Rhinolalia(Greek rhinos - nose; lalia - speech) - a violation of the timbre of the voice and pronunciation of sounds, caused by anatomical and physiological defects of the speech apparatus and characterized by a peculiar combination of incorrect articulation of sounds and voice disorders. With rhinolalia, the pronunciation of both vowels (due to the nasal timbre of the voice) and consonant sounds is impaired. Types of rhinolalia: open, closed and mixed.

Speech with rhinolalia

Rhinolalia differs from a similar disorder in mechanism - rhinophonia, in which only the timbre of the voice is impaired, and the articulation of sounds does not differ from normal. In rhinolalia, the mechanism of articulation, phonation and voice formation is caused by a violation of the interaction of the oropharyngeal resonators. With normal phonation, the nasopharyngeal and nasal cavities are separated from the pharyngeal and oral cavities when pronouncing speech sounds other than nasal ones. These cavities are separated by the palatopharyngeal closure.

Simultaneously with the movement of the soft palate during phonation, a thickening of the posterior wall of the pharynx (Passavan roller) occurs, which also helps contact the posterior surface of the soft palate with the posterior wall of the pharynx. When pronouncing nasal sounds “mm”, “n-n”, the air stream freely penetrates into the space of the nasal resonator. An unbalanced resonance leads to a change in the acoustic spectrum of the voice and the appearance of nasality or nasalization, and this is the main sign of rhinophony.

If the change in acoustic parameters is accompanied by a spectrum of deviations in the aerodynamic conditions of speech production (insufficient air pressure in the oral cavity, air leakage through the nasal passages), then adaptation to these conditions creates distortions in pronunciation. This is rhinolania.

Open rhinolalia

With open rhinolalia, the timbre of consonants is also disturbed, mainly those in which nasopharyngeal closure is more accurate in normal ratios. The sound of hissing and fricatives “f”, “v”, “x” is disrupted by the addition of an additional hoarse sound that occurs in the nasal cavity. The plosives "p", "b", "d", "t", "k" and "g" sound unclear because the air pressure necessary for accurate pronunciation is not generated in the oral cavity. With open rhinolalia, the air flow in the oral cavity is so weak that it is insufficient to vibrate the tip of the tongue when producing the sound “r”.

Causes of open rhinolalia

The causes of open rhinolalia are divided into 2 groups: organic and functional. Organic causes are divided into congenital and acquired:

• a common cause of congenital open rhinolalia is cleft soft or hard palate;
• acquired open rhinolalia is formed when a hole appears between the oral and nasal cavities or when the soft palate is paralyzed.

Functional open rhinolalia is explained by the lack of retraction of the soft palate during phonation in children with sluggish articulation. Functional open rhinolalia manifests itself in hysteria, sometimes as an independent defect, sometimes as an imitative one.

Examination for open rhinolalia

Examination for open rhinolalia, as a rule, does not reveal organic changes in the hard or soft palate. A sign of functional open rhinolalia is a violation of the pronunciation of only vowel sounds, while with consonant sounds the velopharyngeal closure is sufficient and nasalization is not detected. The prognosis for functional open rhinolalia is favorable. The nasal timbre of the voice disappears after phoniatric exercises, and pronunciation disorders are eliminated using methods that are also used for dyslalia.

Causes of congenital rhinolalia

Congenital facial defects in an infant occur due to exposure to the embryo during intrauterine development. The embryo experiences a delay in the development of those parts of the gill apparatus from which the embryonic tubercles appear, forming the face, nasal and oral cavities. Unfused processes of the upper jaw with the lower create gaps in the upper lip, face, hard and soft palate. The misalignment of one palatine process with the nasal septum forms lateral defects of the palate, which leads to an open connection of one half of the nasal cavity with the oral cavity.

The dangerous period for the occurrence of clefts is 4-8 weeks of pregnancy. Up to 6 weeks, facial clefts appear, 7-8 weeks - the upper lip and palate. The causes of birth defects are hereditary and are often passed down through the male line. Father's signs:

• asymmetry of the eyes, nasolabial folds,
• deviated nasal septum,
• small tongue defect
• stripe in the sky.

Surgical treatment of children with open rhinolalia

Open congenital rhinolalia requires comprehensive medical, pedagogical and orthodontic approaches. In the early stages, orthodontic closure of the hard and soft palate defect with a temporary obturator is required. A soft rubber obturator is needed when feeding a baby. The rigid obturator is made individually and is worn by the child until surgical closure of the defect in the bottom of the nasal cavity and the velum palatine. The obturator is removed 14 days before the planned operation.

Surgical treatment of rhinolalia is carried out in stages. Cheiloplasty, an operation to restore the upper lip, and uranoplasty, an operation to restore the integrity of the bottom of the nasal cavity, are indicated even for newborns. Contraindications for performing these operations at such an early age:

• anemia;
• pneumonia;
• intrauterine hypotrophy;
• birth injuries;
• asphyxia;
• prematurity;
• congenital heart defects;
• spina bifida;
• fistulas in the digestive tract;
• hypoplasia;
• pulmonary aplasia;
• the presence of other severe developmental defects.

Uranoplasty methods: “gentle” uranoplasty is performed on children over one and a half years old, provided there are no contraindications. A proven way to restore the anatomical structure of the nasopharynx is “radical” uranoplasty, which is traumatic and technically complex. For children 3-5 years old, non-through clefts are corrected, and for children 5-6 years old, through clefts (unilateral and bilateral) are corrected. “Radical” uranoplasty is not recommended in early childhood (up to 3 years), since this surgical intervention often provokes slow growth of the lower jaw.

