Voice Exam 3 (Final) - Resonance Disorders

Resonance

The modification of sound as it passes through the vocal tract, shaped by the oral, nasal, and pharyngeal cavities.

Nasal resonance disorders

Three types: Hypernasality, hyponasality, and assimilative nasality.

Hyponasality

A resonance disorder where there is too little nasal resonance on nasal sounds.

Hyponasal sound substitution

Hyponasal clients often substitute nasal sounds (/m/, /n/, /ŋ/) with oral sounds (/b/, /d/, /g/).

Temporary hyponasality

Yes, it can be temporary (e.g., due to congestion).

Causes of hyponasality

Nasal obstruction, enlarged adenoids, deviated septum, nasal polyps.

Common breathing pattern for hyponasal patients

Mouth breathing.

Assessment of hyponasality

Subjective perceptual judgments and instrumental measures.

Hypernasality

Excessive nasal resonance during the production of non-nasal sounds.

Causes of hypernasality

Velopharyngeal insufficiency/incompetence, cleft palate, neurological disorders.

Submucous cleft

A cleft covered by a thin layer of tissue, making it less visible but still affecting function.

Bifid uvula

A split or cleft in the uvula, which can be a sign of submucous cleft.

Velopharyngeal inadequacy/insufficiency (VPI)

Failure of the velum and pharyngeal walls to close the nasal cavity during speech.

Causes of VPI

Cleft palate, submucous cleft, neuromuscular disorders, trauma, or surgery.

Assessment of hypernasality

Perceptual analysis, nasometry, aerodynamic measures, and imaging (e.g., nasoendoscopy).

Hypernasality and hoarseness

Yes, due to vocal strain or compensatory vocal behaviors.

Auditory feedback treatment for hypernasality

Clients listen to their own speech through amplification or recordings to modify resonance.

Respiration training for hypernasality

Teaching appropriate breath support and airflow control during speech.

Focus approach for hypernasality

Shifting focus of sound toward the oral cavity using techniques like exaggerated oral resonance.

Open Mouth approach for hypernasality

Encouraging speaking with an open mouth to improve oral resonance and reduce nasal resonance.

Assimilative nasality

When a normally oral sound becomes nasalized due to surrounding nasal sounds.

Cul-de-sac resonance

Sound trapped in a cavity with only one exit, creating a muffled quality.

Types of cul-de-sac resonance

Oral, nasal, and pharyngeal.

Obstructions in oral/nasal/pharyngeal cavities

Main causes of velopharyngeal problems.

Velopharyngeal incompetence

A velopharyngeal problem presented by a client with spastic dysarthria.

Nasometer II

An instrument that measures acoustic energy from oral and nasal cavities to calculate nasalance.

Identifying open velopharyngeal port

Using a mirror under the nose (fogging) or instrumentation like nasometry or airflow measures.

Instruments for measuring air flow

Pneumotachograph, nasal anemometer, oral-nasal airflow mask.

Importance of perceptual analysis of speech

It's essential and as important as instrumental assessment for diagnosis regarding voice resonance.

Velopharyngeal problems and articulation in younger children

They can cause compensatory articulation errors, like glottal stops or pharyngeal fricatives.

Oral endoscopy

A visual examination of oral structures using a small camera.

Advantages of oral endoscopy

Direct visualization of structures and movement.

Disadvantages of oral endoscopy

May cause discomfort and requires specialized equipment.

Spectrograms for differentiating resonance disorders

They are not very practical for differentiating hypernasality, hyponasality, or assimilative nasality.

Nasoendoscopy/videonasoendoscopy

A procedure using a flexible scope through the nose to view the velopharyngeal mechanism.

Advantages of nasoendoscopy

Direct view of VP closure patterns during speech.

Disadvantages of nasoendoscopy

Invasive, may cause discomfort.

Aspects assessed during direct oral structure visualization

(1) Hard palate shape, (2) soft palate length/movement, (3) uvula shape, (4) tonsil size, (5) tongue size/mobility, (6) dentition.

Signs of a submucosal cleft

Bifid uvula, zona pellucida, notch in hard palate, and abnormal muscle insertion in velum.

Importance of oral tongue inspection

Yes, because tongue posture and movement can affect resonance.

Sounds with open velopharyngeal port

Nasals (/m/, /n/, /ŋ/).

Difference between legal and ethical behaviors

Legal behaviors follow the law; ethical behaviors follow professional moral principles, which may go beyond legal requirements.

Ways to classify professional actions

Ethical/legal, unethical/legal, ethical/illegal, unethical/illegal.

Four primary principles of ASHA's Code of Ethics

(1) Responsibility to persons served, (2) Responsibility to the public, (3) Responsibility to the profession, (4) Responsibility for professional relationships.

General understanding of ASHA's Code of Ethics

A framework guiding SLPs in providing competent, honest, and respectful services that protect clients and the integrity of the profession.