Nasal Speech: What Parents Need to Know

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:

  • A short soft palate
  • Submucous cleft palate
  • Abnormalities of the palate or throat

If VPD is suspected at any age, a referral should be made to a specialized VPD Team or to a cleft lip and palate team for proper diagnosis and management.

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.

The 22q Center at Nationwide Children’s is internationally recognized for its outcomes following speech surgery for children with VPD and 22q11.2 deletion syndrome.

Nationwide Children’s Hospital will host the first International Symposium on Velopharyngeal Dysfunction on September 16-17, 2016. The symposium will bring together surgeons, speech pathologists and other craniofacial specialists from around the world to share research and clinical strategies to improve care for all children affected by VPD. For more information about on nasal speech and VPD, listen to our PediaCast.

Adriane Baylis, PhD, CCC-SLP
Adriane Baylis, PhD, CCC-SLP, is a speech scientist, craniofacial speech pathologist and director of the Velopharyngeal Dysfunction Program. She is also Assistant Professor of Clinical Plastic Surgery, Speech and Hearing Science, and Pediatrics at The Ohio State University. Her clinical interests include perceptual and instrumental assessment of velopharyngeal dysfunction in children with cleft palate and other craniofacial anomalies. Her research focuses on measurement of speech outcomes in children with cleft palate and the multifactorial nature of speech disorders and velopharyngeal dysfunction in 22q11.2 deletion syndrome.
Richard Kirschner, MD
Richard E. Kirschner, MD, FACS, FAAP, has joined Nationwide Children's Hospital as chief of Plastic and Reconstructive Surgery and director of the Cleft Lip and Palate-Craniofacial Center.Dr. Kirschner is nationally recognized as a leading authority in cleft lip and palate, velopharyngeal dysfunction, 22q11.2 deletion syndrome and hemangiomas/vascular malformations. He has been widely published in many leading professional publications, is co-editor of the text Comprehensive Cleft Care, and is actively involved in research and teaching. Dr. Kirschner has taught at educational symposia in several countries and is co-founder and medical director of Casa Azul America, Inc., a non-profit organization for the delivery of cleft care to underserved children in central Mexico.

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