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Cleft Palate > Chapter Seven Resonance > Flashcards

Chapter Seven Resonance Flashcards

1
Q

Resonance

A

The natural frequency at which an object vibrates effectively

resonance is shaped by the vocal tract

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2
Q

_______are common in individuals with a history of cleft lip and palate or other craniofacial anomalies.

Can be due to ______

Velopharyngeal dysfunction can cause a resonance disorder (hypernasality) and also _________

Significant nasal emission can cause….

A

Resonance disorders

velopharyngeal dysfunction, or obstruction in vocal tract

nasal emission of the air

other speech characteristics due to lack of adequate oral airflow and air pressure

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3
Q

Normal Resonance

Speech requires both ….

Airflow is converted into air pressure by ….

Sound is modified by …

A

airflow and sound.

articulators, which is needed for pressure-sensitive consonants (plosives, fricatives and affricates)

resonance, which is needed for voiced consonants and vowels

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4
Q

Schema of Speech Production

A
  1. Lungs
    a) VC vibration
    b) Sound
    c) Resonance
    d) Vowels and voiced consonants
  2. Lungs
    a) Open glotiis
    b) Airflow
    c) Air pressure
    d) Voiceless consonants
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5
Q

Normal Resonance

Resonance—tendency of a system to ….

Resonance with speech—

Resonance provides the ____
and _______of the voice.

A

vibrate (oscillate) with a larger amplitude at some frequencies than others due to the natural vibration of the system

modification of phonated sound through selective enhancement of certain frequencies

quality and uniqueness

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6
Q

Resonance is determined by …

Smaller cavities enhance ____ frequencies.

Larger cavities enhance _____frequencies and result in a ____sound.

A

size and shape of cavities of the vocal tract (pharyngeal, oral, and nasal cavities).

higher

lower
richer

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7
Q

Resonance is a component of all ….

Vowels are actually ______sounds.

They are produced by ….

Vowels affect the size and shape of oral cavity, changing ________of _______ and _____of the vowel.

A

voiced consonants and all vowels.

resonance

changing the size and shape of the oral cavity with tongue, mandible, and lips.

selective enhancement
formant frequencies
perception

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8
Q

____vowels have more nasal resonance than ____vowels.

______position causes more oral impedance and more oral pressure, which increases _______of the sound.

A

High; low

High tongue; transpalatal transmission

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9
Q

Resonance disorder—

Types include the following:

A

abnormal transmission of sound energy through the oral, nasal, and/or pharyngeal cavities of the vocal tract during speech production

  1. Hypernasality: excessive nasal resonance
  2. Hyponasality: excessive oral resonance
  3. Cul-de-sac resonance: “potato in the mouth speech”/ muffled
  4. Mixed resonance: hard to diagnose. COmbination of both hypo and hyper
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10
Q

Hypernasality—

Due to…

Most perceptible on ____

A

abnormal nasal resonance during the production of oral sounds

abnormal coupling (sharing of acoustic energy) of the oral and nasal cavities during speech

vowels; any sound of hypernaslity is evident on vowels. They are produced with a more open vocal tract

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11
Q

Hypernasality

When severe…

A

Voiced oral consonants become nasalized (e.g., m/b, n/d).
-Obligatory production

Other consonants may be substituted by nasals (e.g., n/s).
-Compensatory production

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12
Q

Causes of Hypernasality

Causes include:

A

A velopharyngeal opening

A thin velum due to a submucous cleft

A very large oronasal fistula (as noted below)

Nasal articulation on certain oral sounds (phoneme-specific) due to mislearning

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13
Q

Hyponasality and Denasality

Hyponasality—

Denasality—

In both cases, individual sounds “______”

A

a reduction in normal nasal resonance during speech, particularly with nasal sounds

no nasal resonance during speech, including with nasal sounds

stuffed up

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14
Q

Hyponasality and denasality particularly affect ______but also affect _____if severe.

Nasal consonants sound similar to their ….

