Chapter Seven Resonance Flashcards
Resonance
The natural frequency at which an object vibrates effectively
resonance is shaped by the vocal tract
_______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….
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
Normal Resonance
Speech requires both ….
Airflow is converted into air pressure by ….
Sound is modified by …
airflow and sound.
articulators, which is needed for pressure-sensitive consonants (plosives, fricatives and affricates)
resonance, which is needed for voiced consonants and vowels
Schema of Speech Production
- Lungs
a) VC vibration
b) Sound
c) Resonance
d) Vowels and voiced consonants - Lungs
a) Open glotiis
b) Airflow
c) Air pressure
d) Voiceless consonants
Normal Resonance
Resonance—tendency of a system to ….
Resonance with speech—
Resonance provides the ____
and _______of the voice.
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
Resonance is determined by …
Smaller cavities enhance ____ frequencies.
Larger cavities enhance _____frequencies and result in a ____sound.
size and shape of cavities of the vocal tract (pharyngeal, oral, and nasal cavities).
higher
lower
richer
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.
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
____vowels have more nasal resonance than ____vowels.
______position causes more oral impedance and more oral pressure, which increases _______of the sound.
High; low
High tongue; transpalatal transmission
Resonance disorder—
Types include the following:
abnormal transmission of sound energy through the oral, nasal, and/or pharyngeal cavities of the vocal tract during speech production
- Hypernasality: excessive nasal resonance
- Hyponasality: excessive oral resonance
- Cul-de-sac resonance: “potato in the mouth speech”/ muffled
- Mixed resonance: hard to diagnose. COmbination of both hypo and hyper
Hypernasality—
Due to…
Most perceptible on ____
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
Hypernasality
When severe…
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
Causes of Hypernasality
Causes include:
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
Hyponasality and Denasality
Hyponasality—
Denasality—
In both cases, individual sounds “______”
a reduction in normal nasal resonance during speech, particularly with nasal sounds
no nasal resonance during speech, including with nasal sounds
stuffed up
Hyponasality and denasality particularly affect ______but also affect _____if severe.
Nasal consonants sound similar to their ….
nasal sounds; vowels
oral cognates (e.g., b/m, d/n, g/ŋ).
Hyponasality and Denasality
Caused by ______ in nasopharynx or nasal cavity due to:
blockage
Allergic rhinitis: inflammation of nose
Common cold
Adenoid hypertrophy:
Hypertrophic tonsils that
intrude into the pharynx
Hyponasality and Denasality
Causes with history of cleft lip/palate:
Deviated septum
Choanal stenosis or atresia
Stenotic naris
Maxillary retrusion which restricts pharyngeal and nasal cavity space
Cul-de-Sac Resonance
Cul-de-sac resonance—
Sound is absorbed by _____
Speech is perceived as ….
acoustic energy is blocked from exiting at a cavity’s normal outlet
soft tissues.
muffled and low in volume.
Types of cul-de-sac resonance are defined by ….
Types include:
blockage at the cavity’s exit point.
Oral cul-de-sac resonance
Nasal cul-de-sac resonance
Pharyngeal cul-de-sac resonance
Oral cul-de-sac resonance—
Causes include:
1.
2.
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
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 _________
sound is partially blocked from exiting the nasal cavity during speech.
VPI and anterior nasal blockage.
VPI; blockage due to nares stenosis.
Pharyngeal cul-de-sac resonance—
Causes include:
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
Mixed resonance—
Although hypernasality and hyponasality cannot occur simultaneously, they can both occur on ______in the same speaker.
Causes
any combination of hypernasality (with or without nasal emission), hyponasality, and cul-de-sac resonance
different sounds
VPI and obstruction and
Apraxia
Effect of Surgery on Resonance**
Surgery can change the _____of the resonating cavities and affect _____.