Closed rhinolalia

Closed rhinolalia is formed when the physiological nasal resonance is reduced when pronouncing speech sounds. If there is no nasal resonance for nasal sounds, they sound like oral “b”, “d” or like “mb” (instead of “b”), “nd” (instead of “d”). With closed rhinolalia, the sound of vowel sounds also changes due to the muffling of individual tones in the nasopharyngeal and nasal cavities. In this case, vowel sounds acquire an unnatural, dead tone in speech.

Causes of closed rhinolalia

The cause of closed rhinolalia is organic changes in the nasal space or functional disorders of the velopharyngeal closure. Organic changes are a consequence of painful phenomena as a result of which the nasal passage decreases and nasal breathing becomes difficult (chronic hypertrophy of the nasal mucosa, mainly of the posterior inferior conchae, polyps in the nasal cavity, adenoid growths, occasionally nasopharyngeal polyps, etc.). Functional closed rhinolalia occurs more often in children and occurs when there is sufficient patency of the nasal cavity.

With normal phonation, a seal occurs between the oral and nasal cavities and vocal vibration penetrates only through the oral cavity. If the separation from the oral cavity is incomplete, the vibrating sound penetrates into the nasal cavity. As a result of breaking the barrier between the oral and nasal cavities, the space for vocal resonance increases. At the same time, the timbre of the vowels “i”, “ya”, “u” changes, during the articulation of which the oral cavity is narrowed. The vowels “e” and “o” sound less rhinophonically, and the vowel “a” is less disturbed than others, since when pronouncing “a” the oral cavity is open.

Mixed rhinolalia

Some authors identify mixed rhinolalia - a speech condition characterized by reduced nasal resonance when pronouncing nasal sounds and the presence of a nasal timbre (nasalized voice). The reason is a combination of nasal obstruction and insufficiency of the palato-pharyngeal contact of functional and organic origin.

Typical combinations of a shortened soft palate, submucosal cleft of the soft palate and adenoid growths, which in such cases prevent air from leaking through the nasal passages when pronouncing oral sounds. The state of speech worsens after adenotomy, as velopharyngeal insufficiency occurs and signs of open rhinolalia appear.

Therefore, a speech therapist should carefully examine the structure and function of the soft palate, determine which type of rhinolalia (open or closed) most disrupts the timbre of speech, discuss with the doctor the need to eliminate nasal obstruction and warn parents about the risk of deterioration in the timbre of the voice. After surgery, correction techniques developed for open rhinolalia are used.

Diagnosis of rhinolalia

Diagnosing rhinolalia is not a problem for a doctor, however, difficulties arise when determining the type of rhinolalia. For differential diagnosis, the patient is examined by the following doctors:

• phoniatrist;
• speech pathologist;
• neurologist;
• speech therapist;
• orthodontist;
• otolaryngologist;
• pediatrician.

The examination reveals the etiology of the disease, determines the nature of pathological changes and the severity of symptoms. The following instrumental diagnostic methods are used:

• electromyography;
• rhinoscopy;
• X-ray of the nasopharynx;
• pharyngoscopy.

These techniques visualize the nature of pathological changes and severity in each individual patient. The speech therapist, using a number of progressive techniques, evaluates the following parameters:

• voice disorders;
• voice mobility;
• structure of the articulatory apparatus;
• parameters of physiological and phonation breathing.

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 clearly felt, and if the nasal passages are pinched, the sounds are muffled. Thus, it is possible to diagnose the open form of rhinolalia.

Correction of rhinolalia

Correction of rhinolalia in children begins with determining the severity of the anatomical defect. The doctor must make a timely decision about surgical intervention and tell the parents about the possible consequences if this is not done. The final decision regarding surgical treatment is made by the child’s parents. After surgical correction of rhinolalia, the child undergoes coursework with a speech therapist. The specialist must teach the child to correctly make movements with the soft palate and tongue when forming sounds and individual words. Modern correction of rhinolalia allows a child to completely get rid of this pathology when a child reaches school age. The baby is practically no different from his peers.

Eliminating rhinolalia with massage and exercises

To eliminate the nasal tone of the voice, both the child, the speech therapist, and the parents will have to work hard. First of all, you will need to activate the soft palate and make it move. This will require a special massage. If the child is small, adults do the massage:

• With a clean, alcohol-treated index finger (pad) of the right hand, in a transverse direction, stroking and rubbing the mucous membrane at the border of the hard and soft palate (in this case, a reflex contraction of the muscles of the pharynx and soft palate occurs);
• the same movements are made when the child pronounces the sound “a”;
• make zigzag movements along the border of the hard and soft palate from left to right and in the opposite direction (several times);
• Using your index finger, perform acupressure and jerk-like massage of the soft palate near the border with the hard palate.

If the child is already big enough, then he can do all these massage techniques himself: the tip of the tongue will cope with this task perfectly. It is important to correctly show how all this is done. Therefore, you will need a mirror and the interested participation of an adult. First, the child does the massage with the tongue with his mouth wide open, and then, when there are no more problems with self-massage, he will be able to perform it with his mouth closed, and it is completely unnoticeable to others. This is very important, because the more often the massage is performed, the sooner the result will appear.

When performing a massage, you must remember that you can cause a gag reflex in a child, so do not massage immediately after eating: there should be at least an hour break between meals and massage. Be extremely careful and avoid rough touches. Do not massage if you have long nails: they can damage the delicate mucous membrane of the palate.

