive with a fairly minor clerft palate.

I would assume common children born with a cleft would've been mostly doomed, infant mortality being high as it already was. But King Tut survived a minor cleft palate. He's actually the aforementioned close relative to my MC. (Or at least that's my story and I'm sticking to it, Egyptologists might beg to differ on the matter of pedigree.)

Interestingly enough, there are several legends about my MC going through several wetnurses and refusing to suckle. Eventually a special nurse had to be found. I'd not connected those stories to the speech impediment until I made the cleft palate connection. When I did make the connection, I almost did the snoopy dance, I was so excited by the unexpected correlation!

The Wikipedia page on cleft lip and cleft palate has a lot of info, including with regards to speech sounds, in case you haven't come across it already https://en.wikipedia.org/wiki/Cleft_...d_cleft_palate

That was my first stop. Made a great starting point, but I'm still hoping to be able to hear some samples. I can't quite wrap my head around what it would sound like.

I've heard the speech of someone who has a cleft palate and it sounds very nasal. The whole resonance of the speech is different. It's hard to describe. My 2nd cousin had severe speech issues. . .The resonance of his voice was very different to other children and you could recognise his voice on a crowded street without being able to see him, because it was unique.

Ooh, I REALLY like the idea of a voice that's so unique it's instantly recognizable even in a crown. That could come in extremely handy for my MC. When you say nasal, do you mean nasal like helium-voice or nasal like badly stuffed sinuses? Is it high pitched, reedy, or breathy? Or a combination thereof?

frimble3 · Jun 3, 2017

Don't know where you are in Colorado, but is there a chance you could get in touch with a speech pathologist, therapist or such, who might have sample tapes? I imagine patient privacy wouldn't let you access actual patients, but I'm thinking they might have something to demonstrate to parents what their child might sound like without intervention. They might also be able to offer further information.

neandermagnon · Jun 4, 2017

Jack Judah said:
I would assume common children born with a cleft would've been mostly doomed, infant mortality being high as it already was. But King Tut survived a minor cleft palate. He's actually the aforementioned close relative to my MC. (Or at least that's my story and I'm sticking to it, Egyptologists might beg to differ on the matter of pedigree.)

Interestingly enough, there are several legends about my MC going through several wetnurses and refusing to suckle. Eventually a special nurse had to be found. I'd not connected those stories to the speech impediment until I made the cleft palate connection. When I did make the connection, I almost did the snoopy dance, I was so excited by the unexpected correlation!

I'd consider that pretty good evidence. There are other conditions that could cause both feeding problems and speech problems, but if there's other evidence of cleft palate, the above definitely fits the picture.

If suckling was that difficult for the baby, then pouring animal milk down their throat would be an option, as long as you're in the economic position to secure enough animal milk. There would be a high risk of gastroenteritis from this though. Even modern formula feeding carries a higher risk of gastroenteritis than breastfeeding. But it's not implausible that a rich infant could survive all this. And although there's a high risk of ear infection from uncorrected cleft palate, ear infections aren't necessarily fatal, and don't always lead to deafness either. The current NHS advice that the majority of ear infections get better on their own and don't require antibiotics.

That was my first stop. Made a great starting point, but I'm still hoping to be able to hear some samples. I can't quite wrap my head around what it would sound like.

https://www.youtube.com/watch?v=sW7UAY30i-w&t=216s I found this video on you tube about speech therapy for kids with cleft palate. The nasal emission thing is what I was trying to describe. This happens due to the hole in the palate, i.e. air going between the mouth and nose through the cleft. The speech therapy techniques are for kids who've had the cleft repaired. The video explains lots about it and the therapist demonstrates what nasal emission speech sounds like. Your MC would always sound like that because it's impossible to make many sounds before the cleft is repaired.

Ooh, I REALLY like the idea of a voice that's so unique it's instantly recognizable even in a crown. That could come in extremely handy for my MC. When you say nasal, do you mean nasal like helium-voice or nasal like badly stuffed sinuses? Is it high pitched, reedy, or breathy? Or a combination thereof?

Hopefully the video above explains what I meant by nasal. It's literally speaking through the nose (i.e. sound coming out of the nose instead of the mouth).

Regarding my 2nd cousin, there was more going on with his vocal tract than just a cleft palate. He wouldn't have survived even a few days after being born without medical intervention.

That said, with far fewer babies with cleft palates surviving during the period you're writing about, there'd be much fewer people who'd have the same speech problems, so your MC's voice would be distinctive. If you're drawing parallels with him and with a king who also had a minor cleft palate, then people would hear the similarities in the speech patterns, i.e. he'd sound just like this king.