Adenoidectomy:
Tonsillectomy:
1.
anatomy ; speech
- Can improve hyponasality
- Can exacerbate or cause velopharyngeal insufficiency with hypernasality (and nasal air emission)
- Can eliminate pharyngeal cul-de-sac resonance
Treatment
Surgery
Prosthetic device
Speech therapy
ONLY when abnormal resonance is phoneme-specific due to faulty articulation
Nasal Emission
Nasal emission—
Four basic types of nasal emission:
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)
- Inaudible nasal emission
- Audible nasal emission
- Nasal rustle (turbulence)
- Phoneme-specific nasal emission (PSNE)
Nasal Emission
Inaudible nasal
emission—
There is very little _____to the flow and therefore, little friction or _____.
_______ masks the sound of nasal emission.
occurs with a relatively large opening
impedance;pressure
Hypernasality
Inaudible nasal emission
Can cause secondary characteristics including:
Weak or omitted consonants
Short utterance length
A nasal grimace
Compensatory articulation
productions
Dysphonia
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.
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
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 ……
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
Obligatory Distortions and Compensatory Errors
Obligatory distortions—occur when…
Compensatory errors—
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***
Obligatory distortions due to a large velopharyngeal opening: 1. 2. 3. 4.
Weak or omitted consonants bc it is difficult to build up intraoral pressure
Short utterance length
Nasalization of oral consonants
Nasal grimace
Weak or Omitted Consonants
Loss of air through the velopharyngeal valve reduces _______in the oral cavity.
The greater the nasal air emission, the ______
the amount of airflow
weaker the consonants.
Short Utterance Length
Large opening causes need to replenish lost airflow by …
Utterance length becomes ____ and speech is ____.
taking more frequent breaths.
shortened; choppy
Nasalization of Oral Consonants
When voiced plosives are produced with large velopharyngeal opening or large fistula, these oral phonemes will sound more like their ________
nasal cognates (e.g., m/b, n/d, and g/ŋ).
Nasal Grimace:
Overflow muscle reaction in attempt to _______
Muscle contractions just above the nasal bridge and/or at the side of the nares
close velopharyngeal valve
Compensatory Articulation Productions
For an oronasal fistula:
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:
Compensatory Articulation Productions
For VPI:
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
Dysphonia—
characterized by breathiness, hoarseness, low intensity, and/or glottal fry during phonation
Dysphonia
Children with clefts, craniofacial anomalies, or VPI have risk for dysphonia, due to the following:
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.
Normal Velopharyngeal Function
Function (Articulation)
Anatomy (Structure)
Neurophysiology (Movement)
Velopharyngeal Dysfunction (VPD)
Learning (Articulation)
Velopharyngeal Mislearning
Anatomy (Structure)
Velopharyngeal Insufficiency
Neurophysiology (Movement) Velopharyngeal Incompetence
Velopharyngeal dysfunction (VPD):
Velopharyngeal insufficiency (VPI):
Velopharyngeal incompetence (VPI):
Velopharyngeal mislearning
General term for abnormal VP function
Anatomical (structural) defects
Neurophysiological (movement) disorder
Articulation (learning) disorder
Velopharyngeal Insufficiency (VPI)
Velum moves normally, but
is too short for closure due to abnormal structure
Velopharyngeal Insufficiency (VPI) Causes include:
History of cleft
Submucous cleft palate (overt or occult)
Short velum or deep pharynx (cranial base anomalies)
Adenoid atrophy
Irregular adenoids
Hypertrophic (enlarged) tonsils
History of Cleft Palate
______of patients with cleft palate will have VPI.
Velum may be _____following repair.
Velum may have a ___________
20% to 30 %
too short
notch on posterior nasal surface.
Submucous Cleft
May cause:
Small notch in the posterior border of the velum
Hypoplasticity of musculus uvulae muscles
Anterior orientation of the levator veli palatini muscles
Zona pellucida
Deep Pharynx
Velum may be normal but ____to reach the posterior pharyngeal wall due to an abnormally______
It can be seen in some _______
unable; deep pharynx.
craniosynostosis syndromes.