In addition to massage, the soft palate will also need special gymnastics. Here are some exercises:

• the child is given a glass of warm boiled water and asked to drink it in small sips;
• the child gargles with warm boiled water in small portions;
• exaggerated coughing with the mouth wide open: at least 2-3 coughs on one exhalation;
• yawning and imitation of yawning with the mouth wide open;
• pronunciation of vowel sounds: “a”, “u”, “o”, “e”, “i”, “s” is energetic and somewhat exaggerated.

Articulation exercises for rhinolalia

For open and closed rhinolalia, it can be very useful to perform articulation exercises for the tongue, lips and cheeks. They are designed to activate the tip of the tongue:

1. Hang your long, narrow tongue down toward your chin and hold it in this position for at least 5 seconds (repeat the exercise several times).
2. Slowly stick your long and narrow tongue out of your mouth (do the exercise several times).
3. With a long and narrow tongue, sticking out as much as possible from the mouth, make several quick oscillatory movements from side to side (from one corner of the mouth to the other).
4. The mouth is wide open, the narrow tongue makes circular movements, like the hand of a clock, touching the lips (first in one direction and then in the other direction).
5. The mouth is open, a narrow long tongue is protruding from the mouth, and moves from side to side (from one corner of the mouth to the other) on the count of “one - two”.
6. The mouth is open, the long narrow tongue rises to the nose, then falls to the chin, counting “one or two.”
7. A narrow long tongue from the inside presses on one or the other cheek.

Forecast of rhinolalia

The prognosis for correction of rhinolalia is favorable, the disorder is eliminated with the help of special exercises and speech therapy. The effectiveness of overcoming rhinolalia depends on the results of the surgeon’s work, as well as the completeness, quality and early start of work with a speech therapist. Systematic and fairly long-term correction allows us to assume positive dynamics during the course of the disease. At the same time, the material intended for correction must be appropriate for the child’s age, be accessible and understandable. The effectiveness of treatment depends on the following factors:

• characteristics of the child’s personality and intellectual integrity;
• the presence of concomitant pathologies;
• degree of compensatory capabilities;
• how timely the correction was started;
• quality of surgical interventions performed.

The speech environment and the willingness of parents to help the child in all available ways are of decisive importance. The results of the work can be assessed by the degree of normalization of speech function and the absence of nasal speaking. Systematic implementation of all doctor’s prescriptions and speech therapy classes allow us to count on good treatment results. Functional rhinolalia has a very favorable medical prognosis.

Prevention of rhinolalia

Prevention of rhinolalia includes preventing the appearance, as well as removing functional disorders and anatomical defects of the patient’s speech apparatus. Prevention consists of avoiding factors that can cause 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.

Questions and answers on the topic "Rhinolalia"

Question:Hello. My son had uranoplasty when he was 1.5 years old. At 3.5, an adenotomy was performed. He speaks through his nose and has a strong nasal voice. How can I improve the situation? Is it too late to see a speech therapist? We are not diagnosed with rhinolalia, which doctors should we contact to clarify the diagnosis?

Answer: Hello. Start with a speech therapist.

Question:Hello! I am 20 years old, I had a cleft lip and palate. I went to speech therapists, my speech somehow improved, but the nasal sound remained. This is understandable, the sky is short and does not completely block the passage. Is it possible to somehow reduce nasality with the help of speech therapy? Compensate for speech? Can mastering lower diaphragmatic breathing help with this? Or should we think about lengthening the soft palate? Then there will be scars, but even if they are, is it possible to restore a new long palate after surgery or will the scars greatly affect its functioning?

Answer: Hello. You really need speech therapy. There are techniques for reducing nasal sounds using special exercises for the palate and phonopedic techniques.

Question:Hello! My son is one and a half years old; from birth he has a complete cleft lip and soft palate with a split uvula, partial cleft of the hard palate and alveolar process. The lip was stitched up and we are planning to eliminate the palate defect. How to prepare for surgery, maybe classes with a loop therapist? How can I help the baby now? Gymnastics for the development of the speech apparatus?

Answer: Hello. Everything will be needed only after the operation, in 3-5 months. You will need massage, gymnastics and a speech therapist for classes. Now prepare for the operation.

Question:Hello. A 5-year-old child, after pharyngitis, began to speak through his nose and began to snore heavily at night. The nose is breathing, there is no runny nose. We were treated, but there was no result. What could it be?

Answer: Hello. Speaking through the nose, rhinolalia is a symptom of swelling of the nasal mucosa that does not block breathing. Snoring is a symptom of difficulty breathing through the nose, which is hampered by swelling. You need an x-ray of the paranasal sinuses and an examination of the nose and nasopharynx by an otolaryngologist (using a mirror or endoscope). Then the treatment methods will become clear to you and to your doctor.

Question:Hello. A 17-year-old child has open rhinolalia due to congenital cleft lip and palate. They performed surgeries and visited speech therapists, but it was not possible to achieve normal speech. Poor pronunciation of voiceless sounds. When pronouncing hissing and whistling sounds, the air speaks through the nose. The child began to stutter severely: is this related to rhinolalia? How to achieve good speech with open rhinolalia? And how long will it take?

Answer: Hello! The time depends on many reasons. Continue persistently with your speech therapist.

– disorders of articulation and voice formation caused by defects in the structure and functioning of the speech apparatus. Rhinolalia is characterized by gross distortions of sound pronunciation, nasalization of consonants and vowels, secondary impairment of phonemic processes and written speech, and underdevelopment of the lexico-grammatical aspect of speech. A diagnostic examination for rhinolalia includes consultation with an otolaryngologist, maxillofacial surgeon, and speech therapist to identify anatomical and functional defects of the articulatory apparatus and the degree of impairment of all aspects of speech. In order to overcome rhinolalia, surgical, physiotherapeutic, orthodontic treatment can be carried out; psychotherapy, speech therapy work.