AFAIK cleft palate is mostly due to environmental factors, not genetic factors, but it can be part of a genetic syndrome and there can be interplay between genetics and environment (e.g. a genetic predisposition that doesn't happen unless environmental things also happen). I'd be interested what other medical issues the relative (the king?) had, i.e. whether he had a genetic syndrome. Them both having a cleft palate isn't proof they were related (but that doesn't mean they weren't related). Having the same genetic syndrome would make it likely that they were related, if it's one that's hereditary (as opposed to ones like Down's Syndrome where a fertilised egg randomly has an extra chromosome)

Jack Judah · Jun 4, 2017

neandermagnon said:
I'd consider that pretty good evidence. There are other conditions that could cause both feeding problems and speech problems, but if there's other evidence of cleft palate, the above definitely fits the picture.

There definitely is a lot of circumstantial evidence pointing that direction. Little hints, mainly, almost all of which mean nothing on their own. But when you combine them, they start to paint a pretty clear picture: My MC was purportedly born prematurely; even after several months, his mother seems to have been worried he wasn't viable; later, we have mention of a wetnurse issue; then in adulthood he was denied the priesthood (with the only likely reason being a physical defect of some sort); and he was known to have a speech impediment. All told, I think I'm justified when I kick off my boots, jump up from my desk and :snoopy:

Not going to lie, it's the opportunity to connect these kind of neglected dots that keeps me writing historical fiction. I love the eureka moments!

If suckling was that difficult for the baby, then pouring animal milk down their throat would be an option, as long as you're in the economic position to secure enough animal milk.

This is a great detail. Great enough I'm making sure it goes into the book. Even have a scene where it will fit perfectly.

And although there's a high risk of ear infection from uncorrected cleft palate, ear infections aren't necessarily fatal, and don't always lead to deafness either.

My MC supposedly had a temper. Makes me wonder if his random bouts of murder and genocide weren't due to splitting headaches/ear aches!

https://www.youtube.com/watch?v=sW7UAY30i-w&t=216s I found this video on you tube about speech therapy for kids with cleft palate. The nasal emission thing is what I was trying to describe.

This helped a lot. The other videos in the series look promising as well. Thanks!

That said, with far fewer babies with cleft palates surviving during the period you're writing about, there'd be much fewer people who'd have the same speech problems, so your MC's voice would be distinctive. If you're drawing parallels with him and with a king who also had a minor cleft palate, then people would hear the similarities in the speech patterns, i.e. he'd sound just like this king.

When my MC makes a play to reclaim his birthright, this detail will come in extremely handy. In fact, my mind fairly boggles with all the ways I can use this!

AFAIK cleft palate is mostly due to environmental factors, not genetic factors, but it can be part of a genetic syndrome and there can be interplay between genetics and environment (e.g. a genetic predisposition that doesn't happen unless environmental things also happen). I'd be interested what other medical issues the relative (the king?) had, i.e. whether he had a genetic syndrome.

Poor Tutankhamun. King Tut's parents were siblings, so inbreeding (multi-generational most likely) played a big role in him getting the short end of the genetic stick. Beyond the mild cleft palate, the latest DNA work and scans confirm he had Kohler Disease, mild kyphoscoliosis, a hypophalangism of the right foot, and was suffering from a roaring case of juvenile aseptic bone necrosis and recurring bouts of malaria. By the time of his death at 18ish, the necrosis and hypophalangism had led to such a badly clubbed foot, he couldn't walk on his own.

Beyond the scoliosis and hypophalangism, additional evidence of genetic abnormalities is hinted at, but so far, I haven't been able to find specifics. I do know he was buried with the mummies of two premature infants, his children by his sister. So we know all the inbreeding was definitely starting to have serious repercussions.

My MC has the benefit of slightly more diverse breeding, but his mother was Tut's half sister and herself the product of several incestuous unions. I'd diagram the family tree to clarify, but the last time I tried untwisting that jumble of perverted pairings, I ended up pulling most of my hair out and polishing off a bottle of bourbon before running down the street babbling incoherently about mummies' mommies. Let's just say that family was inordinately fond of one another and that just about everybody only had to worry about visiting one Grandma come the holidays.

So with all of that said, I'm assuming my MC would've been subject to some issues at least from all of the bad genes floating around, not to mention God knows what else considering his father's family had their own history of keeping it in the family.

Jack Judah · Jun 4, 2017

frimble3 said:
Don't know where you are in Colorado, but is there a chance you could get in touch with a speech pathologist, therapist or such, who might have sample tapes? I imagine patient privacy wouldn't let you access actual patients, but I'm thinking they might have something to demonstrate to parents what their child might sound like without intervention. They might also be able to offer further information.

I really probably should have thought of doing this. An excellent suggestion. Thanks frimble!

neandermagnon · Jun 5, 2017

Jack Judah said:
Not going to lie, it's the opportunity to connect these kind of neglected dots that keeps me writing historical fiction. I love the eureka moments!

I can totally understand that.

This is a great detail. Great enough I'm making sure it goes into the book. Even have a scene where it will fit perfectly.

