Understanding Hyponasal Resonance : Causes, Implications, and Treatment Options

Resonance is the voice quality that results from sound vibrations in the throat, mouth, and nose. Hyponasal resonance is a resonance defect that occurs because of a defect or obstruction in the nasal cavity. This can cause the speech to sound as if the person has a stuffy or running nose.

As we read further, we will get to know more about hyponasal resonance, its anatomy and physiology, its causes, and implications.

Resonance is something that relates to speech and is the modification of voiced sound as it travels through the cavities of our vocal tract, including the pharyngeal cavity, oral cavity, and nasal cavity. Resonance is based on two factors, the function of the velopharyngeal valve and the shape and size of the resonating cavities.

The velopharyngeal valve comprises the soft palate (velum), the lateral pharyngeal walls, and the posterior pharyngeal wall. During nasal breathing, our soft palate is down and rests against the base of our tongue. Simultaneously, the pharyngeal walls are relaxed. Thus, the nasopharynx is patent for unobstructed nasal breathing. However, during the speech, the velopharyngeal valve opens and closes to direct sound energy into the nasal or oral cavity, as appropriate for each phoneme in the speech.

The nasopharynx contributes to the normal voice resonance and production. Hyponasal resonance is a defect in resonance that occurs when there is an obstruction or defect in the nasal cavity. ⁽¹⁾ This causes the speech sound through very little air escaping from the nasal cavity. Thus, the sound of the speech appears as if the person is talking with a stuffy or running nose. Generally, this condition arises from the inflammation or enlargement of adenoids and several other defects of the nasal cavity.

If you have ever pinched your nose closed and talked, you produce a different sound. Doing this prevents sound, from passing through the nasal cavity. A hyponasal resonance disorder also sounds similar to this, making nasal consonants more oral in quality. (ex. /b/ for /m/, /g/ for / ŋ, /d/ for /n/)⁽²⁾

Children suffering from craniofacial disorders, especially cleft palate, commonly have problems with their voice quality.⁽¹⁾ Hyponasal resonance can be corrected through several treatment options and corrective surgeries right after birth to resolve any sort of anatomical (including craniofacial disorders) defects. Apart from this, speech therapy can also help in treating hyponasal resonance. Although the condition is primarily diagnosed and treated during childhood, it may also persist in adulthood.

Normal resonance is primarily dependent on normal anatomical structures and physiological functions of the velopharynx. The velopharyngeal structures include the soft palate (velum), the lateral pharyngeal walls, and the posterior pharyngeal wall. The coordinated movement of all these velopharyngeal structures results in proper velopharyngeal closure. And, velopharyngeal closure occurs to produce most speech sounds, when the air and sound need to be directed into the mouth and blocked from entering the nasal cavity.

During normal speech, the velum or soft palate moves in a superior and posterior direction to achieve closure against the posterior pharyngeal wall. Often, the posterior pharyngeal wall moves anteriorly to assist in achieving contact. The lateral pharyngeal walls move medially to close against the soft palate. Thus, with the coordinated action of all these structures, velopharyngeal closure occurs as a sphincter or valve. Apart from speech, velopharyngeal closure is also required for other pneumatic activities like sucking, whistling, and blowing.

Different basic velopharyngeal closure patterns occur in normal resonance or the case of normal speakers, due to variances in the relative contribution of the velum (soft palate), lateral pharyngeal walls, and posterior pharyngeal wall in achieving velopharyngeal closure. Four basic types of closure patterns describe velar closure, and they are coronal, circular, sagittal, and circular with the passavant ridge (the bulge of the posterior pharyngeal wall that meets the velum).⁽³⁾

When the velopharyngeal mechanism does not function properly or when there is any variation in the normal pharyngeal closure procedure, there is a resonance disorder, including hyponasal resonance.

Obstruction in the nasopharynx or the nasal cavity causes hyponasal resonance. This obstruction can be due to adenoid hypertrophy, swelling of the nasal passages secondary to allergic rhinitis, a deviated septum, the common cold, choanal atresia, midface deficiency, stenotic naris, and others. More about the causes of hyponasal resonance are mentioned below.⁽⁴⁾

An enlargement of the adenoids or tonsils causes hyponasal resonance. Usually, enlarged adenoids and tonsils mean there is an infection that the body is trying to fight off. However, if the enlargement of adenoids and tonsils remains even after infections are gone, they can be problematic. Some children are even born with enlarged adenoids. This can cause a resonance problem and a running or stuffy nose-like speech.

