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Otolaryngology (Ear, Nose and Throat)

Hypernasality Program

NewYork-Presbyterian Morgan Stanley Children's Hospital is home to a comprehensive program for children with hypernasality, a condition in which the palate and pharynx (throat) 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 in the division between the back of the mouth and the back of the nose, the oral pharynx and nasopharynx (an area called the "velopharynx"). What normally separates the two areas is the soft palate, which helps to seal off that region. Children who lack the ability to close that separation tend to have "hypernasality" (also known as velopharyngeal insufficiency), where too much air escapes through the nose when they speak.

Children with hypernasality develop a speech disorder, particularly with certain sounds such as "p," "b," "s," and "k," making it very difficult to be understood. There are some children with hypernasality that can be very subtle, and only an experienced speech therapist can detect it; other children experience such speech impairment that only their own parents can understand what they are saying.

Studies have shown that severe hypernasal speech can affect children socially; those with hypernasality are often 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. The goal of our program is to accurately diagnose the condition and provide effective treatment to improve each child's speech and enhance his or her quality of life.

Evaluation and Diagnosis

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 having the child make certain speech sounds which are more likely to bring out the nasality.

Typically, one of the most important assessments is a "video-nasopharyngoscopy," which is performed by an otolaryngologist. This test involves inserting a flexible fiberoptic telescope into the nose to see the anatomy of the nasopharynx. The speech therapist prompts the patient to make certain speech sounds during the exam. The test helps to define how large the gap is at the back of the throat and to see which structures are not able to help close off that gap. The results of this test help the doctor choose the most appropriate treatment. Other diagnostic tests that may be used include video fluoroscopy, X-rays of the neck to evaluate the way the velopharyngeal valve closes.

Treatment

When a child's anatomy and function appear to be normal, but, for some reason, the child is unable to close the velopharynx, the condition can often be corrected with speech therapy. Some children benefit from a special device to lift the palate or to help seal off the back of the throat.

When the cause of hypernasality is a disorder of the anatomy, surgery may be indicated. Surgeons at NewYork-Presbyterian Morgan Stanley Children's Hospital perform the following procedures to correct hypernasality:

Furlow palatoplasty: Typically performed in children with cleft palate or "submucous" 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 causes hypernasality.

Sphincter pharyngoplasty: Flaps of tissue from the back of the throat are used to build a "speed bump" in the nasopharynx, 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 child's throat.

Contact

Pediatric Otolaryngology
Directions
(212) 305-8933
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