Rhinolalia - a violation of the timbre of the voice and problems with sound pronunciation, develops against the background of an incorrect palatopharyngeal closure. According to statistics, there is 1 case per 800 people. The problem is based on a variety of disorders, so a variety of specialists are involved in its solution: orthodontists, dentists, psychologists, otolaryngologists and others.

Closed rhinolalia develops against the background of an existing obstacle, which leads to the impossibility of a free exit of a jet of air through the nasal passages. It is divided into two subspecies:

  • functional: when sounds are uttered, the soft palate oscillates with an excessive range, but there are no obstructions in the nasopharynx. The palate blocks the passage sound waves into the nasopharynx. Most often diagnosed in children with neurological disorders;
  • organic: occurs when there are obstructions in the nasal passages that close them and prevent sound waves from passing through. Treatment is carried out only surgically: an obstacle is removed (polyps, adenoids).

Open rhinolalia develops with existing defects of the soft or hard palate, lips, which are anatomical or physiological in nature. It can also be organic and functional. In the first case we are talking about the wrong structure speech apparatus in the anatomical sense (more often, congenital), in the second, the cause of the problem is a sluggish, incomplete movement of the soft palate during the pronunciation of sounds.


Open rhinolalia

Feature of open rhinolalia- there is a free passage between the nasal and oral cavities, so sound and air waves move uncontrollably when you try to talk.

Mixed rhinolalia, in which there are some obstacles in the nasal passages, and anatomical defects in different parts of the oral and nasal cavities. It is considered the most difficult in terms of treatment. Doctors first have to surgically remove the existing obstruction, and then carry out work to restore speech for a long period.

If rhinolalia is diagnosed from birth, then the reasons for its development may be:

  • "wolf mouth" ̶ cleft of the soft and hard palate;
  • "cleft lip" - splitting of the alveolar process in the area upper lip, palate;
  • features of the soft palate in plan anatomical structure, it is significantly shortened;

Causes of acquired rhinolalia:

  • injuries of the soft palate;
  • paresis of the soft palate;
  • complications after diphtheria;
  • polyps, adenoids.

Adenoids

All of the above factors can be eliminated surgically. But rhinolalia can develop against the background of various neurological diseases. Often in childhood the disease may be the result of imitation of others, when their wrong speech is repeated.

Symptoms of congenital rhinolalia:

  • insufficient weight gain due to leakage of milk through the nasal passages;
  • frequent pneumonia, bronchitis, otitis due to the lack of warming of the inhaled air;
  • in addition, there are nystagmus (high-frequency fluctuations of the eyes), ptosis.

The child does not babble, does not pronounce the sounds familiar to the baby. The patient begins to pronounce the first words only at 2 years and older., but his speech is incomprehensible to others, slurred. An open rhinolalia makes the sounds nasal (they are pronounced “on the nose”), they are heard as exactly the same, all consonants are similar to the sound "x".

Children try to pronounce the words clearly, but articulation is disturbed, strange grimaces appear on the face, which only worsens the overall impression. Open rhinolalia functional type characterized by slurred and incorrect pronunciation of vowels, while consonants are absolutely clear.


Rhinoscopy

Closed organic rhinolalia leads to incorrect pronunciation of nasal sounds: "m" is replaced by "b", "n" by "d". The timbre of the voice changes, because a person is forced to constantly breathe through his mouth. At closed function type the voice becomes unnatural, monotonous, as if from underground, there is no emotionality, a change in tone.

The main role of solving the problem is assigned to psycho- and physiotherapy. Most often, it is possible to achieve 100% success, but audible violations still remain: fuzzy pronunciation, “swallowing” some sounds.

The first stage of correction begins with a massage of the soft palate: it is stroked, pressed on it and at the same time a drawn out sound “a” is pronounced. Gymnastics is combined with it: the child must imitate movements when yawning, swallowing, coughing. On a high note, the vowel sounds “a, o, e, y, and” are pronounced, this is done necessarily on exhalation with the mouth.

It is important to teach the patient how to breathe correctly. For this, the following exercises are carried out:

  • deflation of light objects. You need to start from a distance of 15 cm, gradually increasing it. You can teach a child to feel the air stream with the help of loose cotton swabs, they are inserted into the nasal passages, if they do not breathe properly, they fly out;
  • the formation of bubbles in a glass of water;
  • blow up balloons with your mouth, play the harmonica. They are introduced into classes only after the previous, simpler ones have been successfully mastered and consolidated.

Logopedic massage

It is necessary to conduct classes aimed at restoring the correct articulation:

  • puffing and retraction of the cheeks,
  • tongue licking,
  • sucking simulation,
  • movements to the side with the tongue hanging out,
  • stretching the lips with a narrow tube and others.

Second phase- work with sounds. First, the child must learn to pronounce all the vowels correctly. They start with one, it is first pronounced silently (we learn to form a mouth gap and breathe correctly), then only sounds are introduced. If the child has problems controlling the air stream, or does not understand how it should move correctly when pronouncing vowel sounds, then the doctor will cover his nose with his fingers.

Third stage- correction of consonant sounds. Work is carried out on the letters in a certain order: F, P, T, K, B, D, M, N, R, L. First, each sound is pronounced in isolation, then it is combined with a vowel, and only after that reverse syllables are taught. Most effective method̶ teach a child with rhinolalia to pronounce consonants in a singsong voice.

Complex correction of rhinolalia should proceed in a constant mode. The speech therapist must show the exercises to parents, and they must deal with the baby daily and more than once.

