Speech Therapy or a Prosthetic? What is Appropriate for Hypernasal Speech?

When dealing with hypernasal speech, the cause is typically with the velum (i.e., the soft tissue on the top of the mouth located in the back of the oral cavity). The velum may be WEAK or it may be INSUFFICIENT. Knowing the difference between these two scenarios may indicate whether a trial speech therapy period is warranted or if a prosthetic device may be more appropriate.

Treatment for a weak velum:

For a WEAK velum, trial speech therapy is suggested. There are several techniques and feedback tools that a speech therapist can use to encourage oral resonance by increasing the strength and coordination of the velopharyngeal area (i.e., the soft tissue velum and the muscles in the back of the throat) to close appropriately for speech. Specific sound misarticulations can also be coached into correct production.

Treatment for an insufficient velum:

For an INSUFFICIENT velum, however, speech therapy will most likely not aid in increasing the intelligibility of speech as the muscle and/or structure of that velopharyngeal area is not a sufficient size to maintain closure. In this scenario, surgery or a prosthetic device is the most likely course of action. The major prostheses available are speech bulbs and palatal lifts. A speech bulb is a piece that fits to partially close off the space between the velum and the pharyngeal wall to assist an insufficient closing. A palatal lift is a device that fits along the roof of the mouth to close off fistulas (i.e., very small holes in the roof of the mouth) and lift the soft palate up to decrease the effort necessary to close off the nasal cavity. A craniofacial specialist can assist you with determining appropriate options.

Process Reduction Therapy:

Process Reduction Therapy is a combination of the above situations. There is research indicating that using a prosthetic and gradually reducing the size may encourage an increased ability for the nasal cavity to close off.

Speech therapy is an excellent option for many children with hypernasal speech. Determining the cause of the hypernasal speech will provide the appropriate path for the child and help guide treatment. Contact a licensed speech pathologist with questions or concerns.