What is Hypernasality?
Hypernasality appears mostly in children with excessive nasal resonance in the oral cavity during speech due to cleft palate. Its main cause is an improper separation between the oral and the nasal cavities. In such cases, parents must opt for speech therapy before going ahead with surgical procedures like palatoplasty.
Every individual has a peculiar quality of voice and people with nasal voice might sound having clogged or runny nose. It is normal to have nasal sound during the time that one is suffering from cold, but if it persists forever than it becomes clear that it’s a nasal disturbance causing such voice. While speaking the soft palate on the roof of the mouth raises until it touches or presses the back of the throat. It leads to a seal which controls the amount of air going through the nose and finally altering the effect of the sound.
Further, the walls of the throat along with the soft palate and the sides all together build a gateway known as a velopharyngeal valve. If that valve does not work properly then a few unwanted changes or modulation in the speech can be noticed.
Are There Different Types of Nasal Voices?
There are mainly two types of nasal voices which are mentioned below:
- Hyponasal: This is caused by very little air passing through the nose while a person speaks. Due to this, the voice does not possess a sufficient amount of resonance.
- Hypernasal: This is caused by excessive leakage of the air via nose when a person speaks. The presence of excessive air gives too much resonance to the voice which is not required in actual.
Whenever there is a doubt about nasal voices and speech clarity about kids, one must consult an ENT specialist. Many of the speech issues are treatable by a suitable treatment and even some of the structural alterations can also be rectified by surgical options.
How to Identify Hypernasality in Kids?
The effect of hypernasal voice on speech can be easily noticed as it gives the appearance as if the person is talking from the nose instead of the mouth. It happens due to an air leak which accompanies while talking.
Following are the few symptoms of hypernasality:
- Difficulty in pronouncing consonants like p, t, and k which requires high air pressure.
- Escape of the air via nose during pronunciation of s, Ch, and sh combinations.
What are the Causes of Hypernasality?
There are several things which control the voice quality which include shape and size of the mouth, throat, and nose along with the air passage through these. Hypernasal voice mainly occurs due to VPD or velopharyngeal dysfunction. In hypernasality, the main trouble lies in the improper functioning of the velopharyngeal valve causing speech disorders.
Velopharyngeal Dysfunction (VPD) is of following types causing hypernasality or the resonance disorders:
- Velopharyngeal insufficiency occurs sometimes due to a structural problem for eg., if the soft palate remains short.
- Velopharyngeal malfunctioning occurs sometimes and the valve does not close when it is required to because of improper movement.
- Velopharyngeal mislearning appears when a child is unable to learn efficiently how to control the airflow movement through the throat as well as mouth while speaking or has never learned how the valve should be used.1,2
There can be several causes of VPD. Sometimes even more than one reason contributes towards VPD causing speech impairment, especially in kids. However, the parents need to be vigilant to be able to identify the issues and reach out for treatment options with the help of doctors or speech therapists. Some of the VPD causes include:
- Adenoid Surgery: At times such surgeries are required as a need for definite reasons. But such surgery involves removal of the glands which are placed behind the nose and hence makes larger space at the back of the throat. Although, this condition appears temporarily and improves a few weeks after the surgery.
- A Short Palate: It leads to excessive space between the throat and palate because of which air escape becomes easier and troublesome for speech.
- Cleft Palate: It is a sort of birth defect in which a baby’s mouth is not properly formed. A surgical repair is possible however in most of the cases VPD still persists after the surgery.
- Brain Injury or any Neurological Disease: Any traumatic brain injury or a condition like that of cerebral palsy can impair the efficient movement of the soft palate causing VPD.
- Mislearning: This is a very commonly found VPD issue. Children do not learn the right technique to produce different sounds while speaking. This can be improved by proper instructions and training to the kids.
Sometimes, untimely hearing loss can result in speech and language impairment and thus can lead to hypernasality.3,4
How Do You Reduce Hypernasality?