Surgical intervention is prescribed if there are problems of a congenital nature in the anatomical structure of the palate, lips and nasal passages. Carrying out options:

  • uranoplasty: a cleft palate is corrected by closing it with a flap of closely spaced tissues. It is performed at the age of 3-5 years in several stages. If the operation is scheduled earlier (1-2 years), then it is performed without bone interventions. After the surgeon’s work, the orthodontist is definitely connected to the treatment: it is necessary to restore the correct growth of teeth, provide the patient with an anatomically correct bite, which ultimately affects speech;

Uranoplasty
  • : correction of cleft lip and soft palate. The standard procedure is carried out in one stage, and the stitches are removed after 5-6 hours. This procedure is recommended to be performed as early age child, which avoids problems with weight, the development of chronic respiratory diseases. Early correction of the "cleft lip" and "cleft palate" in most cases solves the problem intellectual development, because the lack of speech provokes a general delay in the intellect .;
  • cheiloplasty: elimination of clefts of the upper lip and nose. The optimal time for such an intervention is the age of up to 3 years. Cheiloplasty is performed for full-term children with normal weight gain, without symptoms of mental and physical retardation. Before plastic surgery, the patient undergoes a complete medical examination. After cheiloplasty, as a rule, it is possible to completely restore speech, but later it may be necessary to perform an operation to hide visible scars and sutures at the site of the operation.

Two-stage bicycle pharyngoplasty for congenital isolated (complete) cleft palate using a pharyngeal flap

If rhinolalia has arisen against the background of the presence of formations in the nasopharynx, then they are also removed surgically. Since this type of impairment is more common in adults and older children, immediately after the procedure, the quality of speech is restored on its own. But work with a speech therapist may be needed if the rhinolalia was in a neglected state, the child was used to pronouncing vowels and consonants incorrectly.

After the operation, complications may develop: infection of the surgical wound or suture, inflammation, bleeding. This all leads to an increase in the duration of healing of the sutures, and a second intervention may be required.

As soon as the surgeons are allowed to proceed with the correction, speech therapists are included in the work on the patient, the standard first stage of the correction is carried out in full. If it began even before the operation (this is often practiced), then the patient simply restores the already acquired skills and perform massage and soft palate gymnastics. Further activities are carried out according to the classical correction scheme.

Be sure to involve an orthodontist in the postoperative period. Often, with existing anatomical disorders in the structure of the palate, lips and nose, there are problems with the growth and position of the teeth. This also negatively affects the development of the speech apparatus, therefore, it must be corrected before the skills of pronunciation of vowels and consonants are consolidated.

Read more in our article on rhinolalia correction.

Read in this article

What is rhinolalia

Violation of the timbre of the voice and problems with sound pronunciation, which develop against the background of an incorrect palatopharyngeal closure, are classified in medicine as rhinolalia. This disease occurs quite often, according to statistics, 1 case per 800 people. In some cases, rhinolalia is considered as a concomitant disorder with other speech problems, but official science speech therapy distinguishes it as an independent pathology.

Despite the fact that the disease in question is called nasal or rhinophony, this does not accurately characterize it. The problem is based on a variety of disorders and therefore a variety of specialists are involved in its solution - orthodontists, dentists, psychologists, otolaryngologists and others.

Types of change in sound pronunciation

Depending on what violations have arisen in the process of the functionality of the oropharynx and nasopharynx, rhinolalia is classified in medicine. There are three main types of it.

Closed

It develops against the background of an existing obstacle, which leads to the impossibility of a free exit of a jet of air through the nasal passages. The closed type of rhinolalia is divided into two subspecies:

  • functional- when sounds are uttered, the soft palate oscillates with an excessive range, but there are no obstructions in the nasopharynx. The palate blocks the passage of sound waves into the nasopharynx. The considered subspecies of closed rhinolalia is most often diagnosed in children with neurological disorders.
  • organic- occurs when there are obstacles in the nasal passages that close them and prevent sound waves from passing through. Treatment of organic closed rhinolalia is carried out only surgically - the obstacle (polyps, adenoids) is removed.

open

It develops with existing defects in the soft or hard palate, lips, which are anatomical or physiological in nature. An open rhinolalia can also be organic and functional - in the first case, we are talking about an abnormal structure of the speech apparatus in the anatomical sense (more often congenital), in the second, the cause of the problem is a sluggish, incomplete movement of the soft palate when pronouncing sounds.

A feature of the open rhinolalia is that there is a free passage between the nasal and oral cavities, so the waves of sound and air move freely, uncontrollably when trying to talk.

mixed

This is how a disease is classified, in which there are some obstacles in the nasal passages, and anatomical defects in different parts of the oral and nasal cavities.

This type of rhinolalia is considered the most difficult in terms of treatment. Doctors first have to surgically remove the existing obstruction, and then carry out work to restore speech for a long period.

Watch in this video about the causes and types of rhinolalia:

Causes of rhinolalia

The violation in question may be congenital or acquired in origin. If rhinolalia is diagnosed from birth, then the reasons for its development may be:

  • "" - cleft soft / hard palate;
  • "" - splitting of the alveolar process in the region of the upper lip, palate;
  • features of the soft palate in terms of the anatomical structure - it is significantly shortened;
  • absence or insufficient size of a small tongue.

"Cleft palate"

Acquired rhinolalia has its own reasons for development:

  • injuries of the soft palate;
  • paresis of the soft palate;
  • complications after diphtheria;
  • curvature of the nasal septum;
  • the formation and growth of tumors in the nasal passages, cavities;
  • polyps, adenoids.

All of the above factors that provoke the violation in question can be eliminated surgically. But rhinolalia can develop, which most often happens, against the background of various neurological diseases. Often in childhood, the disease can be the result of imitation of others, when their incorrect speech is repeated.

Symptoms: sounds, speech

If a child develops an open organic rhinolalia of a congenital type, then from the first days of his life, pronounced symptoms appear:

The child does not babble, does not pronounce the sounds familiar to the baby. The patient begins to pronounce the first words only at the age of 2 years and older, but his speech is incomprehensible to others, slurred. An open rhinolalia “makes” the sounds nasal (pronounced “on the nose”), they are heard as exactly the same - the consonants all look like the sound “x”.