General information

Rhinolalia is a distortion of sound pronunciation and voice timbre due to a violation of the velopharyngeal closure. Rhinolalia occurs with a frequency of 1 case in 760 people. Some authors consider rhinolalia as a form of mechanical dyslalia, however, it is generally accepted in modern speech therapy to classify rhinolalia as an independent speech disorder. To denote rhinolalia in the literature, the terms “nasality” or “rhinophonia” are sometimes used, however, both of these concepts do not fully reflect the essence of the speech disorder, since they indicate only a specific voice disorder (nasalization), while with rhinolalia the articulatory and acoustic aspects of speech suffer .

The diversity and complexity of the disorders underlying rhinolalia necessitate the participation of specialists in the field of surgical dentistry, orthodontics, otolaryngology, speech therapy, and psychology in overcoming it.

Classification of rhinolalia

The mechanism of development of rhinolalia is associated with a disruption in the interaction of the nasal cavity and oropharynx. Depending on the characteristics of this disorder, it is customary to distinguish open and closed forms of rhinolalia. Taking into account possible causes (anatomical defects or dysfunction of the speech apparatus), each of the forms can be organic and functional.

Open rhinolalia characterized by the presence of a constant open communication between the nasal and oral cavities, which determines the free passage of the air stream simultaneously through the nose and mouth during speech and the occurrence of nasal resonance during phonation.

Closed rhinolalia associated with the presence of an obstacle blocking the exit of the air stream through the nose. Depending on the level of location of the anatomical obstacle (nasal cavity or nasopharynx), closed anterior and closed posterior rhinolalia are distinguished, respectively.

With a combination of nasal obstruction and insufficiency of the velopharyngeal ring, they speak of mixed rhinolalia. In this case, there is an absence of nasal sounds and a nasal tone to the voice.

Causes of rhinolalia

Depending on the time of occurrence, open organic rhinolalia can be congenital or acquired. Congenital open rhinolalia occurs in children with clefts of the soft and hard palate (“cleft palate”), splitting of the alveolar process of the upper jaw and upper lip (“cleft lip”), shortening of the soft palate, bifurcation or absence of a small uvula, hidden (submucosal) clefts of the hard palate. The causes of congenital facial clefts can be infection of a pregnant woman in the early stages of gestation with toxoplasmosis, influenza, rubella, mumps and other infections; contact with pesticides and other harmful substances, smoking, drug and alcohol use during pregnancy, stress, endocrine disorders in the expectant mother. The critical period for the formation of facial clefts is the 7th-8th week of embryogenesis.

Acquired open organic rhinolalia occurs as a result of cicatricial deformities, traumatic perforation of the palate, paralysis and paresis of the soft palate caused by injury or tumor compression of the glossopharyngeal or vagus nerves.

Cases of open functional rhinolalia occur after removal of the adenoids or with post-diphtheria paresis of the soft palate. In this case, there is insufficient lifting of the soft palate and incomplete velopharyngeal closure during phonation.

The causes of closed organic rhinolalia are various kinds of anatomical changes in the nasal cavity or nasopharynx. Anterior closed rhinolalia may be associated with the presence of a deviated nasal septum, nasal polyps, mucosal hypertrophy, and tumors of the nasal cavity. Posterior closed rhinolalia is caused by adenoids, polyps, fibroids of the nasopharynx, growth of the unpaired pharyngeal tonsil, etc.

Closed functional rhinolalia occurs when the soft palate is hypertonic, preventing the air stream from exiting through the nose. This condition can develop as a result of adenoidectomy, neurological disorders, and also against the background of copying the nasal speech of others.

Symptoms of rhinolalia

With open organic rhinolalia caused by congenital facial clefts, the child’s vital functions of nutrition and breathing suffer from the first days of life. When feeding a baby, milk leaks out through the nose, so the newborn does not gain enough weight and does not receive the necessary nutrients. The inhaled air does not have time to warm up sufficiently in the nasal passages, because it immediately enters the lower respiratory tract through the cleft. Children with palatal clefts and open rhinolalia are predisposed to malnutrition, otitis media, eustachitis, bronchitis, and pneumonia. Congenital cleft palates are often combined with malocclusion.

The state of intelligence in children with open rhinolalia can be different - from normal to mental retardation and mental retardation of varying degrees. Neurological signs are often observed in children: nystagmus, ptosis, hyperreflexia.

The prelinguistic period in children with rhinolalia proceeds abnormally: attention is drawn to the absence of modulated and varied babbling, quiet or silent articulation of sounds. Speech development with rhinolalia is also delayed: the child often pronounces his first words after 2 years. Speech is slurred, inexpressive and incomprehensible to others.

With open organic rhinolalia, the articulation of sounds and sound pronunciation are grossly impaired. The root of the tongue is constantly in a raised position, and the tip of the tongue is in a passive, lowered position, and therefore most of the consonants acquire a “back-lingual” connotation and resemble the sound [x]. With open rhinolalia, all sounds have a strong nasal (nasal) connotation and are practically not differentiated from each other; the voice becomes dull and quiet.

In an effort to pronounce sounds more clearly, children strain their facial muscles, muscles of the lips, tongue and wings of the nose, which leads to grimaces and further worsens the overall impression of speech.

Inaccurate articulation and distorted sounds are accompanied by a secondary impairment of auditory differentiation and phonemic analysis, leading to disorders of written speech - dysgraphia and dyslexia. Limitation of speech contacts in children with rhinolalia leads to insufficient development of vocabulary and grammatical aspects of speech, i.e. ONR.

If a child with open organic rhinolalia realizes and experiences his defect, this causes him to develop secondary mental layers: isolation, irritability, shyness.