Something that's just occurred to me today... it's possible to express human milk by hand (i.e. without a pump). You'd need a clean beaker (or similar container) for feeding the baby and express the milk directly into the beaker, then feed it to the baby. Of course, supplementation with animal milk is also likely, given that it's not very efficient to hand-express breast milk.

I've found a couple of videos that show how to cup feed premature babies or babies with other medical issues that mean they can't suckle yet. The second video is intended for health workers in developing countries, i.e. where there may not be access to high tech equipment. It also shows different kinds of feeding cups - you'd know whether any of them would be plausible given the technological level of your characters.

https://www.youtube.com/watch?v=o01U_i2CDFw

https://www.youtube.com/watch?v=OkhSJ16FHfY

The above techniques don't require suction so a baby with a cleft palate would be able to feed this way even if they can't suckle.

My MC supposedly had a temper. Makes me wonder if his random bouts of murder and genocide weren't due to splitting headaches/ear aches!

It could very well be a contributing factor. Also, I would suspect that he would've had to deal with frustration due to finding it hard to communicate. There are a lot of sounds that can't be made with an unrepaired cleft palate. And even if he's of a high social status, he'd probably still have to deal with ignorance and prejudice, and without the knowledge of science/medicine to explain to people what's wrong.

Poor Tutankhamun. King Tut's parents were siblings, so inbreeding (multi-generational most likely) played a big role in him getting the short end of the genetic stick. Beyond the mild cleft palate, the latest DNA work and scans confirm he had Kohler Disease, mild kyphoscoliosis, a hypophalangism of the right foot, and was suffering from a roaring case of juvenile aseptic bone necrosis and recurring bouts of malaria. By the time of his death at 18ish, the necrosis and hypophalangism had led to such a badly clubbed foot, he couldn't walk on his own.

Beyond the scoliosis and hypophalangism, additional evidence of genetic abnormalities is hinted at, but so far, I haven't been able to find specifics. I do know he was buried with the mummies of two premature infants, his children by his sister. So we know all the inbreeding was definitely starting to have serious repercussions.

My MC has the benefit of slightly more diverse breeding, but his mother was Tut's half sister and herself the product of several incestuous unions. I'd diagram the family tree to clarify, but the last time I tried untwisting that jumble of perverted pairings, I ended up pulling most of my hair out and polishing off a bottle of bourbon before running down the street babbling incoherently about mummies' mommies. Let's just say that family was inordinately fond of one another and that just about everybody only had to worry about visiting one Grandma come the holidays.

So with all of that said, I'm assuming my MC would've been subject to some issues at least from all of the bad genes floating around, not to mention God knows what else considering his father's family had their own history of keeping it in the family.

It's hard to speak of genetic syndromes when someone's that inbred (i.e. parents are full siblings) because it's likely it's not just one bad gene that they've got two copies of. So you could be talking two or three genetic illnesses all at once.

First cousin marriage is a lot less risky. Full siblings share on average 50% of their DNA (very high chance of getting 2 copies of a bad gene) while first cousins only share 12.5% (higher risk than the general population, but not that bad). Some bad genes are fairly mild if you get one copy (as opposed to being an asymptomatic carrier, as is the case if the gene's recessive, which is more common as recessive genes evade natural selection for longer) but a lot more serious if you get two copies. It could be the case that your MC got 1 copy of a bad gene that the king got 2 copies of. This is all speculation though, and probably not that relevant to your story beyond the fact that it's totally plausible that your MC has what appears to be a milder version of whatever the King had.

Jack Judah · Jun 6, 2017

neandermagnon said:
I would suspect that he would've had to deal with frustration due to finding it hard to communicate. There are a lot of sounds that can't be made with an unrepaired cleft palate. And even if he's of a high social status, he'd probably still have to deal with ignorance and prejudice, and without the knowledge of science/medicine to explain to people what's wrong.

The opportunities for added conflict and depth have me very excited. As I have him currently written, he's rather flat and trite. But I do think the cleft palate might be the key to his character. Soon as I lit on it, my immediate thought was, "well, that explains a lot." He's a profoundly alienated soul on page 1. Now I know how he got that way.

Now I just have to figure out how to rewrite his dialogue in a non-offensive, accurate, readable way. That should be an interesting challenge, especially since he's currently a loquacious bugger. Something tells me I'm going to need more bourbon.

Speech problems in an adult with an untreated, partial cleft palate?

Jack Judah

Lost somewhere on the Nile

neandermagnon

Nolite timere, consilium callidum habeo!

Jack Judah

Lost somewhere on the Nile

frimble3

Heckuva good sport

neandermagnon

Nolite timere, consilium callidum habeo!

Jack Judah

Lost somewhere on the Nile

Jack Judah

Lost somewhere on the Nile

neandermagnon

Nolite timere, consilium callidum habeo!

Jack Judah

Lost somewhere on the Nile