A

nasal sounds; vowels

oral cognates (e.g., b/m, d/n, g/ŋ).

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15
Q

Hyponasality and Denasality

Caused by ______ in nasopharynx or nasal cavity due to:

A

blockage

Allergic rhinitis: inflammation of nose

Common cold

Adenoid hypertrophy:

Hypertrophic tonsils that
intrude into the pharynx

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16
Q

Hyponasality and Denasality

Causes with history of cleft lip/palate:

A

Deviated septum

Choanal stenosis or atresia

Stenotic naris

Maxillary retrusion which restricts pharyngeal and nasal cavity space

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17
Q

Cul-de-Sac Resonance

Cul-de-sac resonance—

Sound is absorbed by _____

Speech is perceived as ….

A

acoustic energy is blocked from exiting at a cavity’s normal outlet

soft tissues.

muffled and low in volume.

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18
Q

Types of cul-de-sac resonance are defined by ….

Types include:

A

blockage at the cavity’s exit point.

Oral cul-de-sac resonance

Nasal cul-de-sac resonance

Pharyngeal cul-de-sac resonance

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19
Q

Oral cul-de-sac resonance—

Causes include:
1.
2.

A

sound is partially blocked from exiting the oral cavity during speech.

1,Microstomia—a small mouth opening

2.“Mumbling,” speaking without opening the mouth normally

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20
Q

Nasal cul-de-sac resonance—

It is most noticeable with both ____ (which would otherwise cause hypernasality) and an _______.

Nasal cul-de-sac resonance is common with cleft lip/palate when there is both ____and _________

A

sound is partially blocked from exiting the nasal cavity during speech.

VPI and anterior nasal blockage.

VPI; blockage due to nares stenosis.

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21
Q

Pharyngeal cul-de-sac resonance—

Causes include:

A

sound remains in the oropharynx during speech

Large tonsils that block exit of the oropharynx and entrance to oral cavity

Obstruction on the pharyngeal wall of the hypopharynx or oropharynx

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22
Q

Mixed resonance—

Although hypernasality and hyponasality cannot occur simultaneously, they can both occur on ______in the same speaker.

Causes

A

any combination of hypernasality (with or without nasal emission), hyponasality, and cul-de-sac resonance

different sounds

VPI and obstruction and
Apraxia

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23
Q

Effect of Surgery on Resonance**

Surgery can change the _____of the resonating cavities and affect _____.

Adenoidectomy:

Tonsillectomy:
1.

A

anatomy ; speech

  1. Can improve hyponasality
  2. Can exacerbate or cause velopharyngeal insufficiency with hypernasality (and nasal air emission)
  3. Can eliminate pharyngeal cul-de-sac resonance
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24
Q

Treatment

A

Surgery

Prosthetic device

Speech therapy
ONLY when abnormal resonance is phoneme-specific due to faulty articulation

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25
Q

Nasal Emission

Nasal emission—

Four basic types of nasal emission:

A

when there is an attempt to build up intraoral air pressure for consonants while there is a leak in the system (velopharyngeal valve or oronasal fistula)

  1. Inaudible nasal emission
  2. Audible nasal emission
  3. Nasal rustle (turbulence)
  4. Phoneme-specific nasal emission (PSNE)
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26
Q

Nasal Emission

Inaudible nasal
emission—

There is very little _____to the flow and therefore, little friction or _____.

_______ masks the sound of nasal emission.

A

occurs with a relatively large opening

impedance;pressure

Hypernasality

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27
Q

Inaudible nasal emission

Can cause secondary characteristics including:

A

Weak or omitted consonants

Short utterance length

A nasal grimace

Compensatory articulation
productions

Dysphonia

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28
Q

Nasal Air Emission

Audible nasal emission—occurs when …

There is _______to the flow, making the nasal emission _____.

There is less pronounced ______to mask the nasal emission.

There still may be some of the other secondary characteristics due to a ____of airflow.

