Open and closed forms
With open rhinolalia, the soft palate does not separate the nasal cavity from the oral cavity, and air goes into the nose during speech. The voice acquires a pronounced nasal tint, consonants sound weak and unintelligible, primarily explosive and hissing sounds suffer. The causes include congenital cleft palate, shortening of the soft palate, paresis of the palatine muscles, as well as the condition after removal of the adenoids. With closed rhinolalia, on the contrary, the nasal cavity is blocked, which is why the sounds “m” and “n” sound like “b” and “d”, and speech seems muffled. There is also a mixed form.
- Open - air goes into the nose, nasal tone
- Closed - the nose is blocked, the voice is muffled
- Mixed form with a combination of reasons
- Organic - with anatomical changes
- Functional - when muscle function is impaired without a structural defect
Reasons
The most well-known cause of the open form is a congenital cleft of the soft and hard palate, which is operated on at an early age, but speech after the operation does not straighten itself and requires training. There is also a hidden, submucosal cleft, which is not immediately noticed. Nasality may appear after removal of the adenoids, with paresis of the soft palate due to neurological diseases, or after infections. The closed form is more often associated with adenoids, chronic runny nose, polyps, deviated nasal septum, and less often with neoplasms of the nasopharynx.
- Cleft palate, including submucosal
- Short or inactive soft palate
- Paresis of the palatine muscles in neurological diseases
- Condition after adenotomy
- Adenoids and nasal polyps
- Deviated nasal septum and chronic rhinitis
- Neoplasms of the nasopharynx
How does this affect the child?
Speech becomes incomprehensible to others, which affects communication with peers and self-esteem. Children may avoid conversations and refuse to answer in kindergarten and school. Often there are problems with sound pronunciation and poor vocabulary, because the child practices speaking less. In the closed form with constant mouth breathing, sleep and attention suffer, and a characteristic bite is formed. All this is reversible with timely help, but the longer the disorder exists, the more firmly the incorrect speech stereotype is fixed.
- Slurred speech and communication difficulties
- Decreased speech activity and vocabulary
- Hesitation and refusal to speak in front of strangers
- Sleep disorders due to mouth breathing
- Formation of malocclusion
- Difficulties in learning to read and write
Survey
They begin with an examination by an otolaryngologist: assess the structure and mobility of the soft palate, the condition of the nasal cavity and nasopharynx, and the patency of nasal breathing. An endoscopic examination allows you to see adenoids, polyps, and the operation of the velopharyngeal valve during speech. The speech therapist conducts his own examination: assesses speech intelligibility, sound pronunciation, strength and direction of the air stream. If a neurological cause is suspected, a neurologist is involved. Children with cleft palates also need an oral surgeon and an orthodontist.
- Examination by an otolaryngologist
- Endoscopy of the nasal cavity and nasopharynx
- Assessment of soft palate mobility
- Speech therapy examination of speech
- Consultation with a neurologist for palate paresis
- Consultation with a maxillofacial surgeon and orthodontist for clefts
- Hearing assessment for frequent otitis media
Treatment and activities
The procedure is almost always the same: first, the anatomical or inflammatory cause is eliminated, then speech is addressed. For adenoids and polyps, treatment or surgery is performed, for cleft palate - plastic surgery, for rhinitis - conservative therapy. Speech therapy correction includes exercises to activate the soft palate, proper speech breathing with the direction of an air stream through the mouth, work on the voice and consistent production of sounds. Classes must be regular, with mandatory homework; the result depends on systematicity no less than on the qualifications of the specialist.
- Elimination of ENT causes: treatment or surgery
- Palateplasty for clefts
- Exercises for the soft palate and pharynx
- Speech breathing
- Voice work and sound production
- Regular homework
- Observation by an ENT doctor after treatment
