Q: My son is 22 months old. He has undergone surgery for both cleft lip and palate. Now he says appa, amma, akka and other things by doing actions. Does he need speech therapy?

A:Within the human ear, there is a drum. With each sound this drum moves; this movement in turn is conducted by a chain of three small bones (ossicles) to the inner ear. The inner ear converts these sound waves into electrical impulses and sends the same to the brain. This is how we hear. Whatever we hear is assimilated and is interpreted by the brain. Later, when a need arises to express the same thought, the brain recalls the same sound(s) and produces the same through the voice box and the mouth. This is how every child learns to speak. Hence, proper and good hearing is absolutely essential for a child to develop speech. In the human head, there is a tube called the eustachian tube, which connects the middle ear with the nose and the throat. The function of this tube is to equalise the pressure on either side of the ear drum, so that the drum moves efficiently. If the eustachian tube does not open and close properly, hearing will be impaired. The muscles necessary to open the eustachian tube are situated in the palate. In a child with cleft palate, these muscles do not function well. This dysfunction continues even after an excellent repair of the cleft palate. In addition, children with cleft palate (and cleft lip) have a tendency to catch frequent colds. These two factors often combine together and lead to a collection of mucus (phlegm) in the middle ear. This is called glue ear. The final result is a hearing impairment and consequent delay in learning speech. From the foregoing description, it will be amply clear to you that your son might be having a significant degree of hearing impairment. He will have to be examined by an ENT surgeon. Initially, certain tests like evaluation of hearing, detection of fluid in the middle ear, mobility of the drum may have to be done. If there is glue in the middle ear, it can be suctioned under anaesthesia; occasionally a plastic tube called grommet may be inserted in the drum. Such procedures will improve the hearing and promote speech development. An audiologist can certainly guide all three of you (son, father and mother) and speed up the pace of learning. There are some ENT surgeons, who are familiar with children's ENT ailments; they are called Paediatric ENT surgeons. If you can reach one of these Paediatric ENT surgeons, it will be better. However, almost all ENT surgeons will have some ability to carry out this task. If you need information about the availability of a Paediatric ENT surgeon in your region, you may write a letter to National Headquarters of The Association of Paediatric Otolaryngologists of India at 6. 16th Cross Street, Indira Nagar, Adyar, Chennai 600020. They can provide you with the names of several doctors and you can choose one near you and get the treatment done.