A

emission can say s (but not for very long bc it escapes through nose)

there is a medium-sized velopharyngeal opening

greater resistance; more audible

hypernasality

leak

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29
Q

Nasal Air Emission

Nasal rustle (also called nasal turbulence)—occurs when…

There is _____to the flow, making the nasal emission _____.

Air flow through a small opening results in _______ than flow through a large opening.

Air is released into nasal cavity with pressure, causing very audible ….

Nasal rustle is usually inconsistent, but increases with increase in ……

A

there is a small
velopharyngeal opening

great resistance; more audible

higher air pressure

bubbling of nasal secretions.

utterance length, speed, phonemic complexity, and even fatigue

30
Q

Obligatory Distortions and Compensatory Errors

Obligatory distortions—occur when…

Compensatory errors—

A

articulation placement is normal but a structural or physiological problem causes distortion of speech
(Require physical correction, but don’t treat with SLP bc there is a problem with the anatomy!)

Seen in cleft palate when the primary surgery has not been performed***

misarticulations that occur in response to abnormal structure (or abnormal speech physiology)

Require physical correction and then speech therapy

These occur after the physical correction, but are a result of what they were producing prior to the surgery***

31
Q 
Obligatory distortions due to a large velopharyngeal opening:
1.
2.
3.
4.
A

Weak or omitted consonants bc it is difficult to build up intraoral pressure

Short utterance length

Nasalization of oral consonants

Nasal grimace

32
Q

Weak or Omitted Consonants

Loss of air through the velopharyngeal valve reduces _______in the oral cavity.

The greater the nasal air emission, the ______

A

the amount of airflow

weaker the consonants.

33
Q

Short Utterance Length

Large opening causes need to replenish lost airflow by …

Utterance length becomes ____ and speech is ____.

A

taking more frequent breaths.

shortened; choppy

34
Q

Nasalization of Oral Consonants

When voiced plosives are produced with large velopharyngeal opening or large fistula, these oral phonemes will sound more like their ________

A

nasal cognates (e.g., m/b, n/d, and g/ŋ).

35
Q

Nasal Grimace:

Overflow muscle reaction in attempt to _______

A

Muscle contractions just above the nasal bridge and/or at the side of the nares

close velopharyngeal valve

36
Q

Compensatory Articulation Productions

For an oronasal fistula:

A

Palatal-dorsal production (also called middorsum palatal stop) *IMAGE: tongue is placed on palate and then you produce the stop (closing the fistula)

Velar plosive

Velar fricatives/affricates*IMAGE:

37
Q

Compensatory Articulation Productions

For VPI:

A

Pharyngeal plosive: stop produced @ level of pharynx

Pharyngeal fricative/affricate

Velar fricatives/affricates

Posterior nasal fricative

Nasal snort

Nasal sniff

Glottal stop

Glottal fricative

Breathiness

38
Q

Dysphonia—

A

characterized by breathiness, hoarseness, low intensity, and/or glottal fry during phonation

39
Q

Dysphonia

Children with clefts, craniofacial anomalies, or VPI have risk for dysphonia, due to the following:

A

Hyperfunction to achieve VP valving can lead to vocal nodules.

There may be congenital laryngeal anomalies.

Dysphonia can be due to laryngeal complications from long-term tracheostomy.

Breathiness can be used as a compensatory strategy.

