Voice and Speech Production
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Velopharyngeal incompetence or significant lowering of the soft palate will result in a hypernasal speech quality. In more extreme cases, audible nasal air escape can be heard during speech. There is evidence to suggest that listeners tend to associate negative personal attributes to individuals with hypernasal speech.10 Structural abnormalities such as a cleft palate or submucosal cleft often result in marked hypernasality. Conversely, an inability to produce appropriate nasal resonance (especially for sounds m, n and ng) will result in hyponasal speech quality. This is, of course, most likely to occur in space-occupying conditions of the nasopharynx. Removal of the space-occupying lesion or tissue may result in hypernasality although this is likely to be temporary in most cases. A significant but poorly investigated possible complication of the uvulopalatopharyngoplasty (UPP) surgical procedure is the resultant hypernasal speech.11
Cleft Lip and Palate
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
Velopharyngeal insufficiency (VPI) can occur in children with a repaired cleft palate, those with a submucous cleft and in children without any obvious palatal abnormalities. It can also occur after adenoidectomy, with a reported clinically significant incidence of between 1 in 1500 and 1 in 3000. Stigmata of a submucous cleft are bifid uvula, zona pellucida and hard palate notch, all of which should be examined for at the time of adenoidectomy. VPI occurring after adenoidectomy will spontaneously resolve in about 50% of cases.69 In order to achieve intelligible speech, the palate must be able to seal against the posterior pharyngeal wall and close off the nasopharynx. If this is impaired, nasal emissions and hypernasal speech can ensue. Around 20% of cleft palate children have persistent speech disorder following surgery, falling into the worst category of intelligibility.70
Velo-cario-Facial Syndrome
Merlin G. Butler, F. John Meaney in Genetics of Developmental Disabilities, 2019
A number of earlier reports described individuals with VCFS although the purpose of those reports was to discuss specific speech disorders, heart anomalies, or immune deficiencies (18–20). Sedlačková (21) reported a large series of cases that had the association of hypernasal speech with facial innervation anomalies. Cayler (22) described asymmetric crying faciès and heart anomalies, a common association in VCFS. Kretschmer et al. (19) described three cases with absent thymus and showed photographs of a single case with “DiGeorge’s syndrome” that clearly had the clinical features of VCFS. Kaplan (20) described the palatal anomalies commonly found in VCFS and showed photographs of four cases, of which three had VCFS and one clearly did not. Kinouchi et al. (23) and Takao et al. (24) and Momma et al. (25) also described the same syndrome in the Japanese literature. All of these early reports described the same syndrome and because the authors who approached these clinical cases often did so from different perspectives, we have the unfortunate circumstance of one condition having more than one name. This nosologic dilemma has caused some confusion in both the clinical and research approaches to children with this common genetic syndrome. The disorder has been labeled VCFS, DiGeorge syndrome, Cayler syndrome, conotruncal anomalies face syndrome, Takao syndrome, Sedlačková syndrome, Shprintzen syndrome, 22q11 deletion syndrome, and CATCH 22 (a regrettable acronym meant to invoke humor) therefore leading some researchers and clinicians to conclude that these are all separate disorders. However, let there be no mistake that all of these conditions are one in the same.
Normative nasalance scores in Tamil-speaking Indian children
Published in Logopedics Phoniatrics Vocology, 2022
Apar Pokharel, P. Naina, Swapna Sebastain, Kamran Asif Syed, Mary John, Ajoy Mathew Varghese
Resonance disorders are related to velopharyngeal and upper airway structure and function. Resonance disorders include hypernasality, hyponasality, cul-de-dac resonance, and mixed resonance disorders. A hypernasal speech is seen in clinical populations at risk of velopharyngeal insufficiency such as cleft palate or neuromuscular dysfunction, whereas a hyponasal voice is seen in the population with reduced permeability of the upper airways like nasal obstruction due to adenotonsillar hypertrophy. The speech pathologist has an essential role in identifying and diagnosing the oronasal balance changes in different clinical populations, in order to seek appropriate treatment [1,2]. Resonance disorders especially hypernasality can significantly affect speech quality and draw negative attention from listeners [3].
Bilateral Sixth Nerve Palsy and Nasal Voice in Two Sisters as a Variant of Guillan–Barré Syndrome
Published in Neuro-Ophthalmology, 2018
Francesco Pellegrini, Margaret Wang, Napoleone Romeo, Andrew G. Lee
The “classic” ophthalmoplegic pattern in MFS is a symmetric paresis of upgaze and progressive impairment of horizontal gaze,4 although ocular motor patterns can be variable.8 There can be an asymmetric ophthalmoplegia, abduction or adduction palsies, third nerve palsies, and even an “inverse” MFS with bilateral ptosis and preserved eye movements. Patients can also have central ocular motor signs such as impaired smooth pursuit and vestibulo-ocular reflex cancellation, and sometimes even present with impaired vestibulo-ocular responses with otherwise normal eye movements.9 Patients can have gaze-evoked, dissociated abducting, convergence retraction, or rebound nystagmus. Other cranial nerves may be affected, particularly the seventh nerve with subsequent facial palsy. An “ophthalmoplegia without ataxia” variant of this condition has also been described4 and should be considered in patients presenting with bilateral sixth nerve palsies. Other associated signs and symptoms may include dysesthesia in the limbs, dysphagia, ptosis, and bilateral dilated pupils with photophobia.10 Rhinolalia aperta (or hypernasal speech) is usually indicative of either a structural or neurological disorder affecting the larynx11 and it has been described in MFS.11,12
Validity of test stimuli for nasalance measurement in speakers of Jordanian Arabic
Published in Logopedics Phoniatrics Vocology, 2018
Fadwa A. Khwaileh, Firas S. D. Alfwaress, Ann W. Kummer, Ma’moun Alrawashdeh
Since the nasometer was introduced, numerous studies have been conducted to determine its efficacy in the assessment of speech resonance (9–16). Dalston et al. (12) investigated the relationship between nasalance scores, perceptual judgment of hypernasality, and estimates of VP orifice size through aerodynamic measurements. Results revealed that patients whose nasalance scores were higher than 32% on the Zoo Passage (a standard passage devoid of nasal consonants) typically manifested velopharyngeal openings exceeding 0.10 square centimeters based on aerodynamic measurements. These same patients were also judged to have mild-to-moderate hypernasality based on clinical perceptual assessment. The authors also calculated the sensitivity and specificity of nasometric measures using a nasalance cutoff of 32%. Sensitivity was found to be 0.89 and specificity was 0.95. In other words, 89% of patients perceptually identified as having hypernasal speech had a high nasalance score (sensitivity) and 95% of patients judged as having normal speech resonance had low nasalance scores. Another study resulted in 0.76 sensitivity and 0.86 specificity using nasalance cutoff score of 27% for the Zoo Passage (17). Watterson et al. (18) also found a significant correlation between nasalance score and perceptual judgment of hypernasality when the speech passage is devoid of nasal phonemes.
Related Knowledge Centers
- Eustachian Tube
- Middle Ear
- Palate
- Vocal Tract
- Soft Palate
- Hard Palate
- Nasal Cavity
- Nasalization
- Uvula
- Nasal Consonant