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How Hyponasality Affects a Child's Ability to Communicate

If your child has been diagnosed with hyponasal speech, you probably have a lot of questions. Like, what is hyponasality and how will this affect the way my child communicates?


Hyponasality affects the way your child can balance nasal air emissions. It causes a congested sound as your child speaks. This can lead to difficulties with articulation and communication.


However, there is hope. There are several treatment options for children with hyponasality. Read on to find out about hyponasality and how it affects children’s ability to communicate.


What Is Hyponasality?


A child with hyponasality has a resonance disorder where there is a disruption in the child’s speech sound because not enough air is coming from the mouth and nose. This is usually due to a blockage in the upper airway of the body.


The issue is in the resonance of your child’s speech. Resonance refers to the sound produced by the vocal cords in the vocal tract. The vocal tract is made up of the pharynx, oral cavity, and nasal cavity. If anything is inflamed or in the way of the vocal tract, it can cause issues with the way your child speaks.


What Does Hyponasality Sound Like?


There are several resonance disorders and they can all end up sounding alike to an untrained ear. Also, the difference is language and dialect can affect how people sound when speaking. Because of these factors, sometimes a child’s school may be the first to notice hyponasality. They may send home information and refer your child for evaluation by a speech-language pathologist (SLP).


If you’ve received this information, you may be wondering what hyponasality even sounds like. As a parent, it can be easy to get used to the way your child speaks, which makes it difficult for you to notice any abnormalities.


Hyponasal speech sounds like your child has constant nasal congestion, even if your child is healthy. Swollen adenoids or tonsils can cause blockages in your child’s nasal air emissions that make your child sound like they have a stuffy nose, even when they don’t. This swollen tissue can make articulation difficult for your child.


The position of the tongue, the degrees of the mouth opening, and the opening and closing of the velopharyngeal valve (VP) also all contribute to the shape and size of the vocal tract. When all of these achieve a balance, normal resonance is achieved. Resonance changes for vowels, oral consonants, and nasal consonants. It can also vary based on different dialects and languages.


When there is too little or too much nasality in the oral sound energy, this is a sign of a resonance disorder. These are usually caused by functional or structural issues and can lead to deficits in speech such as articulation errors and mislearning of sounds.


According to the American Speech-Language-Hearing Association, “Nasal airflow “errors” are related to articulation when there is an inappropriate escape of air through the nasal cavity during the production of pressure consonants.”


However, hyponasality is not to be confused with hypernasality, also known as velopharyngeal insufficiency (VPI). Hypernasal speech is when too much air escapes through the nose and mouth while speaking. This is when a child makes more nasal sounds than usual.


Both are types of resonance disorders. There are other types as well including mixed resonance and cul-de-sac resonance.





What Are The Symptoms of Hyponasality?


Hyponasality occurs in children with the following symptoms:

  • Reduced nasal resonance on vowels, sonorants (sound produced with the vocal cords), and nasal consonants

  • Denasalization of nasal consonants


A child may say the nasal phonemes that are similar to their cognates. For example, “b” for the “m” sound, or “d” for “n.”


If you’ve noticed your child with these symptoms and there is no underlying illness, it may be time to get your child checked by a pediatrician to find an underlying cause.


What Are The Causes of Hyponasality?


There are several causes of hyponasal speech. Most are related to a blockage in the craniofacial or upper airway of the body.


A deviated septum is one cause of hyponasality. The bone and cartilage that divides the nose in half is called the septum. Sometimes it can be crooked or have an abnormality either from a break or because it naturally formed that way. The deviated septum can make it hard for your child to balance their airflow, leading to nasal resonance issues.


Another common cause of hyponasality is an enlargement of the adenoids or tonsils. Enlarged adenoids and tonsils usually mean there is an infection that your child’s body is trying to fight off. However, if they remain enlarged even after infections are gone, they can become problematic. Some children are even born with abnormally enlarged adenoids. This can lead to resonance issues and a stuffy nose-sounding speech.


Similar to the enlarged adenoids and tonsils, sinuses can also become inflamed. If your child’s sinuses remain inflamed even when an infection has passed, it can affect their speech.


Nasal polyps, or soft non-cancerous growths on the lining of the nasal passage, is another cause of hyponasality. Foreign objects and tumors can also obstruct the nasal and upper airway passages making it difficult for your child to balance their air and speak. Some of these issues can be present from birth and others are symptoms of other medical issues.


According to WebMD, children with cleft palate or cleft lip have a higher chance of developing a resonance disorder because of velopharyngeal dysfunction (VPD). VPD is when the velum or soft palate does not touch the back of the throat while speaking or swallowing.


Even after cleft palate repair, these children may have difficulties with resonance. Issues with the ears, nose, and throat can lead to velopharyngeal incompetence due to the scars left from pharyngeal flap or sphincter pharyngoplasty (cleft palate repair surgery). These can cause hyponasality.


Also, children who have hearing loss or auditory disorders tend to have higher incidences of hyponasality. Hearing impairments managed with cochlear hearing aids have less resonance feedback.