Children try to pronounce the words clearly, but articulation is disturbed, strange grimaces appear on the face, and this only worsens the overall impression. In contrast to the organic, the open rhinolalia of the functional type is characterized by slurred and incorrect pronunciation of vowels, while the consonants are absolutely clear and well understood.

A closed organic rhinolalia leads to incorrect pronunciation of nasal sounds - “m” is replaced by “b”, “n” by “d”. The timbre of the voice changes, because a person is forced to constantly breathe through his mouth. If there is a speech disorder of a closed functional type, then the voice becomes unnatural, monotonous, “as if from under the ground”, there is no emotionality, a change in tone.

Watch in this video about the symptoms of open and mixed rhinolalia:

Complex correction of rhinolalia

The main role of solving the problem is assigned to psycho and physiotherapy. Only A complex approach help restore speech, teach the child to pronounce consonants and vowels correctly.

Most often, 100% success is achieved, but audible disturbances still remain - not the final clarity of pronunciation, the “swallowing” of some sounds.

The first stage of correction

Work with the patient begins with a soft palate massage - they stroke it, press it and at the same time pronounce the lingering sound "a". Gymnastics is combined with massage - the child must imitate movements when yawning, swallowing, coughing. On a high note, the vowel sounds “a, o, e, y, and” are pronounced and this is done necessarily on exhalation with the mouth.

It is important to teach the patient to breathe correctly and for this, the following exercises are performed:

  • Blowing off light objects - cotton wool from the palm of your hand, thin sheets of paper or flower petals from the table. You need to start from a distance of 15 cm, gradually increasing it. You can teach a child to feel the air stream with the help of loose cotton swabs - they are inserted into the nasal passages and, if breathing is wrong, they simply fly out.
  • Formation of bubbles in a glass of water. To do this, the patient must blow into the tube, which is in the water, through oral exhalation.
  • Blow up balloons with your mouth, play the harmonica. These exercises are quite difficult for rhinolalics and therefore they are introduced into classes only after the previous, simpler ones have been successfully mastered and consolidated.

Even at the first stage, it is necessary to conduct classes aimed at restoring the correct articulation - puffing / retracting the cheeks, licking the lips with the tongue, imitation of sucking, movements to the side with the protruding tongue, stretching the lips with a narrow tube and others.

Second phase

Work begins with sounds and first the child must learn how to pronounce all the vowels correctly. They start with one - at first it is “pronounced” silently (we learn to form a mouth gap and breathe correctly), then only sounds are introduced.

If the child has problems controlling the air stream or does not understand how it should move correctly when pronouncing vowel sounds, then the doctor will cover his nose with his fingers.

Third stage

Correction of consonant sounds begins, and work is carried out on letters in a certain order - F, P, T, K, B, D, M, N, R, L. First, each sound is pronounced in isolation, then it is combined with a vowel, and only after that they teach reverse syllables. The most effective way to teach a child with rhinolalia to pronounce consonants in a singsong voice is to reflexively merge the soft palate and the posterior pharynx with such drawling sounds.

Complex correction of rhinolalia should proceed in a constant mode. The speech therapist must show the exercises to parents and they must deal with the baby daily and more than once. The lack of interaction between the doctor and parents, rare / irregular classes, accelerated passage of all stages lead to the fact that speech remains slurred.

Watch in this video about how and what to work on for parents and a speech therapist with rhinolalia in a child:

Surgery to restore speech

Surgical intervention is prescribed if there are problems of a congenital nature in the anatomical structure of the palate, lips and nasal passages. In this case, doctors choose:

  • Uranoplasty– a cleft palate is corrected by closing it with a flap of closely spaced tissues. Such an operation should be carried out at the age of 3-5 years, because there is time to prepare the child for school, to restore and establish speech. Such a surgical intervention is carried out in several stages.

If the operation is scheduled at an earlier childhood age (1-2 years), then it is performed without bone interventions. Be sure after the surgeon's work, the orthodontist is connected to the treatment - it is necessary to restore the correct growth of teeth, provide the patient with an anatomically correct bite, which ultimately affects speech.

  • Velopharyngoplasty– correction of cleft lip and soft palate. A fairly common, standard procedure, which is carried out in one stage, and the stitches are removed within 5-6 hours after surgery. A similar procedure is recommended to be performed at the earliest possible age of the child, which avoids both weight problems and the development of chronic respiratory diseases.

Velopharyngoplasty

Early correction of the "cleft lip" and "cleft palate" in most cases solves the problem of intellectual development - the lack of speech can provoke a general delay.

  • Cheiloplasty– elimination of clefts of the upper lip and nose. The optimal time for such an intervention is the age of up to 3 years, because during this period speech begins to form and it is better if this happens without any disturbances. Cheiloplasty is performed for full-term children with normal weight gain, without symptoms of mental / physical retardation - before plastic surgery, the patient undergoes a full medical examination.

Cheiloplasty

After cheiloplasty, as a rule, it is possible to completely restore speech, but later plastic surgery may be necessary to hide visible scars / sutures at the site of the operation.

If rhinolalia has arisen against the background of the presence of formations in the nasopharynx, then they are also removed surgically. Since this type of violation is more common in adults and older children, immediately after the procedure, the quality of speech is restored on its own - the skill is already used, there are no problems with the perception of the air jet.

But work with a speech therapist may be necessary if the rhinolalia was in a neglected state and the child was simply used to pronouncing vowels and consonants incorrectly.

Postoperative period

Immediately after surgery, no one performs any correction - you need to wait for the patient to fully recover. Since the operation is performed in the oral cavity and nose, complications may develop immediately afterward - infection of the surgical wound or suture, inflammation, bleeding. This all leads to an increase in the duration of healing of the sutures, it may be necessary to re-intervention.


