Nasal Speech Disorders Center
Surgical and non-surgical options
Once the evaluation is complete, we will develop the best treatment plan for your child. We will discuss both surgical and non-surgical options appropriate for your child’s condition. Treatment may involve speech therapy alone, or in addition to surgery or a dental appliance. Ongoing speech therapy may be very important to your child’s overall success with treatment. we will work with your community speech pathologist to provide individualized management programs.
The team may make a recommendation for a surgical procedure. The types of surgical procedures we offer lessen the air leakage from the nose to help the speech sound normal and are tailored to your child’s anatomy. These procedures take about 1-2 hours to perform and require one night in the hospital in most cases. The pain is less than that caused by a conventional tonsillectomy, and entails 1-4 days of sore throat. In a small number of children, the hypernasality may not be corrected with a single procedure alone, and a second procedure could rarely be necessary.
The age at which a child is recommended for a surgical procedure, often depends on the clinical problem. Often surgical recommendations cannot be made until the child can successfully complete the naso exam. This can be accomplished in a cooperative 3 1/2 year old, but usually in the 4 year and older age group. We aim for correction of the hypernasality by kindergarten or first grade, as this is the age when children begin noticing peer differences.
Another treatment option that may be recommended is the creation of a dental appliance to fill in the gap in the back of the throat. This also prevents excess air leakage from the throat during speech and is a removable device. This appliance would be designed by a speech prosthodontist on our team.
This procedure involves a plastic surgical technique to lengthen and thicken the soft palate as well as to realign abnormal placement of the palatal muscles. This operation is performed for children who have hypernasality after previous cleft palate repair, and in patients with a submucous or “hidden” cleft palate. This increased thickness and length of the palate makes it easier for the palate to contact the back of the throat during speech to prevent air leakage from the nose during speech. This procedure also may have a beneficial effect on the ear infections that are frequent in cleft palate patients.
This procedure involves lifting up “arms of muscle” from behind the tonsils in the back of the throat and folding them over each other, sewing them together side to side. This ridge of muscle creates a “speed bump” in the back of the throat that the palate can more easily touch during speech. The size of this bump is chosen based on the child’s anatomy, i.e. the shape and size of the “gap” in the back of throat. This bump of tissue cannot be seen in the back of the throat once it has been created. We feel this procedure is referable to other types of pharyngoplasty (i.e. the pharyngeal flap) because there may be less of a risk of post-operative airway obstruction and in-hospital recovery time is much less (1 night versus 3-5 nights).