Other causes of hyponasality include the following:

  • Abnormal narrowing of the passageway between the nose and pharynx (choanal atresia)

  • Problems with velopharyngeal closure timing

  • Neurological trauma and disorders such as dysarthria, cerebral palsy, apraxia, stroke, and velar paralysis


Sometimes hyponasality is not due to any structural issues but is simply a result of learned misarticulation. In these cases, the child has learned to compensate for difficulties in speaking by mispronouncing certain sounds.


Your child will need to be evaluated by professionals to determine the causes of their hyponasality.


How is Hyponasality Diagnosed?


A pediatric doctor will look at your child’s recent health history and perform a physical exam. Then, if they believe your child’s speech disorder may be caused by hyponasality, your child will get a referral to an otolaryngologist (ENT). This doctor specialized in disorders of the ears, nose, and throat.


They will perform a nasal endoscopy, which uses a small flexible tube with a camera on the end. This will be inserted into your child’s nasal cavity to look inside and figure out what is going on. Once your doctor has an idea of what is causing the speech issue, they can begin treatment.





How is Hyponasality Treated?


Hyponasality can be treated in a few different ways.


Nasal polyps can sometimes be treated with medications to shrink them. If this does not work, then surgery to remove them will be necessary. This is usually an outpatient procedure where the surgeon will remove the polyps using an endoscope and then enlarge your nasal passageway.


If there is a foreign object, it will need to be removed. This may result in surgery, depending on the object.


First, your child’s doctor may try antihistamines, decongestants, and nasal steroid sprays for a deviated septum, but if these don’t work surgery at a children’s hospital may also be needed for correcting a deviated septum. In this surgery, the nasal septum is straightened and recentered.


Sometimes enlarged adenoids need to be removed with a surgery called adenoidectomy. Oftentimes, the nasal passages are still swollen for several weeks after the surgery, so the articulation disorders will continue to persist. However, these phonological issues are usually temporary.


Surgical reconstruction may also be needed to enlarge stenotic nares (nostrils). This will improve the amount of air your child can take in and can help to balance their airflow.


Besides physical treatment, your doctor will likely recommend speech therapy as a way to help your child communicate more effectively. Even if issues in velopharyngeal function get corrected, young children will need help relearning how to balance their airflow and unlearn compensatory language development.


What Role Does Speech Therapy Play?


Once you have identified and treated the cause of your child’s hyponasality from the physical side, you will want to get your child in to see a speech-language pathologist (SLP). An SLP will evaluate your child’s speech samples and come up with a treatment plan. The clinician will treat speech problems with effective strategies for children with communication disorders.


During sessions, the speech therapist can give your child strategies to help them improve their speech sounds.


A speech therapist will teach your child how to adjust articulation placement to produce sounds correctly. They will also help your child speak, loudly, and slowly to compensate for their resonance disorder.


They will also continue to practice sounds to strengthen your child’s speech muscles and improve voice quality. This will improve speech intelligibility and give your child more confidence as they speak.


Where Can I Find a Good Speech Therapist?


If you are looking for an SLP who specializes in resonance and voice disorders for children, then the California Scottish Rite Foundation can help. We offer California residents free-of-charge speech-language and literacy programs. These can boost your child’s confidence and give them the tools they need to successfully communicate.


There are 17 RiteCare Childhood Language Centers throughout California to assist your child. Our centers partner with Universities around the state to provide services for a wide range of language and communication disorders.


How Can Parents Help a Child With Hyponasality Communicate More Effectively?


As with most skills, practice goes a long way. Once you have your child in speech therapy, the SLP should provide you with some strategies to practice at home. Remember to offer your child plenty of emotional support.


Resonance disorders can affect your child’s self-esteem and confidence. Practicing strategies for speaking more clearly at home will give your child a chance to build up their language skills in a safe space. Then, they can take what they’ve learned and apply it to social situations outside of the home.


Hyponasality and School


If your child is school-aged, it is important to let the school and teachers know what is going on with your child. Especially, if they include extended absences for surgery or treatments. The school may offer speech therapy services that you can use.


Also, it is important to let teachers know so that they can accommodate your child’s speaking difficulties. This way they won’t come across issues when there are activities in class that involve speaking.


Let the teacher know that hyponasality can make it more difficult for your child to speak and articulate. They should also be informed that your child’s confidence may be low. This can help your teacher to praise and encourage your child for efforts in speaking to bolster their confidence.


Conclusion


There are options for children with hyponasality. If this resonance disorder is due to a structural issue, surgery may be needed to correct the problem. However, if it is a learned error, practice can help reduce voice sound issues. Either way, it is important to get your child treatment both by an ENT and SLP.


Also, give your child the support and practice they need at home to be successful, and let your child’s teacher and school know about what’s going on.


With all these factors in mind, your child can successfully communicate with hyponasality. The right treatment can make a world of difference in your child’s speaking quality and confidence.


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