Articulation gymnastics

As soon as surgeons are allowed to proceed with the correction, speech therapists are included in the work on the patient - the standard first stage of correction is carried out in full. If it began even before the operation (this is often practiced), then the patient simply restores the already acquired skills and perform massage and soft palate gymnastics. Further development activities correct pronunciation sounds are carried out according to the classical correction scheme.

Be sure to involve an orthodontist in the postoperative period - often with existing anatomical disorders in the structure of the palate, lips and nose, problems arise with the growth and position of the teeth. This also negatively affects the development of the speech apparatus, so it must be corrected before the pronunciation of vowels and consonants is consolidated.

Correction of sound pronunciation in rhinolalia, surgical intervention is the parish of doctors, narrow specialists. But without the help of their parents, they will not cope, because top scores achieved with constant exercise and gymnastics, massage.

As a rule, the prognosis for recovery is favorable, but they depend on several factors - what type of rhinolalia was diagnosed, at what age the operation was performed, how the recovery period went, whether speech therapists and parents are corrective work.

Rhinolalia is a condition that is characterized by defects in the structure of the organs of the nasopharynx, resulting in a distortion of the pronunciation of speech sounds, namely, a disorder of articulation and sound production of varying severity. In common parlance, this condition is called "nasal", that is, all sounds acquire a characteristic nasal sound. Often the condition is complicated by underdevelopment - both the lexical side of speech and its grammatical component. Another common complication is various violations psychological nature, as well as difficult socialization of patients with rhinolalia.

According to statistics, children suffer from this disease much more often than older patients. In addition to various deviations from the norm of acoustic parameters, patients have various deviations of aerodynamic conditions in speech production. Since special conditions arise, the speech apparatus is forced to adapt to them, as a result of which variable pronunciation distortions occur.

Classification of rhinolalia and its etiological causes

By the nature of pathological disorders of the palatopharyngeal closure, the following forms of pathology can be distinguished:

  • closed rhinolalia, which occurs due to a decrease due to a number of physiological reasons nasal resonance;
  • open rhinolalia, which is characterized by the free simultaneous passage of an air stream through the nose and mouth.

Among the etiological causes of this pathological condition, the main organic and functional disorders can be distinguished. So the most common causes of the closed form of rhinolalia are functional disorders of the palatopharyngeal closure or organic disorders of the nasal space.

Organic causes of closed rhinolalia include various diseases or changes that lead to bad nasal passage and difficult nasal breathing. Among these reasons are the following:

  • chronic hypertrophy of the posterior inferior turbinates of the nasal mucosa;
  • adenoid growths;
  • nasal polyps, etc.

Functional closed rhinolalia is often noted in children and is observed with normal nasal patency.

Causes of open rhinolalia can also be organic or functional. Organic causes can be divided into congenital and acquired. Congenital open rhinolalia of organic origin in most clinical cases occurs due to splitting of the soft or hard palate, which is congenital. The acquired form of open rhinolalia occurs due to paralysis of the soft palate or when, for various reasons, an opening occurs between the oral and nasal cavities.

Functional open rhinolalia is observed in children with sluggish articulation. In addition, it often develops in children with hysteria, sometimes it has the character not so much of an independent defect as of an imitative defect.

The organic causes of open rhinolalia include congenital nonunions of the face and palate, namely:

  • cleft lip;
  • cleft of the upper lip and alveolar process;
  • cleft soft or hard palate;
  • submucosal cleft palate, etc.

The above pathologies occur even in the prenatal period and are a consequence of negative impact on the fetus of various external and internal factors. These factors include the acceptance of various medicines(usually hormonal) infectious diseases mothers during pregnancy, mental shocks of a pregnant woman, alcohol, smoking and a combination of several factors at the same time.

In this case, the severity of rhinolalia will depend on the size and shape of the birth defect.

Symptoms and clinical manifestations of rhinolalia

With open organic rhinolalia, caused by various congenital anomalies, the baby suffers from the very first hours of his life such vital functions as breathing and nutrition. As a rule, the sucking reflex in such children is preserved, but feeding becomes difficult, since the child does not take the breast, and when artificial feeding the mixture flows out through the nose, as a result of which the newborn does not receive the nutrients he needs and is significantly behind in development. Since nasal breathing is impaired, such children often suffer from chronic inflammatory diseases of the respiratory system, which causes the development of rhinolalia. Among other things, congenital palatine clefts are accompanied by various malocclusion, which only contributes to speech problems. Often this is due to the fact that in such children the preservation of intelligence varies from the norm to very significant developmental delays.

The development of speech - both in the pre-linguistic period and in the period speech development- proceeds abnormally. There is no characteristic babble. Or he is very quiet, barely distinguishable. The child begins to pronounce the first words already at the age of more than 2 years, his speech is slurred and slurred, it is difficult to understand it to others.

With open organic rhinolalia, all sounds have a pronounced nasal connotation, the child has impaired articulation and pronunciation of sounds. All consonants are more reminiscent of the sound "x", they cannot be distinguished from each other. The voice is soft and muffled. Trying to pronounce sounds correctly, the child uses the facial apparatus or strains the muscles of the lips, wings of the nose or tongue, which only aggravates the situation.

Speech problems are also reflected in auditory perception and the ability to phonetically analyze addressed speech. In addition, due to the limited communication with peers, such children have a rather poor lexicon and there are problems with writing. The combination of such changes can lead to the fact that in a child with an open organic rhinolalia, speech therapists are forced to state general underdevelopment speech. At the age when the child begins to realize his defect, various mental disorders and the layers associated with them join the changes in the speech apparatus: isolation, irritability, shyness, etc.

