🧩 Resonance Disorder Clinical Scenarios

Speech sounds excessively nasal on vowels and voiced stops. What resonance disorder?

Hypernasality.

Oral sounds like /b/ and /d/ are replaced by nasal sounds. Diagnosis?

Severe hypernasality from VPI.

Speech sounds “stuffy” and nasal consonants lack resonance. Disorder?

Hyponasality.

Client’s voice is muffled, low in volume, like “talking through cotton.” Disorder?

Cul-de-sac resonance.

Patient alternates between hypernasality on vowels and hyponasality on nasals. Diagnosis?

Mixed resonance.

Hypernasality present, but structure appears intact. What’s suspected?

Phoneme-specific nasal emission (mislearning).

A repaired cleft client shows air escape and nasal rustle on /s/ and /ʃ/. Cause?

Small VP gap causing nasal turbulence.

Speech shows weak stops, short utterances, and nasal grimace. Disorder?

Large VP opening with nasal emission.

Client demonstrates hypernasality and glottal stop substitutions. What two problems?

VPI and compensatory articulation.

Child produces /n/ for /s/ but structure is normal. Likely cause?

Compensatory mislearning (phoneme-specific nasal emission).

💨 Airflow & Nasal Emission Scenarios

Air escapes audibly through the nose during /p, t, s/. Disorder?

Nasal emission.

Airflow through the nose is heard as a faint hiss on fricatives. Diagnosis?

Small VP leak—nasal rustle.

Weak pressure and no noise with nasal airflow. Diagnosis?

Large VP leak—inaudible emission.

No nasal emission but hypernasality persists. Likely cause?

VPI with small gap allowing sound but not air noise.

After palatal repair, nasal emission occurs only on /s/. Diagnosis?

Phoneme-specific nasal emission.

🎙️ Velopharyngeal Function Scenarios

Oral pressure consonants are weak, but vowels normal. Impairment site?

Velopharyngeal valve.

A child with bifid uvula and hypernasality shows no structural hole orally. Diagnosis?

Submucous cleft palate.

VP closure appears complete on /a/, incomplete on /s/. What disorder?

Inconsistent or phoneme-specific VP dysfunction.

Speech improves temporarily when child pinches nose closed. Cause?

VPI.

After adenoidectomy, new onset of hypernasality. Likely cause?

Short or weak velum—unmasked VPI.

🔇 Obstruction & Hyponasality Scenarios

Child recovering from a cold sounds “stuffy.” Disorder?

Temporary hyponasality.

Speech lacks nasal resonance after enlarged adenoids noted. Cause?

Nasal blockage from adenoid hypertrophy.

Cleft palate patient after VPI surgery now sounds denasal. Cause?

Over-correction causing nasal obstruction.

Speech resonance normal except nasals absent. Diagnosis?

Hyponasality or denasality.

Nasal resonance decreases when lying down but normal when upright. Cause?

Gravity-related nasal blockage.

🧠 Mixed & Secondary Characteristics

Speaker has both hypernasality on vowels and nasal blockage from septal deviation. Disorder?

Mixed resonance (VPI + obstruction).

Client’s speech shows nasal emission, nasal grimace, and weak stops. Diagnosis?

Severe VPI.

Cleft patient has muffled voice and retruded maxilla. Disorder?

Cul-de-sac resonance from oral cavity crowding.

Hypernasality noted with poor VP timing despite intact structure. Disorder?

VP mislearning or apraxia.

Speech normalized after palatal obturator placement. Problem confirmed?

Structural VPI.