-insufficient amount of nasal resonance; a blockage somewhere in the nasopharynx or nasal cavity
-affect production of nasal consonants, sound more like oral cognates (b, d, g)
-obstruction due to hypertrophy, swelling, allergic rhinitis, cold, deviated septum, choanal atresia, stenotic naris, mid face deficiency
VP insufficiency: caused by cleft palate, short velum, sub mucous cleft palate, deep pharynx, tonsils, s/p adenoidectomy, s/p maxillary advancement, s/p nasopharyngeal tumor removal (anatomical or structural deficit) *most common!
VP incompetence: caused by cerebral palsy, neuromotor disease, brainstem tumors, TBI, CVA, cranial nerve damage (neurophysiological disorder, poor movement)
VP mislearning: caused by history of VPI, artic disorder, severe HL or deafness, produces phoneme specific hyper nasality, *corrected by therapy alone!
-perceptual assessment and oral examination, then instrumental procedures if needed
-perceptual assessment: targeted speech sample using connected speech, ex. syllable repetition, counting (60-69, 90-99), repeated sentences. Evaluate artic, air flow, and resonance (use a scale)
-supplemental tests: listening tube, straw, cul de sac test (tests hyper nasality), fistula test (anterior v posterior sounds)
-intra oral exam: VP function cannot be assessed, can determine palatal and velum integrity, look for cleft palate
-instrumental assess: nasometry (records acoustic sound data from nose emissions), video fluoroscopy (barium test, can see muscle movement well), nasopharyngoscopy (FEES, superior view of velum
-SLP not involved in hypo nasality, cul de sac resonance, VPI, hyper nasality
-SLP tx for hyper nasality and nasal emissions due to mislearned VP, and compensatory misarticulations secondary to VPI, or apraxia phoneme specific nasal emissions, also used after surgical correction
-surgery: for obstructions, VPI, repair cleft. Surgery types: superiorly based pharyngeal flap, sphincter pharyngoplasty, augmentation procedure
-prosthetic management: considered when surgery is not an option, palatal obturator, palatal lift, speech bulb obturator