With open functional rhinolalia, it is mainly the sound pronunciation of vowels that suffers; consonant sounds remain intact due to sufficient velopharyngeal closure.

Closed organic rhinolalia is accompanied by a violation of the pronunciation of nasal sounds ([m], [m"], [n], [n"]), replacement of [m] with [b], [n] with [d]. At the same time, the timbre of the voice also suffers; Due to the impossibility of nasal breathing, children are forced to breathe through their mouths. Children with closed organic rhinolalia are prone to colds and the development of asthenic syndrome. With closed functional rhinolalia, the voice acquires a dull, unnatural, dead tone.

Diagnosis of rhinolalia

The examination of children and adults with rhinolalia is multifaceted and is carried out by various specialists: otolaryngologist, maxillofacial surgeon, orthodontist, neurologist, phoniatrist, speech therapist, psychologist. The most important instrumental studies to identify the causes of rhinolalia are radiography of the nasopharynx, rhinoscopy, pharyngoscopy, electromyography, etc.

During a speech therapy examination of a patient with rhinolalia, the main attention is paid to assessing the structure and mobility of the articulatory apparatus, physiological and phonation breathing, and voice disorders. To identify open rhinolalia, the Gutzmann test is used - pronouncing the vowels [a] and [i] with alternate closing and opening of the nasal passages. When the nostrils are pinched, the sounds are muffled, and at the same time the speech therapist feels with his fingers a strong vibration of the wings of the nose. Then the sound pronunciation of all vowels and consonants, the prosodic side of speech, phonemic processes, the state of vocabulary and grammar are examined; for schoolchildren - the state of reading and writing.

Speech therapy classes for the correction of open organic rhinolalia are carried out in the pre- and postoperative period. Before the operation, articulation exercises, breathing exercises, speech therapy massage (finger massage of fragments of the hard palate and vibration massage of the soft palate) are performed. At this stage, it is necessary to work on the production and automation of available sounds (while maintaining their nasal tone), develop the strength and flexibility of the voice, expand the child’s vocabulary, cultivate auditory attention and phonemic hearing, etc.

The goal of postoperative work to correct rhinolalia is to consolidate the achieved skills in new anatomical conditions. For this purpose, massage of postoperative scars of the palate, development of full velopharyngeal closure, development of differentiated oral and nasal exhalation, correction of sound pronunciation, elimination of the nasal tone of the voice, elimination of gaps in the lexico-grammatical structure and phrasal speech are carried out.

Forecast and prevention of rhinolalia

Functional rhinolalia, as a rule, has a favorable prognosis and is eliminated with the help of phoniatric exercises and speech therapy sessions. The effectiveness of overcoming organic rhinolalia is largely determined by the results of surgical treatment, the timing of the start and completeness of speech therapy work.

Prevention of rhinolalia consists of preventing the occurrence and timely elimination of anatomical defects and functional disorders of the speech apparatus.

Rhinolalia

forms of rhinolalia, elimination of rhinolalia, gymnastics of the soft palate, exercises for the cheeks, lips, tongue



Rhinolalia (from the Greek rhinos - nose, lalia - speech) is a violation of the timbre of the voice and sound pronunciation, caused by anatomical and physiological defects of the speech apparatus.

Rhinolalia in its manifestations differs from dyslalia by the presence of an altered nasalized (from the Latin paziz - nose) voice timbre.

With rhinolalia, the articulation of sounds and phonation differ significantly from the norm. With normal phonation, during the pronunciation of all speech sounds except nasal sounds, a person separates the nasopharyngeal and nasal cavities from the pharyngeal and oral ones. These cavities are separated by velopharyngeal closure, caused by contraction of the muscles of the soft palate, lateral and posterior walls of the pharynx. Simultaneously with the movement of the soft palate during phonation, thickening of the posterior wall of the pharynx (Passavan roller) occurs, which promotes contact of the posterior surface of the soft palate with the posterior wall of the pharynx.

During speech, the soft palate continuously lowers and rises to different heights depending on the sounds being spoken and the rate of speech. The strength of the velopharyngeal closure depends on the sounds being pronounced. It is smaller for vowels than for consonants. The weakest velopharyngeal closure is observed with the consonant “b”, the strongest with “c”, usually 6-7 times stronger than with “a”. During normal pronunciation of the nasal sounds m, m, n, n, the air stream freely penetrates into the space of the nasal resonator.


Depending on the nature of the dysfunction of the velopharyngeal closure, various forms of rhinolalia are distinguished.

Forms of rhinolalia and features of sound pronunciation

Open rhinolalia

With the open form of rhinolalia, oral sounds become nasal. The timbre of the vowels “i” and “u” changes most noticeably, during the articulation of which the oral cavity is most narrowed. The vowel “a” has the least nasal connotation, since when it is pronounced the oral cavity is wide open.

The timbre is significantly impaired when pronouncing consonants. When pronouncing sibilants and fricatives, a hoarse sound is added that occurs in the nasal cavity. Explosive “p”, “b”, “d”, “t”, “k” and “g” sound unclear, since the necessary air pressure is not generated in the oral cavity due to incomplete closure of the nasal cavity.

The air flow in the oral cavity is so weak that it is not sufficient to vibrate the tip of the tongue necessary to produce the sound “r”.

Diagnostics

To determine open rhinolalia, there are different methods of functional research. The simplest is the so-called Gutzmann test. The child is forced to alternately repeat the vowels “a” and “i”, while the nasal passages are either closed or opened. With the open form, there is a significant difference in the sound of these vowels. With the nose pinched, sounds, especially “i,” are muffled, and at the same time the speech therapist’s fingers feel a strong vibration on the wings of the nose.
You can use a phonendoscope. The examiner inserts one “olive” into his ear, the other into the child’s nose. When pronouncing vowels, especially "u" and "i", a strong hum is heard.

