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Otolaryngology (Ear, Nose and Throat)
Hypernasality Program
Hypernasality is a condition in which the palate and pharynx tissues do not close properly causing air to escape through the nose during speech instead of coming out of the sides and back of the throat. The problem lies with the division between the back of the mouth and the back of the nose - the oral pharynx and nasal pharynx. What normally separates the two is the soft palate which helps to seal that area off. Children who lack the ability to close off that separation, the area known as the velopharynx between the oral pharynx and the nasal pharynx tend to have hypernasality (also known as velopharyngeal insufficiency), or too much air that escapes through the nose. Children with hypernasality develop a speech disorder particularly with certain sounds such as "p," "b," "s," and "k," making it very difficult for him or her to be understood. There are some children with hypernasality that can be very subtle, and only an experienced speech therapist can pick it up; other children are so unintelligible only their own parents can understand what they are saying.
In children, the most common cause for hypernasality is having a short palate in association with a previous cleft palate repair, from a facial deformity, or from neurologic problems. Although rare, some children who have had their adenoids taken out can also have hypernasality.
Studies have shown that children with severe hypernasal speech are often debilitated socially and are perceived as being less intelligent and less attractive than their peers with normal speech. Such perceptions can seriously affect a child's self-esteem and emotional development and growth.
At the Hypernasality Program, a patient's care begins with a thorough assessment and diagnosis by a speech therapist and an otolaryngologist. The speech therapist performs a perceptual speech analysis, which includes listening to the child, recording his or her speech, and stimulating the child to make certain speech sounds that are more likely to bring out the nasality.
Typically, one of the most important assessments is a video-nasopharyngoscopy performed by the otolaryngologist. This test involves inserting a flexibile fiberoptic telescope in the nose to document the anatomy and pathophysiology of the nasopharynx. During this test, the speech therapist prompts the patient to make speech sounds during the recorded video. The test helps to indicate how large the gap is at the back of the throat, which structures are not trying helping to close off the gap, and other contributing mechanisms to closing the gap. In addition to confirming findings on the speech assessment, the results of this test also aids our otolaryngologists in planning a surgical intervention and repair. Other diagnostic tests involve video fluoroscopy -- X-rays of the neck in real time that help evaluate the dynamic nature of the velopharyngeal valve closure.
Various surgical techniques may be considered, based on the child's particular anatomy. The most common surgeries include:
Furlow palatoplasty -- Typically performed on children with cleft palate, this procedure is used to realign the muscles of the soft palate while also lengthening the structure. The additional length makes it easier for the palate to contact the back of the throat, closing the gap that results in hypernasality.
Sphincter pharyngoplasty -- Flaps of tissue from the back of the throat are used to build a "speed bump" in the nasopharynx (area behind the soft palate) which helps the soft palate connect with the back of the throat. The size of the bump is tailored to the size and shape of the gap at the back of the throat.
When the anatomy is correct and the function is correct, but for some reason, the child is choosing not to close the velopharynx, oftentimes the condition can be corrected with speech therapy and in some cases, the use of a prosthetic device to lift the palate or help to seal off the back of the throat.
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- Pediatric Otolaryngology
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