40
Q

Normal Velopharyngeal Function

A

Function (Articulation)

Anatomy (Structure)

Neurophysiology (Movement)

41
Q

Velopharyngeal Dysfunction (VPD)

A

Learning (Articulation)
Velopharyngeal Mislearning

Anatomy (Structure)
Velopharyngeal Insufficiency

Neurophysiology (Movement) Velopharyngeal Incompetence

42
Q

Velopharyngeal dysfunction (VPD):

Velopharyngeal insufficiency (VPI):

Velopharyngeal incompetence (VPI):

Velopharyngeal mislearning

A

General term for abnormal VP function

Anatomical (structural) defects

Neurophysiological (movement) disorder

Articulation (learning) disorder

43
Q

Velopharyngeal Insufficiency (VPI)

Velum moves normally, but

A

is too short for closure due to abnormal structure

44
Q 
Velopharyngeal Insufficiency (VPI)
Causes include:
A

History of cleft

Submucous cleft palate (overt or occult)

Short velum or deep pharynx (cranial base anomalies)

Adenoid atrophy

Irregular adenoids

Hypertrophic (enlarged) tonsils

45
Q

History of Cleft Palate

______of patients with cleft palate will have VPI.

Velum may be _____following repair.

Velum may have a ___________

A

20% to 30 %

too short

notch on posterior nasal surface.

46
Q

Submucous Cleft

May cause:

A

Small notch in the posterior border of the velum

Hypoplasticity of musculus uvulae muscles

Anterior orientation of the levator veli palatini muscles

Zona pellucida

47
Q

Deep Pharynx

Velum may be normal but ____to reach the posterior pharyngeal wall due to an abnormally______

It can be seen in some _______

A

unable; deep pharynx.

craniosynostosis syndromes.

48
Q

Adenoid Atrophy

Adenoid atrophy, particularly around puberty, can increase the _______, causing gradual onset of VPI.

Parents often report that their child has begun to “______.”

The biggest concern is if there is _______due to cleft palate or submucous cleft palate.

A

depth of the pharynx

mumble

tenuous closure

49
Q

Irregular Adenoids

Normal VP closure requires ______

Adenoid irregularity (marked indentation or protrusion) _____a tight seal.

Irregular adenoids can cause ______ and ______

A

a tight seal.

prevents

small gap and nasal emission

50
Q

Hypertrophic Tonsils

Can extend into ______

May interfere with _______ movement

May intrude between the _____ and _____, preventing a tight VP seal

A

pharynx

lateral pharyngeal wall

velum and posterior pharyngeal wall

51
Q

Velopharyngeal Insufficiency (VPI)

Surgical or treatment procedures:

1.
2.
3.
4.

A

Adenoidectomy

Tonsillectomy- VERY, VERY rare

Maxillary advancement

Oral, nasal, and pharyngeal cavity tumors

52
Q

Adenoidectomy

Adenoidectomy can cause VPI due to ________.

It is often _____and resolves within ____.

Permanent VPI is a risk, especially with history of ______

VPI post adenoidectomy cannot be corrected with _____

A

sudden increase in the nasopharyngeal dimension

temporary; 6 weeks

cleft or submucous cleft.

speech therapy.

53
Q

Tonsillectomy

VERY ____has a negative effect on resonance

Only exceptions
1.
2.

A

rarely

Significant scarring

Learned protective response to pain

54
Q

Maxillary Advancement

Done surgically or through distraction to corrects …

Often done for patients with ____

Improves _____ and aesthetics and eliminates ______

A

mid-face retrusion and Class III malocclusion

history of cleft

facial profile; obligatory distortions

55
Q

Maxillary Advancement

Moving the maxillary forward also moves the ____forward

Risk for VPI greatest with _____

A

velum

history of cleft

56
Q

Oral, Nasal, and PharyngealCavity Tumors

Treatment
1.
2.

Both increase ________, which can cause VPI.

A
  1. Resection (surgical removal) of tissue
  2. Radiation therapy to shrink tissue

nasopharyngeal space

57
Q

Velopharyngeal Incompetence (VPI)

Velum has normal structure, but has inadequate movement for closure due to ________

A

abnormal neurophysiology

58
Q 
Velopharyngeal Incompetence (VPI)
Causes include:
1.
2.
3.
A
  1. Neurological injury (e.g., traumatic brain injury, cerebral palsy, stroke)
  2. Neuromuscular diseases (e.g., muscular dystrophy, myasthenia gravis, etc.)
  3. Cranial nerve damage
59
Q 
Velopharyngeal Incompetence (VPI)
Often associated with:
1.
2.
3.
A

