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Hypernasality is a speech resonance disorder that occurs when there is too much air leakage through the noise during speech which results in a hollow sound to speech and sometimes audible air escape through the nose during speech. This leakage can affect the speaker’s ability to be understood. The cause is usually due to velopharyngeal insufficiency which can occur after cleft palate repair surgery, in children with certain syndromes, rarely after adenoid surgery, and in sometimes otherwise normal children. This type of speech disorder can make it very difficult for a child to be understood by those outside their family, and sometimes even parents have difficulty understanding what their children are trying to say.
This type of speaking can lead to teasing by peers. Studies of children with hypernasal speech have shown that normal-speaking children are less likely to want to play with children who speak this way. Studies of adults with hypernasality have shown that they are considered to be less intelligent and less attractive than normal speaking adults. Employment opportunities can be severely limited for these people in our communication-based society. Our goal is to correct the speech disorder early in a child’s life so that a child’s speech blends seamlessly with their peers, and they can be understood by their family, friends and community.
Normal speech is a product of several systems working together. This includes muscles and structure of the lips, tongue, throat, lungs and hearing. The coordinated movement of these structures results in making; sounds to communicate (called articulation), making voice (whether normal, high, or low pitch), and having a normal nasal balance (called resonance). When most of us speak, air from our lungs resonates in our throats (the throat and nasal cavity) and passes into the mouth, where we move our tongue and lips with air to produce sound. Normal nasal balance occurs when most of the airflow is coming from the mouth when we speak. You can feel it by putting your hand up to your mouth when you speak- you will feel warm, soft air. When there is a disruption of the structures and or the coordination of the speech system, nasal speech problems may occur.
There are several types of nasal speech disorders. The two primary types of resonance disorders are hypernasality and hyponasality. Hypernasality occurs when there is too much air coming from the nose during speech. Hyponasality occurs when there is not enough air coming from the nose and mouth. A person with hyponasality often sounds congested as if you have a cold and or allergies.
The Nasal Speech disorders center provides a place where parents of children with hypernasal speech can bring their child for a relaxed and comprehesive examination to determine exactly what factors are affecting their child’s speech . During your visit, your child will have several types of evaluations in one setting. A medical history of your child’s general and speech health will be taken. A complete head and neck examination will be performed. A speech evaluation will be performed to further define your child’s speech problem in a play setting that will put the child at ease and enable us to get a sense of his or her strengths and struggles in an every day setting.
One of the most important parts of the evaluation is the nasopharyngocopic (“naso”) exam. This brief examination will be done if surgical treatment of your child’s speech problem may be necessary. It involves looking at the back of your child’s throat while they are speaking to see how the muscles of the throat work during speech. This exam helps us determine what is the best type of treatment for the speech problem.
We do need the cooperation of your child to do this exam so we try to make it as pleasant as possible. We will talk about making a “movie of the throat” and you and your child will be able to watch the exam on the monitor screen.
To prevent discomfort during the nasopharyngoscopic exam, we place a few anesthetic drops or spray in one side of the nose. A very small flexible telescope is gently placed in the nose so that we may see the back of the throat. your child will be asked to say a few words or sentences with the telescope in place. This procedure takes about 1-2 minutes to complete and the goal is to get a brief speech sample so that we can determine the cause of the hypernasality. From this exam we can usually pinpoint a cause for the VPI and what can be done to fix it. This may include speech therapy alone, or speech therapy in conjunction with a surgical procedure to fix the deficiency.
If more information is needed to help plan treatment, we may ask your child to have a videoflouroscopic exam, or “speech xray”. This is an xray study performed by a radiologist and a speech pathologist. A few drops of dye are placed in the nose and with your child speaking, a 1-2 minute xray film is taken. This exam would be scheduled after your first visit to our center, if necessary.