Functional open rhinolalia is caused by various reasons. It is explained by insufficient elevation of the soft palate during phonation in children with sluggish articulation.

One of the functional forms is “habitual” open rhinolalia. It is often observed after removal of adenoid growths or, less commonly, as a result of post-diphtheria paresis, due to prolonged restriction of the mobile soft palate.

A functional examination in the open form does not reveal any changes in the hard or soft palate. A sign of functional open rhinolalia is a more pronounced violation of the pronunciation of vowel sounds. With consonants, the velopharyngeal closure is good.

The prognosis for functional open rhinolalia is usually favorable. It disappears after phoniatric exercises, and disturbances in sound pronunciation are eliminated by the usual methods used for dyslalia.

Organic open rhinolalia can be acquired or congenital. Acquired open rhinolalia is formed with perforation of the hard and soft palate, with cicatricial changes, paresis and paralysis of the soft palate. The cause may be damage to the glossopharyngeal and vagus nerves, injuries, tumor pressure, etc.

The most common cause of congenital open rhinolalia is congenital cleft of the soft or hard palate, shortening of the soft palate.

Rhinolalia, caused by congenital clefts of the lip and palate, represents a serious problem for various branches of medicine and speech therapy. It is the subject of attention of dental surgeons, orthodontists, pediatric otolaryngologists, psychoneurologists and speech therapists. Clefts are adjacent to the most common and severe malformations.

The incidence of children born with clefts varies among different peoples, in different countries, and even in different regions of each country. A. A. Limberg (1964), summarizing information from the literature, notes that for every 600-1000 newborns, one child is born with a cleft lip and palate. Currently, the birth rate in different countries of children with congenital pathologies of the face and jaws ranges from 1 in 500 newborns to 1 in 2500, with a tendency to increase over the past 15 years.

Facial clefts are defects of complex etiology, i.e. multifactorial defects. Genetic and external factors or their combined action in the early period of embryo development play a role in their occurrence.

There are:
1. biological factors (influenza, mumps, rubella measles, toxoplasmosis, etc.);
2. chemical factors (pesticides, acids, etc.); endocrine diseases of the mother, mental trauma and occupational harm;
3. There is information about the effects of alcohol and smoking.

The critical period for nonfusion of the upper lip and palate is the 7-8th week of embryogenesis.

The presence of a congenital cleft lip or palate is a common symptom for many nosological forms of hereditary diseases. Genetic analysis shows that familial patterns of cleft lip and palate are quite rare. However, medical and genetic counseling of families for the purposes of diagnosis and prevention is of great importance. Currently, microsigns of cleft lips and palate have been identified in parents: a groove on the palate or uvula of the soft palate, a cleft uvula, an asymmetrical tip of the nose, an asymmetrical arrangement of the bases of the wings of the nose (N. I. Kasparova, 1981).

Children with congenital clefts have serious functional disorders (sucking, swallowing, external respiration, etc.), which reduce resistance to various diseases. They need systematic medical supervision and treatment. According to the state of mental development, children with clefts constitute a very heterogeneous group: children with normal mental development; with mental retardation; with mental retardation (of varying degrees). Some children have individual neurological microsigns: nystagmus, slight asymmetry of the palpebral fissures, nasolabial folds, increased tendon and peristal reflexes. In these cases, rhinolalia is complicated by early damage to the central nervous system. Much more often children experience functional disorders of the nervous system, pronounced psychogenic reactions to their defect, increased excitability, etc.

A characteristic feature of children with rhinolalia is a change in oral sensitivity in the oral cavity. Significant deviations in stereognosis in children with clefts in comparison with the norm were noted by M. Edwards. The reason is dysfunction of the sensorimotor pathways, caused by inadequate feeding conditions in infancy. Pathological features of the structure and activity of the speech apparatus cause various deviations in the development of not only the sound side of speech; various structural components of speech suffer to varying degrees.

Closed rhinolalia

Closed rhinolalia occurs when physiological nasal resonance is reduced during the production of speech sounds. The strongest resonance is for the nasal m, m", n, n". When pronounced normally, the nasopharyngeal valve remains open and air enters directly into the nasal cavity. If there is no nasal resonance for nasal sounds, they sound like oral sounds b, b" d, d". In speech, the opposition of sounds on the basis of nasal - non-nasal disappears, which affects its intelligibility. The sound of vowel sounds also changes due to the deafening of individual tones in the nasopharyngeal and nasal cavities. In this case, vowel sounds acquire an unnatural connotation in speech.

The cause of the closed form is most often organic changes in the nasal space or functional disorders of the velopharyngeal closure. Organic changes are caused by painful phenomena, as a result of which nasal breathing becomes difficult.

M. Zeeman distinguishes two types of closed rhinolalia (rhinophonia): anterior closed - with obstruction of the nasal cavities and posterior closed - with a decrease in the nasopharyngeal cavity.

Anterior closed rhinolalia is observed with chronic hypertrophy of the nasal mucosa, mainly of the posterior inferior concha; for polyps in the nasal cavity; with a deviated nasal septum and tumors of the nasal cavity.

Posterior closed rhinolalia in children can be a consequence of adenoid growths, less often nasopharyngeal polyps, fibroids or other nasopharyngeal tumors.

Functional closed rhinolalia is often observed in children, but is not always correctly recognized. It occurs with good patency of the nasal cavity and undisturbed nasal breathing. However, the timbre of nasal and vowel sounds may be more disturbed than with organic forms.

