When we speak, air comes up from our lungs, through our voice box, and enters our mouth and nose to produce the resulting sound quality called resonance.
We’ve all experienced an abnormally “nasal” sound to our voice when we have nasal congestion or large tonsils and adenoids. This is called hyponasal speech (too little nasal resonance); however, in some cases the opposite may be true – there can be too much sound or air leaking through the nose while speaking. This is referred to as hypernasal speech (too much nasal resonance).
Hypernasal speech is typically associated with a medical condition called velopharyngeal dysfunction, or VPD. VPD is typically diagnosed in children in the preschool or school-age years, but it can also be present in adults due to acquired or neurologic causes. Parents of children with VPD often report that their child’s speech sounds “nasal” and may even hear a nasal rustle or puffs of air escaping through the nose when their child speaks.
Most children with VPD also have articulation difficulties and may be difficult to understand. The cause of VPD varies, but is most commonly due to:
Treatment may include surgery to repair the palatal abnormality and to help direct sound and air away from the nose and back into the mouth during speech, and in some cases, speech therapy to target articulation skills. In addition, children with VPD who also have other medical conditions (e.g., heart abnormalities) or learning difficulties often require evaluation by a geneticist in order to determine if there is an identifiable genetic cause of their VPD.
The most common genetic cause of VPD is a condition known as 22q11.2 deletion syndrome. Children with 22q11.2 deletion syndrome benefit from a comprehensive evaluation by a team of expert professionals in order to ensure development of the safest and most effective treatment plan for their VPD.
Adriane Baylis, PhD, CCC-SLP, is a speech scientist, craniofacial speech pathologist and director of the Velopharyngeal Dysfunction Program. She is also an assistant professor of clinical plastic surgery, speech and hearing science, and pediatrics at The Ohio State University.
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