How is normal speech produced?
Speech results from a sequence of events which includes producing airflow out of the lungs (exhaling), a vibration of the muscles of the voice box (vocal cords), and regulating the amount of resonating air allowed to escape the body through the mouth and/or nose. The air escaping the mouth can then be manipulated by the lips, teeth, and tongue to produce a specific speech sound.
What is the difference between hypernasal and hyponasal speech?
There is often a lot of confusion between the terms hypernasal as opposed to hyponasal speech. Both of these speech disorders are known as disorders of resonance (problems regulating the amount of air leaving the mouth and/or nose).
Hyponasal speech is the sound of speech that results from too little air escaping through the nose (sounds like talking with a stuffy nose). It would be hard to normally pronounce the letter “m” for example. The most common reason for this type of speech are enlarged ADENOIDS that block the air passage to the nose and can be corrected with ADENOIDECTOMY.
Hypernasal speech is the sound of speech that results from too much air escaping through the nose while talking. There are certain letters and sounds that should not have air escaping through the nose during speech. Examples of these are vowels, or letters like “s”, “b”, and “k”. To keep air from passing through the nose, the roof of the mouth (velum) must touch the back of the throat (pharynx). If these do not touch correctly, resulting in a complete seal of this area, too much air is allowed to pass through the nose and hypernasal speech results. This is known as velopharyngeal incompetence or VPI .
What are the causes of hypernasal speech?
Hypernasal speech can be caused by anything resulting in velopharyngeal incompetence. Clefting (splitting) of the roof of the mouth (CLEFT PALATE), a palate that is too short, or the inability to move muscles involved with closure of the velopharyngeal complex (as in cerebral palsy) can cause hypernasal speech. Less commonly, hypernasal speech can occur in someone with an undiagnosed problem of the palate muscles, especially if an ADENOIDECTOMY is performed.
How is hypernasal speech evaluated?
Hypernasal speech may be first noted by the parent, primary care doctor, or teacher. The child should then be evaluated by a speech-language pathologist (a specialist in speech problems). A speech pathologist is able to evaluate and identify abnormal speech patterns. The speech pathologist will also look for obvious abnormalities in the mouth and listen with special instruments to the amount of airflow passing through the nose.
Instruments using computer analysis of airflow (nasometry) may also be used during an evaluation to detect abnormalities, as well as follow progress of therapy. If hypernasal speech is identified, an x-ray study is done to help localize the problem area and referral to an ear, nose and throat specialist occurs.
What will an ear, nose and throat specialist do?
The ear nose and throat specialist is an expert in evaluating and treating hypernasal speech. We have the ability to look at your child’s anatomy to determine the cause of hypernasal speech.
This is done through nasal endoscopy, a procedure that uses a tube to look closely at the anatomy inside the nose and deeper in the throat. Nasal endoscopy is used with the speech pathologist in attendance. Along with the nasometry and x-ray results, the findings on nasal endoscopy will allow a plan of treatment to be developed for your child’s hypernasal speech. This treatment plan, either medical or surgical therapy, will then be discussed with you.
What is the treatment for hypernasal speech?
Speech therapy may be all that is necessary for some forms of hypernasal speech. This type of therapy may take several months or years to achieve the desired result. However, if therapy does not result in resolution of the hypernasal speech, or if the defect is very large, surgical correction may be necessary. This generally involves three basic methods:
- Augmenting (adding to) the back of the throat, to make closure easier,
- Making the velar port (back of nose) smaller, or
- Lenthening or repairing the palate (roof of mouth). Please see PALATOPLASTY for more information.
The doctors at our Pediatric ENT offices are experienced and ready to help your child.
Home/Voice and Resonance/Speech Therapy for Children with Hypernasality
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Old-fashioned articulation texts (pre-phonology) used to contain large sections, even whole chapters, on how to do this. Let me give you one method to get you started. This one is central to all the rest because it uses a simple biofeedback procedure.
Getting rid of nasalization is mostly a matter of ear training. The following represents the way that therapists like Alexander Graham Bell and Charles Van Riper did this. This is good old-fashioned articulation therapy.
Van Riper called these types of things “phonetic placement techniques” and modern therapists have called them “oral motor” (meaning “mouth movement”) techniques. This is all the same thing.
Discover Oral and Nasal Airflow
- Start with any phoneme that the client can make with good oral airflow—Say S, or T, or L, or Y.
- Have him make this sound as he always does as he holds one end of a tube up to his mouth. Place the other end at his ear. Let him hear that the sound is coming out his mouth.
- Next, have him hold the tube up to his nose as he makes the phoneme, and let him hear that the sound is NOT coming out his nose.
- Now repeat this procedure with the nasal consonants–– M, N, Ng.
- Teach him that some sounds come out the mouth, and others come out the nose. Make a simple consonant chart to demonstrate this. Teach him that ALL the consonants come out the mouth except M, N, and Ng.
- Now make a list of all the vowels as he understands them––A, E, I, O, U, and sometimes Y–– and teach him that ALL the vowels come out the mouth.
Discover the Problem
- Use the tube to explore the vowels your client is making with nasal airflow when he should be using oral airflow.
- Help him understand that he is making the sounds through his nose when he should be making them through his mouth.
- Encourage careful listening and discrimination of oral and nasal airflow. Help him understand the problem.
Learn Oral/Nasal Control
- Have the client learn to control oral and nasal airflow.
- Have him hold the tube at his nose and ear, and have him make a nice oral sound, like S. Then tell him to “Make it come out your nose.” Most kids with average or above IQ can learn this type of thing. They can drive their good oral phoneme out through their nose on purpose.
- Now have him practice this sound back and forth between oral and nasal. Again, most kids can learn this if they have the intellectual capacity.
- Now work on his nasalized vowel. Have him make it “out your nose” and then “out your mouth.” For example, sequence “Ah” and “Ng” so the client is practicing “Ah-Ng-Ah-Ng-Ah-Ng.”
- Progress to syllables and words, and eventually phrases, sentences, and paragraphs. Continue to use the tube as needed.
The hollow tube is very important in this work. It will amplify the client’s speech sounds, and it will teach him exactly where the airstream is exiting his speech mechanism. There are many other tools that can be used, such as a PVC elbow joint, a RapperSnapper (I love these!), a toy stethoscope, or SuperDuper’s Elephone.
All of this information and more will be found in my upcoming publication, The Marshalla Guide: A Topical Anthology of Speech Movement Techniques for Motor Speech Disorders and Articulation Deficits, hopefully scheduled for publication in 2016 😀