In patients with open functional rhinolalia, the pronunciation of vowels suffers to a greater extent. Such a child pronounces consonants quite well, which is associated with quite sufficient palatopharyngeal closure for this. With a closed functional rhinolalia, as a rule, only the timbre of the voice suffers, which acquires an unnatural, dull, “dead” shade.

Closed organic rhinolalia is characterized by distortion of consonant sounds. The child often changes the sound "m" to the sound "b", "n" to "d", etc. With this form of pathology, nasal breathing is difficult, and therefore the child constantly breathes through the mouth, which leads to the fact that such children are susceptible to various inflammatory diseases of the upper respiratory tract, and also often suffer from chronic forms of bronchitis and pneumonia, which have a recurrent course.

Differential diagnosis of rhinolalia

Diagnosis of rhinolalia, as a rule, is not difficult for specialists, however, certain problems arise when determining the type of rhinolalia. In order for such differential diagnosis to become effective, the patient must be examined by the following narrow specialists:

  • otolaryngologist;
  • defectologist;
  • speech therapist;
  • neurologist;
  • orthodontist;
  • phoniatra;
  • pediatrician, etc.

Examination by narrow specialists allows you to identify the etiology of the disease, to characterize the nature of pathological changes and the severity of all symptoms as accurately as possible. Importance have the following instrumental methods diagnostics:

  • radiography of the nasopharynx;
  • rhinoscopy;
  • electromyography;
  • pharyngoscopy, etc.

These techniques make it possible to visualize the nature of pathological changes and their severity in each individual patient.

Of course, the most significant is the examination by a speech therapist, who, using a number of progressive techniques, will be able to assess the following parameters:

  • structure articulation apparatus;
  • his mobility;
  • voice disorders;
  • parameters of physiological and phonation respiration, etc.

To diagnose open rhinolalia, the Gutzmann technique is used, which is based on the fact that the patient pronounces the sounds “a” and “i” alternately, while the doctor opens and closes the nasal passages. In the presence of pathological changes, the vibration of the wings of the nose is very clearly felt, and when the nasal passages are clamped, the sounds are significantly muffled. Thus, it is possible to diagnose an open form of rhinolalia.

Measures for the correction of rhinolalia

Correction of rhinolalia should have an integrated approach. As a rule, congenital anomalies in the structure of the facial skull are subject to surgical correction. Congenital defects are corrected with plastic surgery. Such operations are aimed at restoring the anatomical structure of the organs of the nose and pharynx, as well as eliminating cosmetic defects. In addition, some patients need surgery to remove nasal polyps, adenoids and other pathological formations that interfere with normal nasal breathing. It also requires correction of the bite and deformities of the upper jaw by an orthodontist. In addition, general strengthening procedures and sanitation of the ENT organs are necessary, which is necessary to prevent hearing loss.

Speech therapy correction aimed at eliminating rhinolalia includes:

  • formation of the correct operation of the articulatory apparatus;
  • normalization of breathing - both in the physiological and in the speech aspect;
  • pronunciation correction;
  • solving problems with phonetic perception, if any;
  • elimination of the nasal timbre of the voice;
  • dysgraphia prevention;
  • strengthening the skills of free communication;
  • work on increasing vocabulary;
  • control of the general development of speech, etc.

The combination of these activities allows you to socialize the child and restore, to some extent, speech functions. Among other things, a child suffering from rhinolalia needs the help of psychologists.

Prevention and medical prognosis of rhinolalia

Systematic and sufficiently long-term correction suggests a positive trend in the course of the disease. At the same time, the material intended for correction should correspond to the age of the child, be accessible and understandable for perception.

The effectiveness of treatment depends on the following factors:

  • how timely therapy was started;
  • the presence of concomitant pathologies;
  • degree of compensatory possibilities;
  • features of the personality of the child and the safety of intelligence;
  • the quality of the surgical interventions performed, etc.

Of decisive importance is speech environment and willingness of parents to help the child with all accessible ways. The results of the work can be evaluated by the degree of normalization speech function and the absence of nasal speaking.

Functional rhinolalia has a very favorable medical prognosis. Prevention is to avoid factors that can provoke birth defects in a child even in the prenatal period. If such defects of the speech apparatus do occur, then their timely correction is necessary.

Systematic implementation of all prescriptions of doctors and speech therapy classes allow you to expect good results of treatment.

Rhinolalia in children and adults is not so rare. A speech pathologist can help you deal with this speech disorder. In this article I will try to talk about what rhinolalia is, its forms, symptoms and directions of corrective work.

Rhinolalia (twang)

This is a pathological change in the timbre of the voice and a distortion of the pronunciation of speech sounds as a result of a violation of the normal participation of the nasal cavity in the process of speech formation. If only the timbre of the voice is disturbed (acquires a nasal tone), and the articulation of sounds is not disturbed, then such a violation of the voice is called rhinophony.

In Russian, there is a division of sounds according to the participation in their formation of the nasal cavity. 4 nasal sounds (these are the sonors M, Mb, H, Hb), the rest are mouth sounds. The nasal cavity should not take part in the formation of oral sounds. Normally, the oral cavity is separated from the nasal cavity.

The soft palate is an active organ, and it is a kind of door between the oral and nasal cavities. If necessary, the soft palate can rise and close the passage to the nasal cavity, and can go down and open this passage, if necessary.

In the case of rhinolalia, the normal participation of the nasal cavity in the process of speech production is disturbed in two ways. In the first case, the exhaled stream of air can be directed through the nose when pronouncing all sounds (nasal and oral), resulting in excessive resonance of the nasal cavity. This is an open rhinolalia.

In the second case, the exhaled air stream, when pronouncing all sounds, is directed through the mouth, as a result of which there is insufficient resonance of the nasal cavity (M sounds like B, N sounds like D). Such a rhinolalia is called closed.