Another cause of hyponasal resonance is a deviated septum. The bone and cartilage dividing the nose in half is known as the septum. Sometimes, this can be crooked or have an abnormality. The deviated septum can make it difficult to balance the airflow, thus resulting in nasal resonance issues.

Children with cleft palate or cleft lip have an increasing chance of developing a resonance disorder because of velopharyngeal dysfunction (VPD). Velopharyngeal dysfunction is when the soft palate or velum does not touch the back of the throat while speaking or swallowing.⁽⁴⁾

Sinus inflammation can also occur similar to the enlarged adenoids and tonsils. If the sinuses get inflamed, it can affect speech.

Nasal polyps could be one more cause of hyponasal resonance. Nasal polyps are soft non-cancerous growths on the lining of the nasal passage. Tumors and foreign objects can also obstruct the nasal and upper airway passages and cause difficulty for the affected person or child to balance their air and speak.

Another cause of hyponasal resonance could be cleft palate repair. Children might have problems with resonance even after cleft palate repair. Problems with the ears, nose, and throat can cause velopharyngeal incompetence due to the scars left from pharyngeal flap or cleft palate repair surgery. These can lead to hyponasality or hyponasal resonance.

Another cause of hyponasal resonance could be adenoid surgery. Adenoid surgery is a medical procedure in which the glands behind the nose are removed surgically. This can leave ample space in the posterior part of the nose, and this in turn can cause the air to escape through the nose. However, this is a temporary condition and generally resolves after a few weeks of the surgery.

Neurological diseases like cerebral palsy and traumatic brain injuries can inhibit the soft palate or velum in the mouth from moving properly, and this can be a cause of hyponasal resonance.

DiGeorge syndrome is a chromosomal abnormality in the body that affects the growth and development of various parts of the body, especially in those in the neck and head regions. So, this condition can also lead to hyponasal resonance.

Let us study the potential effects of hyponasal resonance and know how treatment and management strategies can prove effective in improving the quality of life in the affected individuals.

Hyponasal resonance affects the clarity and intelligibility of an individual’s speech, thus making it hard for others to understand them. Sometimes, this can also lead to social and communication difficulties.

Sometimes, hyponasal resonance in a person can affect their self-esteem and can lead them to remain socially isolated. Because someone with hyponasal resonance sounds like talking with a stuffy or running nose, they might feel inferior while communicating with others and thus start isolating themselves from others.

Hyponasal resonance also comes with potential psychological implications, such as anxiety, depression, low self-esteem, and confidence. This happens in the case of children or adults who have a severe issue with their resonance.

As they say, “When there is a problem, there is also a solution”. However, hyponasal resonance can be treated in several ways. Some of the most effective treatments and management strategies for this condition include speech therapy, surgical intervention, or prosthetic devices that can improve nasal airflow during speech.

Nasal polyps can be treated with medications initially. These medications, typically corticosteroids, aim to reduce inflammation and shrink the polyps. However, not all nasal polyps respond to medication, especially if they are large or have been present for a long time. In cases where medications fail to provide relief or when the polyps recur frequently, surgery becomes a viable option. Surgical intervention removes the polyps and clears the nasal passages, allowing for better airflow and reduced symptoms. After surgery, a combination of medications might be prescribed to prevent recurrence.

Similarly, for a deviated septum causing hyponasal resonance, some antihistamines, nasal steroid sprays, and decongestants might be tried. However, if all these do not work, surgical intervention to correct the deviated septum would be necessary. This surgery would straighten and recenter the nasal septum.

Enlarged adenoids also cause hyponasal resonance. Adenoidectomy is a surgery that is used to remove enlarged adenoids. However, the nasal passages remain swollen for several weeks post-surgery, so the hyponasal resonance might persist for some more time. However, this issue will be resolved in some time.

Apart from all these physical treatments, speech therapy might also be recommended to improve normal resonance and communicate more effectively.

Individuals, especially children affected by hyponasal resonance can overcome the problems associated with the condition only through proper treatment and management strategies. Early diagnosis and treatment are extremely important for persons with hyponasal resonance disorder to improve their speech and quality of life.

Hyponasal resonance can sound like a blockage sound from the nasal cavity. This is a condition that occurs when there is an obstruction in the nasal cavity, due to various reasons, including enlarged adenoids, deviated septum, nasal polyps, velopharyngeal dysfunction, and more. Any individual experiencing this resonance disorder should consult the doctor and go for a proper diagnosis as early as possible, so that the condition could be effectively treated, or at least managed to some fair extent. Speech therapy, surgery, and other means of appropriate treatment can be effective in improving resonance and help the affected individuals lead a better quality of life with increased self-esteem and confidence.

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