Speech Therapist,
The Smile Train, MMHRC.


The mechanics of speech require integration of the respiratory, phonatory, resonatory and articulatory musculature.

The Velopharynx in life:

The isthmus between the oral and nasal cavities must be closed during swallowing and speech, or else food will be regurgitated out of the nares, vowels will be excessively resonated in the nasal chambers, pressure consonants will lose their characteristic explosive and frication noises, and air will be audibly emitted through the nares.
The velopharyngeal port was not designed primarily as a means of coupling or uncoupling the oral and nasal cavities for speech.  Rather, Velopharyngeal closure exists primarily to:

  1. Seal off the nasal from the oral cavities in order to isolate the oropharyngolaryngeal tract from atmospheric pressure during deglutition, producing a partial vacuum to facilitate compression of the food bolus by the tongue, cheeks, and pharynx, and therapy forcing it into the esophagus.
  2. Open the Eustachian tube during swallowing in order to ventilate the middle ear.

In only three phonemes of English, the nasal semi vowels, it is permissible for the velopharyngeal valve to remain open, coupling the oral with the nasal cavitites; /m/,/n/, and /h/ (as in sing).  The reminder of English phonemes are correctly produced with the velopharyngeal port closed, meaning all vowels and consonants.
If the port is left open, voiced consonants will be excessively resonated in the nasal cavities and intra oral air pressure for plosives, fricatives and affricatives will be reduced or absent.  In an attempt to produce them, air escapes through the nose and results in a weak, nasally distorted production of the target sound.  It should also be mentioned that a certain amount of nasal resonation of vowels is normal.  The borderline between normal and pathologic hypernasality often is a matter of perceptual preference.

Cleft Lip and Palate:
Clefts of the hard and soft palate are the most serious of all causes of hypernasality and nasal emission.

Associated problem with cleft lip and palate are:

  1. Articulation
  2. Language
  3. Resonance
  4. Hearing loss (conductive)

Mainly children with cleft palate will be having more of resonance disorder.


Classification and Definition of Nasal Resonatory Disorders

1. a) Hypernasality and nasal air emission
Hypernasality synonyms are rhinolalia aperta, hyper-rhinolalia, and open nasalaity.  Defined as excess resonance of vowels and voiced consonants within the nasal cavities.  The anatomic-physiologic basis is open coupling between the oral and nasal cavities due to incomplete closure of the hard palate / or velopharyngeal sphincter.
b) Nasal air emission
Defined as abnormal flow of air from the nares during the production of high pressure, consonants.
c) Nasal and Facial Grimaces
Defined as occluion of the nares by contracting the alae of the nose with associated wrinkling of the forehead.
3.Mixed Nasality

Articulatory Defects:
These are inevitable in children with cleft lip and palate.  Rarely does cleft lip alone produce defects of articulation unless its repair produces an exceptionally short, light upper lip that prevents lower one from reaching it for the bilabial sounds /p/, /b/ and /m/.
Compansatory articulatory and phonatory substitutions in cleft palate are:

  1. The glottal stop
  2. The glottal fricatives
  3. The pharyngeal stop
  4. The pharyngeal fricative
  5. Velar fricative
  6. The posterior nasal fricative
  7. The mid-dorsum palatal stop

Diagnosis and Treatment:
Perceptual Evaluation
Judgment as to the pressure and severity of a nasal resonatory disorder lies within the ear of the speech pathologist and not a mechanical or electronic instrument, although such devices can support the classical impression. 

Contextual Speech Impression:
Having the patient simulate speech as closely as possible.  Depending upon age and co-cooperativeness, two kinds of connected speech sample will be obtained and  simultaneously audio recoded for conformational analysis later.

Semi Objective Test:

  1. Mirror Clouding Test

By placing a hand mirror or cold shiny metal object under the patients nares, the patient will be asked to repeat a sentence that is free of all nasal semivowels.
Eg. In English                            In Tamil
“We see three geese”                “ Pappa  Pattu Padu”
People who have normal palatal and velopharngeal closure should not leak air through nose during such phrases.  Fogging of the mirror under one or both  nares indicates velopharngeal insufficiency.

Use of the Nasal View System in Diagnosis:
            The Nasal view System is highly beneficial in the identification of resonance based disorders which have Hyper nasality and Nasal Emission.
            By having a patient read or repeat zoo passage (0% nasal consonants) using the nasal view system, one can objectively determine if the patient has significantly increased or decreased nasalance.  Perhaps most importantly, the objective data provided via the nasal view system is used to document Pre and Post therapy change in the patients speech production.

Therapy Techniques of use in Nasal View System:
            Many of the Speech Therapy techniques used to modify hypernasality & nasal emission deal with attempts to increase oral airflow.  A simple but effective therapy technique forces on having the patient accentuate the movements of mandible and lips during speech to emphasize oral airflow.  The patient is taught to implement this treatment technique while using the Nasal View System, objective nasal & auditory data feedback will be provided to the patient regarding their change in hyper nasality and nasal emission.

Orientation & Home Training:
            For the children below the age of 2 years, we provide orientation to the parents regarding the speech & Language stimulation at home.
            For the children above 2 years will be taught.
Resonance Therapy

  1. Oro Motor Exercises
  2. Articulation Therapy

Not only we provide speech & language therapy for the children with cleft lip & palate.  We also train them to sing songs.
            Hence we could present “SSS
                        Beautiful Smiles
                        Intelligible Speech
                        Junior Singers