Velar and/or pharyngeal hypotonia

Dysarthria

Apraxia of speech

60
Q

Hypotonia—a state of

Can cause poor _____ and _____movement

Is common in patients with _______

A

low muscle tonicity and sometimes, reduced muscle strength

velar and pharyngeal

velocardiofacial syndrome

61
Q

Dysarthria—an ______disorder that affects all the subsystems of speech, including:

A

oral-motor

Respiration

Phonation

Articulation

Velopharyngeal function

62
Q

Dysarthria

Characteristics of dysarthria related to VPI:

A

Hypernasality

Weak or omitted consonants

Short utterance length

Decreased volume

63
Q

Apraxia of speech—

Affects ______of speech subsystems:
1.
2.
3.

A

a motor speech disorder that causes difficulty combining and sequencing motor movements

coordination

Phonation
Articulation
Velopharyngeal function

64
Q

Characteristics of apraxia related to VPI:

Characteristics are due to:

A

Inconsistent nasalization of oral consonants and inconsistent denasalization of nasal consonants

Poor coordination, timing, and duration of VP closure

Velum raises inappropriately for nasal sounds and lowers inappropriately for oral sounds

65
Q

Velar Paralysis or Paresis

______ or ______ can cause specific velopharyngeal paralysis or paresis (partial loss of movement or weakness)

Often ______causing a unilateral VP opening

Common with ____

A

Brain stem OR cranial nerve damage

unilateral

hemifacial microsomia

66
Q

Velar Fatigue and Stress Incompetence

Velar fatigue and stress sometimes occurs in ____when playing wind instruments, even though speech is unaffected.

Velar fatigue may be first symptom of a ______.

A

musicians

progressive neurological disorder

67
Q

Velopharyneal Mislearning

Velopharyngeal mislearning is an articulation disorder that includes …

Velopharyneal mislearning results in an open ______, causing ______
or _______during the production of those speech sounds.

______, not surgery, is indicated for velopharyngeal mislearning.

________between misarticulations due to mislearning alone versus those due to VPI is critically important.

A

the substitution of nasal or pharyngeal sounds for oral sounds.

velopharyngeal valve;
nasal emission;
hypernasality

Speech therapy

Differential diagnosis

68
Q

Velopharyngeal Mislearning

Learned misarticulations can include:
1.
2.

A

Compensatory productions learned due to VPI or other structural anomalies

Misarticulations in children without structural anomalies, causing phoneme-specific nasal emission or phoneme-specific hypernasality

69
Q

Velopharyngeal Mislearning

Phoneme-specific nasal emission—

Phoneme-specific hypernasality—

A

occurs when the individual uses a pharyngeal fricative or posterior nasal fricative as a substitution for oral fricatives

occurs when the individual consistently substitutes a nasal sound for an oral sound (e.g., ŋ/l or ŋ/r) or uses a high tongue position on certain vowels

70
Q

Velopharyngeal Mislearning

Hearing loss causes ______

VP function is learned through _____ and auditory feedback.

Lack of hearing and _______ affects ability to learn to use the _____for speech.

Individuals with severe hearing impairment or deafness demonstrate abnormal resonance that can be a mixture of

A

abnormal resonance.

imitation and auditory feedback.

auditory feedback; VP valve

hypernasality, hyponasality, and even cul-de-sac resonance.

71
Q

Summary

SLP is responsible for diagnosing ________of resonance disorders and VPD.

There is a need to determine abnormal ______versus abnormal ______.

Differential diagnosis is important so patient will receive _______.

Resonance disorders and VPI are not …

Speech therapy is appropriate for ______errors due to VPI and placement errors that cause phoneme-specific nasal emission or hypernasality.

A

probable cause

structure; function

appropriate treatment

directly treated by SLPs.

compensatory

Cleft Palate (19 decks)

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