Every case of hypernasality is different and the doctor suggests treatment after a complete evaluation of the cause of it. So treatment options also vary as per the individual’s need. Some of the treatments which can help in minimizing and treating hypernasality are listed below:
Medications for Hypernasality:
Few medications like antihistamines, decongestants, and steroid nasal sprays help in relieving congestion, swelling, sinus infections caused by allergies. Antibiotics also help in treating a sinus infection caused by some bacteria and not received by other medications.
Some of the structural imperfections which cause hypernasality and all speech troubles can be fixed with the help of surgeries. Some of the surgeries are listed below:
- Tonsils removal surgery or adenoids removal surgery
- Septoplasty is done in case of a deviated septum
- Endoscopic surgery is required for the removal of nasal polyps
- For lengthening, short soft palate surgeries like Furlow palatoplasty and sphincter pharyngoplasty are done
- Surgeries for rectifying the cleft palate in the babies of 1 year of age etc.
Speech therapy is required both before and after any sort of nose or mouth related surgery. A speech therapist evaluates the condition and accordingly provides the required treatment and assistance to minimize the speech alterations and reach the perfect desired level of speech. A speech therapist can help and teach the right methods of lip, tongue, and jaw movement in order to be able to produce the correct sounds. A therapist also helps in learning a gradual control over the velopharyngeal valve.
However, speech therapy requires constant self-confidence and motivation to continue with the effort of learning the right way to speak overcoming all habit formed ways and hurdles. In case a therapy reflects no successful results for a longer period then a break from therapy and restarting the therapy again after a complete evaluation by a doctor is preferable.
A speech-language therapist might suggest some easy exercises which can also be done at home without much guidance. So practice and repetition of such exercises at home build up confidence an actually improve the speech quality. Some of the common blowing and sucking exercises do not help much with the velopharyngeal valve malfunctioning. So a particular set of required exercises are recommended by the therapist in such case. Also, practice is the best approach to overcome any speech hurdles and this is even suggested by many therapists. So talking, singing, and practicing as much as one can only help at the end to actually build the desired difference in the voice quality.
If a person or a kid has a condition causing nasal voice then there are several treatment options available. But initially, there is a need to diagnose that condition and its cause.
Several structural imperfections like polyps or a deviated septum can be rectified with the help of surgery. A speech-language therapist can help to learn control over the air movement through the nose and mouth. It helps in letting a person speak more clearly and with confidently.
However, like every person is not the same similarly every similar looking condition cannot be treated in one particular way always. So consulting a doctor and a speech therapist is the best in case of doubts about voice or hypernasality. It is always safer to get evaluated especially in case of kids when in doubt. A doctor will certainly be able to identify if there is any structural problem causing speech impairment. In the absence of any structural malfunction, the only best thing is speech or voice therapy which can help in achieving the desired quality of speech.
Also, little vigilance is required mainly towards the kids by the parents so that hypernasality issues can be identified and early treatment can be given to the kids from the beginning itself. This not only builds confidence in such kids but also makes one overall fit and healthy. Otherwise, buildup of disconnect or lack of confidence can affect the academic performance of the kids as well at times because of certain hypernasality issues. Currently, the medical advancement has reached such stages where every disease or medical condition can be treated or at least controlled and minimized in some way or the other. Hence, medical treatment must be taken for hypernasality issues as it might not resolve on its own.
- Kummer, Ann W. “Speech Therapy for Cleft Palate or Velopharyngeal Dysfunction (VPD)” (PDF). Cincinnati Children’s Hospital Medical Center.
- Biavati, Michael J.; Sie, Kathleen; Wiet, Gregory J. (2 September 2011). “Velopharyngeal Insufficiency”. Medscape Reference. WebMD LLC.
- “Specifieke informatie over schisis per type schisis” [Specific information on each type of cleft lip and palate cleft] (in Dutch). Nederlandse Vereniging voor Schisis en Craniofaciale Afwijkingen. 2012. Retrieved 20 May 2012.
- Stegenga, B.; Vissink, A.; Bont, L.G.M. de (2000). Mondziekten en kaakchirurgie [Oral and Maxillofacial Surgery] (in Dutch). Assen: Van Gorcum. p. 388.