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Flashcards in Resonance-Test 2 Deck (23):

Anatomical/physiological etiologies of nasal resonance disorders

Velopharyngeal inadequacy
Velopharyngeal incompetency


What happens during Velopharyngeal Closure

Palate elevates to pharyngeal wall, pharyngeal wall moves forward, lateral pharyngeal wall moves medially


Velum elevated except for ____

Nasal consonants: m, n, ng



Plosives, fricatives, snorting
Facial grimacing


Hyponasality sounds like _____

Sounds like a cold


Cul-De-Sac Resonance

Disorder of muscle hyperfunction
Results from an occluded or obstructed nasal airway in conjunction with significant pharyngeal tension
The typical voice of a deaf child
Tongue retracted posteriorly which creates the peculiar resonance heard in deaf speakers


Etiologies of Hypernasality

Clefts of hard or soft palate
Submucous clefts
Inadequate velar length
Paralysis or paresis of velum
Paralysis/paresis of pharyngeal constrictor muscles
Paralysis/paresis of lateral walls
Anterior levator insertion
Large tonsils
Fistula in hard or soft palate
Deep pharynx


Etiologies of Hyponasality (lack of nasal resonance on nasal consonants)

Deviated septum
Nasal polyps
Enlarged adenoids
High arched palate
Too wide pharyngeal flap
Too large obturator bulb


Evaluation of Resonance Disorders

1. Count from 60-100
2. Mirror under pt's nose
3. Sucking through a straw
4. Cine fluoroscopy/lateral radiography
5. Nasendoscopy
6. Oral monometer
7. See-scape
8. Sound spectrography


When does hypernasality (excess nasal resonance) occur? (evaluation of quality)

1. During production of vowels
2. High pressure consonants (fricatives, affricates, plosives)


Evaluation of hypernasality

1. Reading of single words vs. connected speech
2. Note nasal emission
3. Iowa Pressure Test
4. Phonation of vowels /i/ & /u/ alternately compress & release nostril: adequate--no difference; incompetence--flutter sound
5. Fiberoptic nasopharyngoscopy
6. Videofluroscopy


When hyponasality (lack of nasal resonance) occurs (eval of quality)

1. Vowel sounds are denasalized
2. Voice is dull & muffled
3. Most evident with nasal consonants (m, n, ng)
4. Speech resembles their plosive counterparts: b, d, g


Eval of hyponasality

1. Read from a word list or reading passage loaded with nasals
2. Common substitutions: b/m, d/n, g/ng
3. Inability to hum


Eval of cul-de-sac resonance

1. Evaluate tongue position of /a/ prolongation
2. Look for improvement with:
-Tongue tip sounds: t, d, s, z
-Front vowels: i, I, e
-Front consonants: w, p, b, f, v, th, l


What to do during radiographic studies or speech films

1. quiet breathing
2. vowel "e" prolongation
3. connected speech


What to look at on radiographic studies

1. Measure gap between velum & posterior wall of pharynx
2. Presence & effect of enlarged tonsils
3. Presence & size of adenoid mass
4. Configuration of nasopharynx


Tx Options for VPI

1. Functional: speech tx prior to surgery
2. Surgical intervention: flaps, implants
3. Prosthetics
4. Speech tx following surgery &/or prosthetics



1. Blowing, sucking, swallowing, gagging exercises are unsuccessful
2. Blowing plus speech
3. Establish oral air flow
4. Increase oral articulator mobility



1. Palatal lift
2. Palatal lift & bulb


Speech Bulb

Soft palate too short to contact posterior pharyngeal wall (PPW)
Bulb contacts PPW
Maintain some opening on the sides of the bulb for the nasal breathing


Palatal Lift

Soft palate of sufficient length but lacks sufficient mobility
Soft palate contacts PPW
Maintain some opening on sides of the elevated palate for nasal breathing


Considerations for Pharyngeal Flap

1. Preoperative eval of lateral wall motion is vital
2. 2mm in medial direction
3. Decreased movement-make flap wider


Pharyngeal Flap Procedure

For hypernasal speech
A superiorly based flap of tissue is raised from posterior pharynx & sutured to soft palate thereby decreasing amount of air through the nose
Lateral ports or holes are left so that nose won't be obstructed