Resonance-Test 2 Flashcards
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
Hypernasality
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
- Count from 60-100
- Mirror under pt’s nose
- Sucking through a straw
- Cine fluoroscopy/lateral radiography
- Nasendoscopy
- Oral monometer
- See-scape
- Sound spectrography
When does hypernasality (excess nasal resonance) occur? (evaluation of quality)
- During production of vowels
2. High pressure consonants (fricatives, affricates, plosives)
Evaluation of hypernasality
- Reading of single words vs. connected speech
- Note nasal emission
- Iowa Pressure Test
- Phonation of vowels /i/ & /u/ alternately compress & release nostril: adequate–no difference; incompetence–flutter sound
- Fiberoptic nasopharyngoscopy
- Videofluroscopy
When hyponasality (lack of nasal resonance) occurs (eval of quality)
- Vowel sounds are denasalized
- Voice is dull & muffled
- Most evident with nasal consonants (m, n, ng)
- Speech resembles their plosive counterparts: b, d, g
Eval of hyponasality
- Read from a word list or reading passage loaded with nasals
- Common substitutions: b/m, d/n, g/ng
- Inability to hum
Eval of cul-de-sac resonance
- Evaluate tongue position of /a/ prolongation
- 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
- quiet breathing
- vowel “e” prolongation
- connected speech
What to look at on radiographic studies
- Measure gap between velum & posterior wall of pharynx
- Presence & effect of enlarged tonsils
- Presence & size of adenoid mass
- Configuration of nasopharynx
Tx Options for VPI
- Functional: speech tx prior to surgery
- Surgical intervention: flaps, implants
- Prosthetics
- Speech tx following surgery &/or prosthetics
Therapy
- Blowing, sucking, swallowing, gagging exercises are unsuccessful
- Blowing plus speech
- Establish oral air flow
- Increase oral articulator mobility
Prostheses
- 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
- Preoperative eval of lateral wall motion is vital
- 2mm in medial direction
- 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