During phonation and when pronouncing nasal sounds, the soft palate rises strongly and blocks access to sound waves to the nasopharynx. This phenomenon is more often observed in neurotic disorders in children. With organic closed rhinolalia, first of all, the causes of obstruction in the nasal cavity must be eliminated. As soon as correct nasal breathing occurs, the defect disappears. If, after eliminating the obstruction (for example, after adenotomy), rhinolalia continues to exist, resort to the same exercises as for functional disorders.

Mixed rhinolalia

Some authors (M. Zeeman, A. Mitronovich-Modrzejewska) identify mixed rhinolalia - a speech condition characterized by reduced nasal resonance when pronouncing nasal sounds and the presence of a nasal timbre (nasalized voice). The cause is a combination of nasal obstruction and insufficiency of the velopharyngeal contact of functional and organic origin. The most typical are combinations of a shortened soft palate, its submucosal cleft and adenoid growths, which in such cases serve as an obstacle to air leakage through the nasal passages during the pronunciation of oral sounds.

The state of speech may worsen after adenotomy, as velopharyngeal insufficiency occurs and signs of open rhinolalia appear. In this regard, the speech therapist should carefully examine the structure and function of the soft palate, determine which form of rhinolalia (open or closed) most disrupts the timbre of speech, discuss with the doctor the need to eliminate nasal obstruction and warn parents about the possibility of worsening the timbre of the voice. After surgery, correction techniques developed for open rhinolalia are used.

It is known that with congenital cleft palate, the voice, in addition to excessive open nasalization, is weak, monotonous, non-flying, muffled, and compressed. M. Zeeman even identified this voice disorder as an independent one and called it palatophonia.

However, attention is drawn to the fact that the voice of children with cleft palate in the first year of life does not differ from the voice with a normal structure of the upper jaw. In the pre-speech period, these children scream, cry, and walk in a normal child's voice.

Subsequently, until about seven years of age, children with congenital cleft palates speak (both in the absence of plastic surgery and often after it) in a voice with a nasal tint, sometimes quiet due to behavioral characteristics, but in other qualities clearly not different from normal. An electroglottographic study at this age confirms the normal motor function of the larynx, and myography confirms the normal reaction of the pharyngeal muscles to a stimulus, even with extensive defects of the palate.

After seven years, the voice of children with congenital cleft palates begins to deteriorate: strength decreases, hoarseness and exhaustion appear, and the expansion of its range stops. Myography reveals an asymmetrical reaction of the pharyngeal muscles, thinning of the mucous membrane and a decrease in the pharyngeal reflex are visually observed, and changes appear on the electroglotogram indicating uneven functioning of the right and left vocal folds, i.e., all signs of a disorder of the motor function of the voice-producing apparatus, which is permanent is formed and consolidated by adolescence.

Three main causes of voice pathology in congenital cleft palate can be identified.

This is, firstly, a violation of the velopharyngeal closure mechanism. It is known that due to the close functional connection of the soft palate and the larynx, the slightest tension and movement of the muscles of the velum palate causes a corresponding tension and motor reaction in the larynx. With cleft palate, the muscles that lift and stretch it, instead of being synergists, work as antagonists. At the same time, due to a decrease in the functional load, a degenerative process occurs in them, as in the muscles of the pharynx. The pathological mechanism of closure is enhanced by the congenital asymmetry of the facial skeleton and laryngeal cavities, which is clearly visible on X-rays and tomograms in congenital cleft palate. Anatomical defect of the palate and pharynx leads to a functional disorder of the vocal apparatus.

Secondly, this is the incorrect formation of a number of voiced consonants in rhinolalia in the laryngeal way, when closure is carried out at the level of the larynx and air friction on the edges of the vocal folds is voiced. In this case, the larynx takes on the additional function of an articulator, which, of course, does not remain indifferent to the vocal folds.

Thirdly, the development of the voice is influenced by the behavioral characteristics of persons with rhinophony and rhinolalia. Ashamed of their defective speech, adolescents and adults often speak in a quiet voice and limit verbal communication as much as possible in the microenvironment, thereby reducing the opportunities for developing the strength of their voice and expanding its range.

Features of speech breathing in persons with cleft palate are expressed in increased breathing, in the predominance of the superficial clavicular type of breathing and in shortening of phonation exhalation, which is caused by leakage of air flow into the nasal cavity. The leakage rate depends on the shape of the crevice and can exceed 30%. The duration of exhalation is equal to inhalation. There is no differentiated oral and nasal exhalation.

Speech disorders with rhinolalia

With rhinolalia, speech develops late (the first words appear by two years and much later) and has qualitative features. Impressive speech develops relatively normally, while expressive speech undergoes some qualitative changes.

First of all, it should be noted that the patients’ speech is extremely slurred. The words and phrases that appear in them are difficult to understand for those around them, since the sounds that are formed are unique in articulation and sound. Due to the defective position of the tongue in the oral cavity, consonant sounds are formed mainly due to changes in the position of the tip of the tongue (with little participation of the tongue root in articulation) with excessive activation of the facial muscles.

These changes in the position of the tip of the tongue are relatively constant and correlate with the articulation of certain sounds. Pronunciation of some consonant sounds is particularly difficult for patients. Thus, they cannot implement the necessary barrier at the upper teeth and alveoli to pronounce the sounds of the upper position: l, t, d, ch, sh, shch, zh, r; at the lower incisors to pronounce sounds s, z, c with simultaneous oral exhalation; Therefore, whistling and hissing sounds in rhinolalics acquire a peculiar sound. The sounds k and g are either absent or replaced by a characteristic explosion. Vowel sounds are pronounced with the tongue pulled back and air exhaled through the nose and are characterized by sluggish labial articulation.