Mixed rhinolalia is also distinguished, which is caused by air leakage through the nose with a simultaneous decrease in nasal resonance and it manifests itself in a combination of disorders characteristic of both open and closed rhinolalia at the same time.

Open rhinolalia.

Symptoms:

Change in the position and activity of the tongue (it is pulled back, the back is sharply arched, tense, the tip is weakly expressed);

Violation of the activity of the muscles that move the soft palate (either passively sags or is inactive);

The interaction between articulatory and mimic movements has been changed, which leads to excessive movements of the facial muscles during speech;

Violation speech breathing(speech exhalation uneven); - a total violation of sound pronunciation (all speech sounds are pronounced with a nasal tone, vowels are especially affected, the articulation of consonants is shifted backwards)

Types of open rhinolalia

most large group constitute organic open rhinolalia on the basis of congenital clefts. In this case, parents know about the problems of the child from birth. Corrective work is carried out only in a complex medical-psychological-pedagogical means.

Medical impact is aimed at mechanical normalization of the structure of the articulatory apparatus, psychological impact is aimed at preventing or correcting personality development disorders and pedagogical (speech therapy) means are aimed at overcoming a speech defect directly. Speech therapy work on the correction of this form of rhinolalia is carried out both in the preoperative and postoperative periods.

There are also open organic rhinolalia of a central nature. It manifests itself in the same symptoms as the previous form, but with such a rhinolalia there are no disturbances in the structure of the organs of articulation. This form is due to paralysis and paresis of the muscles of the soft palate.

Due to muscle paresis, the soft palate is passive, sags and does not fulfill its main function. Corrective work is also carried out in a complex manner, but in this case, medical correction is carried out by a neurologist.

And, finally, functional open rhinolalia, which is most often caused by a decrease in the tone of the soft palate when imitating nasalized speech. It is much less common than organic and presents certain difficulties for differential diagnosis. Correction is speech therapy, sometimes psychological or psychotherapeutic help is required.

Closed rhinolalia

Symptoms:

Nasal sounds M, Mb, N, Hb sound like oral B, Bb, D, Db, in speech there is no opposition of sounds according to the participation of the nasal cavity, which affects the overall intelligibility;

Vowels also don't sound very natural due to the stun.

Types of closed rhinolalia

Organic closed rhinolalia. With this form, the speech defect is caused by anatomical disorders in the nose, pharynx, nasopharynx, and depending on where these anatomical defects are located, it is divided into anterior and posterior.

Anterior organic closed rhinolalia can be caused by hypertrophy of the nasal mucosa, polyps in the nasal cavity, tumors of the nasal cavity, and deviated septum. All these anomalies prevent the free passage of air through the nose.

Posterior organic closed rhinolalia can be caused by anomalies in the pharynx and nasopharynx: adenoid growths, fusion of the soft palate with the posterior pharyngeal wall.

Correction begins with the elimination of the cause of obstruction of the nasal cavity. First of all, you need to consult an otolaryngologist. In some cases, surgery will be required. After removing the obstruction of the nasal cavity, you need logopedic correction, but it will require less time and effort than with open rhinolalia.

Functional closed rhinolalia. In this case, there is no disturbance in the structure of the organs of articulation. It can be caused by imitation of defective speech, lack of auditory control. Correction only speech therapy.

Mixed rhinolalia.

In this form, there is a combination of factors that cause both open and closed rhinolalia. Therefore, when eliminating it, it is applied combined method correction, with a predominance of those exercises that are associated with a more pronounced form of rhinolalia.

Speech therapy to eliminate rhinolalia.

It includes general directions regardless of the form, but will be implemented in different ways. Directions speech therapy work with rhinolalia:

Normalization of speech breathing;

Formation of the correct pronunciation of sounds;

Development phonemic perception and differentiation of sounds and, based on them, the development phonemic analysis and synthesis.

In this article, I tried to raise the main issues that relate to such a speech disorder as rhinolalia. If the child is nasal, do not expect it to resolve itself.

Start with a visit to an otolaryngologist to determine the cause of this speech feature, since in most cases you will first need to health care. Also, do not delay a visit to a speech therapist, because in these cases you cannot do without speech therapy work.

If you have any questions about this topic, write in the comments. If this information was useful to you, please share with your friends.

Rhinolalia

Rhinolalia - this is a violation of articulation due to the incorrect structure and functioning of the speech apparatus (nasopharynx, nasal cavity, hard and soft palate). Because of this, the vocal jet resonates excessively or, on the contrary, insufficiently in the nasal cavity during a conversation, and vowels and consonants acquire a nasal sound. Rhinolalia in children is characterized not only by distorted pronunciation of sounds, but also by delays in the development of the lexical and grammatical side of speech due to secondary violations of writing and phonemic processes.

Diagnosis of rhinolalia consists in consultations with an otorhinolaryngologist, speech therapist and maxillofacial surgeon to establish functional and anatomical defects in articulation, as well as the degree of impairment of oral and written speech.

Correction of rhinolalia can include both speech therapy and psychotherapy, as well as physiotherapy, orthodontic and surgical treatment.

Classification and causes of rhinolalia

Depending on the characteristics of the violation of the interaction of the oropharynx and nasopharynx, a closed or open rhinolalia. The closed type of the disease is characterized by the direction of speech exhalation only through the mouth. Due to the reduced physiological nasal resonance, consonant sounds are most distorted: m, m, n, n. With normal articulation, air enters the nasal cavity because the nasopharyngeal closure is open. With no resonance, these sounds are completely oral: m is pronounced like b, n changes to e. The conceptual apparatus of speech suffers greatly because of this. The sound of vowels is also blurred, as they lack some tonal characteristics.

