The Evaluations

I had my first cleft/craniofacial evaluation at the age of eighteen months in either late 1965 or early 1966. I had my last cleft/craniofacial evaluation at the age of thirty-three (33) in June 1997.

Back in the 1960s and 1970s, the evaluations were called cleft palate conferences. My mom and I would spend all day at the hospital visiting the various team members. We would go from one clinic to another. I can recall sitting in an auditorium in front of many medical professionals as they reviewed my case.

I had my last childhood cleft/craniofacial evaluation in 1977 at the age of thirteen. It was more than a cleft/craniofacial evaluation.. It was in preparation for Dr. Tessier's first visit to Kansas City.

I had my one and only cleft/craniofacial evaluation as an adult on Tues., June 24, 1997. It was nine days after my thirty-third birthday.

My dad took me to the appt. We got there a little before 1:00 pm. I had to register as an outpatient and give the people a financial statement. My dad and I went up to the fifth floor, where the clinic is located, to wait. At 1:40 pm, I was finally called in.

First, the audiologist did a hearing test. It was my first one in eight years. My hearing has pretty much stablized over the years. My hearing is within normal range in my right ear. I have a 40 percent hearing loss in my left ear due to a conductive hearing loss.

Then my dad and I spoke with the speech pathologist and a student. Then my PS came into the room. My dad, PS, the speech pathologist, student, and I discussed my history.

Then it was time for my first-ever nasal endoscopy. They took me back to the GI lab. My dad refused to watch so he went out to the waiting room to wait for me. My PS did the nasal endoscopy. He squirted a few drops of local anesthetic into each nostril. Then inserted the scope into my nasal passage and back into the pharyngeal flap. He took four pictures of the flap area. He noted that one of the ports was larger than the other. I had to say some silly tongue-twisters too. :-) There was a roomful of people to watch the procedure: My PS who was actually doing the nasal endoscopy, the team nurse, a nurse from the GI lab, and the speech pathologist, and the student. The nasal endoscopy was not bad at all. However, I was left with an irritated nasal passage for a few hours.

Then it was time to meet with the speech pathologist and student for the nasometry test. My airflow ranged from moderate to severe on many sounds. The speech pathologist and student told me that the problem was not speech-related. I believe my speech was 75% intelligible.

Then I met with the clinic's nurse manager, Deloris. We were talking about my history a little. Then my PS came by. Then the team oral/maxillofacial surgeon came in for a minute and was impressed with the bonework that Dr. Tessier had done.

Then I saw the team dentist for a bit. She took note of my partial.

Finally I met with the team ENT, who recommended either surgery or a hearing aid to correct the loss. It's a loss I have lived with for years and have never done anything about it because I've learned to compensate for it.

I finally left the clinic at about 3:45 PM.

In mid July 1997, I received the results of my evaluation. I had velopharyngeal incomplete or insufficiency.. My palate was too short and allowed air to escape up into my nose. Surgery was indicated to tighten the right port of my pharyngeal flap.

On Monday, Nov. 24, 1997, I had a follow-up speech evaluation. This was two and a half months after my pharyngeal flap revision. My speech and the airflow thru my nose was much improved. I was advised to go thru a six-week trial run of speech therapy. I didn't do it. There is a reason: At the time, I was using nasal stents. I stopped using the stents in October 1998. Thus, I had to learn how to control the airflow.