Resonance Disorders: Effects of Cleft Lip/Palate and VPI on Speech

3 casues of VP insufficiency (VPI)

Structural

Neurologic

Mislearning

Structural causes

- History of cleft

- Submucous cleft palate (overt or occult)

- Fistula (hole in palate)

- short velum or deep pharynx (cranial base anomalies)

- Irregular adenoids

- Hypertrophic (large) tonsils which cause muffled, low volume

Location of the ________ impacts different speech sounds and groups

FISTULA

Neurologic causes

Stroke, CN damage, paralysis, FLACCID dysarthria

Mislearning causes

Hearing impairment/loss, apraxia

Effects of VPI on RESONANCE (sound/acoustics)

- Hypernasality

- Hyponasality

- Cul de Sac resonance

- Mixed resonance

Effects of VPI on ARTICULATION (airflow)

- Nasal emission (audible, inaudible, nasal rustle)

- Compensatory productions (glottal and pharyngeal productions)

Hypernasality

- Due to coupling (sharing of acoustic energy) of oral and nasal cavities during speech. Air in nasla cavity os too much.

- Most perceptible on VOWELS

- Voiced consonants become nasalized

Hypernasality examples:

m/b, n/d, ng/g

Hypernasality causes

VPI: Strutcural defect or neurophysiological disorder affecting VP closure.

Palatal fistula: An unwanted opneing on palate after repair

Mislearning: Use of nasal sounds for oral sounds

Cul-de-Sac TEST

To evaluate hypernasality, the patient will close their nose during production of oral sounds only. If there is a difference in sounds, there is hypernasality. Use /a/ sound to evaluate

Hyponasality

- Not enough nasal resonance on nasal sounds (n, n, ng)

- Nasal phonemes sound similar to oral cognates

- Noticable on VOWELS

Hyponasality examples

b/m, d/n, g/ng

Monica from Friends with a cold "find" for "fine"

Hyposnasality causes

DUE to nasal obstructions

(Allergic rhinitis, adenoid hypertrophy, common colds, nasal congestion/obstruction, midface retrusion, deviated septum)

Cul-de-Sac RESONANCE

- Voice sounds muffled and low in volume

- sound is absorbed in the cavity of soft tissue

- "POTATO-IN-MOUTH speech (enlarged tonsils are the "potatoes."

"POTATO-IN-MOUTH speech (cul-de-sac resonance)

- Enlarged tonsils are the potatoes

- Muffled, low

- Kids with large tonsils, mouth breathers

Cul-de-Sac RESONANCE causes

Due to a blockage in VT, acoustic energy is blocked from exiting the normal outlet

Air pressure waves are absorbed by walls of cavity and unable to interact w/ airpressure due to small or non-existent outlet

Mixed resonance

- Hypernaslity/nasal emission on oral sounds and hypernaslity on nasal sounds

- APRAXIA OF SPEECH! Due to incoordination

Nasal emission

- Air leakage through the nose during speech.

- Occurs on high-pressure sounds (s, p, t, k)

- Can occur with or without hypernasality.

Nasal emission effects on speech

- weak/omitted consonants

- Short utterance length

- low volume

- occasional nasal grimace

Types of nasal emissions

- inaudible

- Audible

- Nasal rustle

- PSNE

Inaubible nasal emission

Cant hear them but may see mirror fog when held under nose

Audible nasal emssion

Can hear turbulance of air through nasal cavity

Nasal Rustle (or nasal turbulance)

Small gab, bubbling of secretions and loud nasal snorting

PSNE

Nasal emission on sibilants (fricative mainly). It can be structural, but mainly, mislearning is the cause. So a normal child with no history of cleft can have this.

Evaluation procedures

- Visualization: nasopharyngoscopy, videofluoroscopy, MRI

- Aerodynamic: oral-nasal airflow

- Acoustics: nasometry

What do you see on a videofluoroscopy?

Velum, pharyngeal wall, VP port

1 multiple choice option

What do you NOT see on a videofluoroscopy?

Lateral walls

1 multiple choice option

Obligatory Misarticulations

- Speech errors caused by a structural or physiological issue

- Require surgery for structural repair

- Nasal emission

Compensatory misarticulations

- Errors that are learned from having a faulty mechanism and persist once the mechanism is repaired

Compensatory production for VPI for Plosives (stops)

Pharyngeal plosives and glottal stops

Compensatory production for VPI for Fricatives

- pharyngeal fricatives

- posterior nasal fricatives

- glottal fricative (/h/)

- nasal sniff

When give an error, make sure to be able to determine what type of misarticulation it is..... ______ OR _________.

Compensatory or obligatory