In accordance with the causes of rhinolalia of the closed type, 2 of its forms are distinguished:

    Organic . Caused by anatomical deformities in the nasal cavity. The obstruction is removed surgically, after which the speech defect disappears, and breathing becomes normal;

    functional . It occurs as a result of hyperfunction of the soft palate, which, due to elevation, directs the air stream through the mouth. This often occurs with neurotic disorders, so a speech therapist and a neurologist are involved in the treatment. After treatment, the habit of pronouncing sounds incorrectly sometimes persists.

An open rhinolalia is more common than a closed one. Air passes through the nose and mouth at the same time, due to the constantly open communication between the oral and nasal cavities. As a result, nasal resonance occurs, which changes the timbre of all sounds.

This speech disorder can also be organic or functional. In the first case, the causes of rhinolalia are both congenital defects (cleft lip, soft and hard palate), and acquired as a result of injuries, scars, paresis, paralysis or tumors. In the second case, functional rhinolalia is due to hypokinesis or hypofunction of the soft palate, which is expressed in its insufficient rise during phonation. Most often, such rhinolalia occurs in children with low muscle tone, with weak nerve impulses, or after frequent diseases of the nasopharynx.

If the factors that cause closed and open rhinolalia are combined, then it is customary to talk about a mixed type of disease. The acoustic and articulatory characteristics of spoken sounds suffer because air leaks through the nose as nasal resonance decreases.

Rhinolalia correction

Complex correction of rhinolalia consists of the following activities:

    Surgical correction of anatomical defects;

    Orthodontic elimination and prevention of repeated deformities of the upper jaw;

    Therapeutic restorative physical education;

    Otorhinolaryngological sanitation to prevent hearing loss;

    Psychotherapeutic help.

Rhinolalia in children should be treated as early as possible, and it is best to complete therapy before adolescence.

The main directions of early speech therapy assistance:

    Normalization of speech and physiological breathing;

    Restoration of the correct palatopharyngeal closure;

    Formation of correct articulation;

    Correction of sound pronunciation;

    Elimination of the nasal timbre of the voice;

    Consolidation of free speech communication skills;

    Bringing back to normal prosodic side speech;

    Development sound analysis and phonemic perception;

    Prevention of dysgraphia and dyslexia;

    Control over common development speech.

IN corrective work the sequence and systematic training should be observed, and the proposed material should be visual and accessible. The speech therapist must constantly monitor the direction of the air stream, the position of the tongue and facial muscles.

The effectiveness of the treatment of rhinolalia depends on a number of external and internal factors:

    The severity of articulation defects;

    Associated disorders and diseases;

    The timing of the start of treatment;

    Time and quality of the performed operations;

    The age of the patient;

    The degree of its compensatory capabilities;

    Hearing conditions;

    personality traits;

    States of intellect;

    Influences of the speech environment.

After correction of rhinolalia, the result is evaluated by the degree of normalization of speech and the absence of nasalization.

In preparation for general education school children suffering from rhinolalia, it is necessary to provide each child with an individual approach and take into account not only the characteristics of the disease, but also the microsocial environment.

Correct distribution therapeutic and educational load is necessary so that the child can complete all the tasks facing him without overwork. Under the influence of surgical interventions, children, as a rule, are weakened somatically, their working capacity, activity and endurance are reduced. Therefore, the treatment of rhinolalia should be clearly organized. Its performance is directly related to joint work doctors, teachers and other professionals.

Normal phonation is characterized by the presence of a shutter between the oral and nasal cavities, when voice vibration penetrates only through the oral cavity. If the separation between the nasal cavity and the oral cavity is incomplete, the vibrating sound also penetrates the nasal cavity. As a result of the violation of the barrier between the oral and nasal cavities, the voice resonance increases. This changes the timbre of sounds, especially vowels. The most noticeable change in the timbre of vowel sounds and and, u, articulations of which the oral cavity is narrowed the most. Vowels sound less nasal e And O, and even less broken vowel A, because when it is pronounced, the oral cavity is wide open.

In addition to the timbre of vowels, with an open rhinolalia, the timbre of some consonants is violated. When pronouncing hissing sounds and fricatives f, v, x added hoarse sound that occurs in the nasal cavity. Explosive sounds ha, b, e, t, k And G, as well as sonorants l And R sound unclear, since the air pressure necessary for their accurate pronunciation cannot be formed in the oral cavity. With prolonged open rhinolalia (especially organic), the air stream in the oral cavity is so weak that it is not enough to vibrate the tip of the tongue, which is necessary for the formation of sound R.

Open rhinolalia can be organic and functional.

Organic open rhinolalia can be congenital or acquired.

The most common reason congenital form is the splitting of the soft and hard palate.

Acquired open rhinolalia It is formed with trauma to the oral and nasal cavities or as a result of acquired paralysis of the soft palate.

The causes of functional open rhinolalia can be different. For example, it occurs during phonation in children with sluggish, articulating soft palate. The functional open form manifests itself in hysteria, sometimes as an independent defect, sometimes as an imitative one.

One of the functional forms habitual open rhinolalia, observed, for example, after the removal of large adenoid growths, occurs as a result of prolonged limitation of the mobility of the soft palate.

Functional examination with open rhinolalia does not reveal organic changes in the hard or soft palate. A sign of a functional open rhinolalia is also that the pronunciation of only vowels is usually disturbed, while when pronouncing consonants, the palatopharyngeal closure is good and nasalization does not occur.

The prognosis for functional open rhinolalia is more favorable than for organic. Nasal timbre disappears after phoniatric exercises, and pronunciation disorders are eliminated by the usual methods used for dyslalia.

Rhinolalia, caused by congenital nonunion of the lip and palate, is a serious problem for speech therapy and a number of medical sciences (surgical dentistry, orthodontics, otolaryngology, medical genetics, etc.). Cleft lip and palate are the most common and severe congenital malformation.

As a result of this defect in children in the process of their physical development, serious functional disorders occur.