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.
depth of the pharynx
mumble
tenuous closure
Irregular Adenoids
Normal VP closure requires ______
Adenoid irregularity (marked indentation or protrusion) _____a tight seal.
Irregular adenoids can cause ______ and ______
a tight seal.
prevents
small gap and nasal emission
Hypertrophic Tonsils
Can extend into ______
May interfere with _______ movement
May intrude between the _____ and _____, preventing a tight VP seal
pharynx
lateral pharyngeal wall
velum and posterior pharyngeal wall
Velopharyngeal Insufficiency (VPI)
Surgical or treatment procedures:
1.
2.
3.
4.
Adenoidectomy
Tonsillectomy- VERY, VERY rare
Maxillary advancement
Oral, nasal, and pharyngeal cavity tumors
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 _____
sudden increase in the nasopharyngeal dimension
temporary; 6 weeks
cleft or submucous cleft.
speech therapy.
Tonsillectomy
VERY ____has a negative effect on resonance
Only exceptions
1.
2.
rarely
Significant scarring
Learned protective response to pain
Maxillary Advancement
Done surgically or through distraction to corrects …
Often done for patients with ____
Improves _____ and aesthetics and eliminates ______
mid-face retrusion and Class III malocclusion
history of cleft
facial profile; obligatory distortions
Maxillary Advancement
Moving the maxillary forward also moves the ____forward
Risk for VPI greatest with _____
velum
history of cleft
Oral, Nasal, and PharyngealCavity Tumors
Treatment
1.
2.
Both increase ________, which can cause VPI.
- Resection (surgical removal) of tissue
- Radiation therapy to shrink tissue
nasopharyngeal space
Velopharyngeal Incompetence (VPI)
Velum has normal structure, but has inadequate movement for closure due to ________
abnormal neurophysiology
Velopharyngeal Incompetence (VPI) Causes include: 1. 2. 3.
- Neurological injury (e.g., traumatic brain injury, cerebral palsy, stroke)
- Neuromuscular diseases (e.g., muscular dystrophy, myasthenia gravis, etc.)
- Cranial nerve damage
Velopharyngeal Incompetence (VPI) Often associated with: 1. 2. 3.
Velar and/or pharyngeal hypotonia
Dysarthria
Apraxia of speech
Hypotonia—a state of
Can cause poor _____ and _____movement
Is common in patients with _______
low muscle tonicity and sometimes, reduced muscle strength
velar and pharyngeal
velocardiofacial syndrome
Dysarthria—an ______disorder that affects all the subsystems of speech, including:
oral-motor
Respiration
Phonation
Articulation
Velopharyngeal function
Dysarthria
Characteristics of dysarthria related to VPI:
Hypernasality
Weak or omitted consonants
Short utterance length
Decreased volume
Apraxia of speech—
Affects ______of speech subsystems:
1.
2.
3.
a motor speech disorder that causes difficulty combining and sequencing motor movements
coordination
Phonation
Articulation
Velopharyngeal function
Characteristics of apraxia related to VPI:
Characteristics are due to:
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
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 ____
Brain stem OR cranial nerve damage
unilateral
hemifacial microsomia
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 ______.
musicians
progressive neurological disorder
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.
the substitution of nasal or pharyngeal sounds for oral sounds.
velopharyngeal valve;
nasal emission;
hypernasality
Speech therapy
Differential diagnosis
Velopharyngeal Mislearning
Learned misarticulations can include:
1.
2.
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
Velopharyngeal Mislearning
Phoneme-specific nasal emission—
Phoneme-specific hypernasality—
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
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
abnormal resonance.
imitation and auditory feedback.
auditory feedback; VP valve
hypernasality, hyponasality, and even cul-de-sac resonance.
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.
probable cause
structure; function
appropriate treatment
directly treated by SLPs.
compensatory
