Hypernasal speech can result from an abnormal communication or passageway between the oral and nasal cavities
Hypernasal speech can result from an abnormal communication or passageway between the oral and nasal cavities, allowing air to move through them and out the nose unintentionally when the speaker tries to pronounce sounds such as m. A test for such air passage is to place a feather at the nostril while making the m sound; if it moves, there is air leakage, and the sound the speaker makes is not the sound that her or she intends. How does this happen? One way is through clefts of the palate. Closely aligned with cleft palates, though not necessarily cooccurring with them, are cleft lips. These can affect articulation and the sounds that require the lips to be sealed tightly.
The purpose of this is for you to apply your understanding of articulation and resonation to cleft lip/palate.
Analyze physiology of communication
Apply knowledge of anatomy and physiology of communication to diagnose and treat patients with communication disorders
Describe the causes and treatment of a cleft lip and the effects of the condition of the production of speech sounds.
- Environmental Factors:
- Exposure to certain medications during pregnancy (e.g., some anti-seizure drugs).
- Maternal smoking or alcohol consumption.
- Maternal diabetes.
- Maternal nutritional deficiencies.
- Combination of Genetic and Environmental Factors:
- In many cases, it is a combination of these factors.
Treatment of Cleft Lip and Palate
Treatment typically involves a multidisciplinary team, including surgeons, speech-language pathologists, orthodontists, and audiologists.
- Cleft Lip Repair:
- Usually performed within the first few months of life.
- Surgical closure of the lip defect.
- Improves appearance and feeding.
- Cleft Palate Repair:
- Usually performed between 6 and 18 months of age.
- Surgical closure of the palate defect.
- Allows for better speech development and feeding.
- Subsequent surgeries may be needed to refine results.
- Speech Therapy:
- Vital for addressing speech difficulties.
- Helps improve articulation, resonance, and velopharyngeal function (the ability to close off the nasal cavity during speech).
- Orthodontic Treatment:
- Addresses dental and jaw alignment issues.
- Audiological Monitoring:
- Cleft palate can increase the risk of ear infections and hearing problems.
Effects on Speech Sound Production
Cleft lip and palate can significantly affect speech production:
- Hypernasality:
- This is the most common speech characteristic.
- Due to the inability to close off the nasal cavity, air escapes through the nose during speech, resulting in a nasal quality.
- Nasal Air Emission:
- Audible escape of air through the nose, especially during pressure consonants (e.g., p, b, t, d, k, g, s, z, sh, ch).
- Articulation Errors:
- Difficulty producing certain sounds, especially those requiring lip closure (e.g., p, b, m) or adequate intraoral pressure (e.g., s, z).
- Compensatory articulation productions are also very common. For example, Glottal stops will replace plosive sounds.
- Velopharyngeal Insufficiency (VPI):
- The velopharynx (soft palate and pharyngeal walls) may not function properly, leading to persistent hypernasality and nasal air emission even after palate repair.
- Reduced Oral Pressure:
- The leak of air through the nasal passage, reduces the oral air pressure, making it difficult to produce crisp consonant sounds.
In summary, cleft lip and palate require comprehensive, long-term management to address both physical and communicative needs
Understanding Cleft Lip and Palate
Cleft lip and cleft palate are congenital conditions that occur when the lip or palate (the roof of the mouth) fail to fuse properly during fetal development. These are distinct but related conditions.
- Cleft Lip:
- A separation or split in the upper lip.
- Can range from a small notch to a complete separation extending into the nose.
- Occurs when the tissues that form the lip do not join completely before birth.
- Cleft Palate:
- A split or opening in the roof of the mouth (palate).
- Can involve only the soft palate (back of the mouth) or extend through the hard palate (front of the mouth).
- Occurs when the tissues that form the palate do not join completely before birth.
Causes of Cleft Lip and Palate
The exact causes are often complex and multifactorial, but they can include:
- Genetic Factors:
- Family history of cleft lip or palate.
- Specific gene mutations.