In children with congenital nonunion of the lip and palate, the act of sucking is very difficult. It presents particular difficulties in children with a through cleft lip and palate, and with bilateral through clefts, this act is generally impossible.

Difficult feeding leads to a weakening of vitality, and the child becomes susceptible to various diseases. To the greatest extent, children with clefts are predisposed to catarrh of the upper respiratory tract, bronchitis, pneumonia, rickets, and anemia.

Often, such children have pathological changes in the ENT organs: curvature of the nasal septum, deformities of the wings of the nose, adenoids, hypertrophy (enlargement) of the tonsils. Often they have inflammatory processes in the nasal region. The inflammatory process can move from the mucous membrane of the nose and pharynx to the Eustachian tubes and cause inflammation of the middle ear.

Frequent otitis, often taking a chronic course, cause hearing loss. Approximately 60 - 70% of children with cleft palate have hearing loss of varying degrees (usually in one ear) - from a slight decrease that does not interfere with speech perception to significant hearing loss.

Deviations in the anatomical structure of the lip and palate are closely related to underdevelopment of the upper jaw and malocclusion with a defective arrangement of teeth.

Numerous functional disorders caused by a defect in the structure of the lip and palate require constant medical supervision.

In our country, conditions have been created for complex treatment in specialized centers at the Research Institute of Traumatology, at the departments of surgical dentistry, as well as in other institutions where a lot of medical and preventive work is carried out.

Doctors of various specialties observe children and jointly adopt a comprehensive treatment plan.

During the first years of a child's life, the leading role belongs to the pediatrician, who manages the feeding and daily routine of the baby, carries out prevention and treatment, and, if necessary, recommends outpatient or inpatient treatment.

Surgery to restore the upper lip (cheiloplasty) is recommended in the first year of a child's life; often it is produced in maternity hospitals in the first days after birth.

In cases of cleft palate, the orthodontist uses various devices, including an obturator, which facilitate nutrition and create conditions for the development of speech in the preoperative period. The otolaryngologist identifies and treats all painful changes in the ear, nasal cavities, nasopharynx and larynx and prepares children for surgery.

Rice. 35. Left-sided cleft of the upper lip and alveolar process

Rice. 36. Left-sided cleft palate

For deviations in mental development and the presence of pronounced neurotic reactions of the child is consulted by a neurologist.

The palate repair operation (uranoplasty) is performed in most cases at preschool age.

As of mental development children with cleft palate are divided into three categories: children with normal mental development; children with mental retardation; children with oligophrenia (of varying degrees). On neurological examination, signs of severe focal brain damage, as a rule, are not observed. Some children have individual neurological microsigns. Much more often, children have functional disorders of the nervous system, sometimes significantly pronounced psychogenic reactions, and increased excitability.

In addition to all of the above, congenital cleft palate has a negative impact on the development of a child's speech.

Cleft lip and palate play different role in the formation of speech underdevelopment. It depends on the size and shape of the anatomical defect.

There are the following types of cracks:

1) cleft of the upper lip; upper lip and alveolar process (Fig. 35);

2) clefts of the hard and soft palate (Fig. 36);

3) clefts of the upper lip, alveolar process and palate - one and two-sided;

4) submucosal (submucosal) cleft palate.

With cleft lip and palate, all sounds acquire a nasal or nasal tone, which grossly violates the intelligibility of speech.

Typical is the imposition of additional noises on nasalized sounds, such as breathing, snoring, larynx, etc.

There is a specific violation of the timbre of the voice and sound pronunciation.

To prevent the passage of food through the nose, the child from a very young age acquires the habit of lifting the back of the tongue to block the passage into the nasal cavity. This position of the tongue becomes habitual and also changes the articulation of sounds.

During speech, children usually open their mouths a little and raise the back of the tongue higher than required. The tip of the tongue therefore does not move fully. Such a habit impairs the quality of speech, since with a high position of the jaw and tongue, the oral cavity takes on a shape that contributes to the entry of air into the nose, which increases nasality.

When trying to make sounds p, b, f, c a child with rhinolalia uses "his" methods. The sounds are replaced by a pharyngeal click, which very peculiarly characterizes the speech of a child with a severe form of rhinolalia. A specific click, reminiscent of the sound of a valve, is formed when the epiglottis comes into contact with back language.

A direct correspondence between the size of the palatine defect and the degree of speech distortion has not been established. This is due to large individual differences in the configuration of the nasal and oral cavities in children, the ratio of resonant cavities and compensatory techniques that each child uses to increase the intelligibility of his speech. In addition, the intelligibility of speech depends on the age and individual psychological characteristics of children.

Speech therapy sessions with a child must be started in the pre-operative period in order to prevent the occurrence of serious changes in the functioning of the speech organs. At this stage, the activity of the soft palate is prepared, the position of the root of the tongue is normalized, the muscular activity of the lips is enhanced, and a directed oral exhalation is developed. All this, taken together, creates favorable conditions for increasing the efficiency of the operation and subsequent correction. 15 - 20 days after the operation, special exercises are repeated; but now the main goal of the classes is to develop the mobility of the soft palate.

The study of the speech activity of children suffering from rhinolalia shows that defective anatomical and physiological conditions of speech formation, the limitation of the motor component of speech lead not only to the abnormal development of its sound side, but in some cases to a deeper systemic violation of all its components.

With the age of the child, the indicators of speech development worsen (compared to the indicators of normally speaking children), the structure of the defect is complicated due to the violation of various forms of written speech (Fig. 37).

Early correction of deviations in speech development in children with rhinolalia has an extremely important social and psychological and pedagogical significance for the normalization of speech, the prevention of difficulties in learning and choosing a profession.

Rice. 37. An example of impaired writing in a child with rhinolalia (There is a cup on the table; Woodpecker hammers a hollow in the trunk)

The setting of correctional tasks is determined by the results of the examination of children's speech.