Thus, vowels and consonants are formed with a strong nasal connotation. Their articulation is often significantly changed, and the sounds are not clearly differentiated from each other. For the patient himself, such articulomes serve as kineme, i.e., a motor characteristic of a certain sound, and in his speech they perform a meaning-distinguishing function, which allows them to be used for speech communication.

All sounds pronounced by the patient are perceived by ear as defective. Their common characteristic for the listener is snoring sounds with a nasal tint. In this case, unvoiced sounds are perceived as close to the sound “x”, voiced sounds - to the fricative “g”; Of these, the labial and labiodental are close to the sound “m”, and the anterior lingual are close to the sound “n” with a slight modification of the sound.

Sometimes articulomes in the speech of a rhinolalic are very close to normal, and their pronunciation, despite this, is perceived by ear as defective (snoring), since speech breathing is impaired, and, in addition, excessive tension of the facial muscles occurs, which in turn affects articulation and sound effect.

Thus, sound pronunciation in rhinolalia is completely affected. Patients usually lack independent awareness of their speech defect or their sensitivity to it is reduced. Listening to a recording of their speech stimulates patients to take serious speech therapy classes.

Thus, in the structure of speech activity in rhinolalia, the defect in the phonetic-phonemic structure of speech is the leading element of the disorder, and the primary one is a violation of the phonetic structure of speech. This primary defect leaves some imprint on the formation of the lexico-grammatical structure of speech, but deep qualitative changes usually occur only when rhinolalia is combined with other speech disorders.

In the literature there are indications of the uniqueness of the formation of written speech in rhinolalia. Without dwelling separately on the analysis of the causes of writing defects in rhinolali, it can be pointed out that the proposed method of working to prevent writing disorders and excludes them in cases of early speech therapy assistance (preschool education).

Speech deficiency in rhinolalia affects the formation of all mental functions of the patient and, first of all, the development of personality. The originality of its development is determined by the unfavorable living conditions in a group for rhinolalic.

Impaired speech as a means of communication makes it difficult for patients to behave in a group. Often their communication with the team is one-sided, and the result of communication traumatizes the children. They develop isolation, shyness, and irritability. Their activity is in a more favorable state, since these patients are often intellectually complete (if rhinolalia manifests itself in its pure form).

Purposeful work to overcome a speech defect contributes to the formation of positive character traits and erases the development of higher mental functions. Follow-up information presented in the literature and observations show that the majority of children with rhinolalia are capable of a high degree of compensation for the defect and rehabilitation of functions.

So, congenital clefts negatively affect the formation of the child’s body and the development of higher mental functions. Patients find unique ways to compensate for the defect, resulting in the formation of incorrect interchangeability of the muscles of the articulatory apparatus. This is the cause of the primary disorder - a violation of the phonetic design of speech - and acts as a leading disorder in the structure of the defect. This disorder entails a number of secondary disturbances in the speech and mental status of the patient. However, this group of patients has great adaptive and compensatory capabilities for the rehabilitation of impaired functions.

In oral speech, impoverishment and abnormal conditions for the prelinguistic development of children with rhinolalia are noted. Due to a violation of speech motor periphery, the child is deprived of intense babbling and articulatory “game”, thereby impoverishing the stage of preparatory tuning of the speech apparatus. The most typical babbling sounds “p”, “b”, “t”, “d” are articulated by the child silently or very quietly due to the leakage of air through the nasal passages and thus do not receive auditory reinforcement in children. Not only the articulation of sounds suffers, but also the development of simple elements of speech. There is a late onset of speech, a significant time interval between the appearance of the first syllables, words and phrases already in the early period, which is sensitive for the formation of not only its sound, but also its semantic content, i.e., a distorted path of development of speech as a whole begins. To the greatest extent, the defect manifests itself in a violation of its phonetic side.

As a result of peripheral insufficiency of the articulatory apparatus, adaptive (compensatory) changes in the structure of the articulation organs are formed when pronouncing sounds; high elevation of the root of the tongue and its shift to the posterior zone of the oral cavity; insufficient participation of the lips when pronouncing labialized vowels, labiolabial and labiodental consonants; excessive involvement of the root of the tongue and larynx; tension of facial muscles.

The most significant manifestations of defective formation of oral speech are violations of all oral speech sounds due to the connection of nasal D and changes in the aerodynamic conditions of phonation. The sounds become nasal, that is, the characteristic tone of the consonants changes. Pharyngealization, i.e. additional articulation due to tension in the walls of the pharynx, occurs as a compensatory means.

There are also phenomena of additional articulation in the laryngeal cavity, which gives speech a peculiar “clicking” sound.

Many other more specific defects are revealed. For example:
1. lowering the initial consonant (“ak” - “so”, “am” - “there”);
2. neutralization of dental sounds according to the method of formation;
3. replacing plosives with fricatives;
4. whistling background when pronouncing hissing sounds or vice versa (“ssh” or “shs”);
5. absence of vibrant r or replacement with the sound s during strong exhalation;
6. adding additional noise to nasal sounds (hissing, whistling, aspiration, snoring, throatiness, etc.);
7. moving articulation to more posterior zones (the influence of the high position of the root of the tongue and the small participation of the lips in articulation). For example, the sound "s" is replaced by the sound "f" without changing the method of articulation. Characteristic is a decrease in the intelligibility of sounds in a combination of consonants in the final position.

The relationship between nasalization of speech and distortions in the articulation of individual sounds is very diverse.

It is impossible to establish a direct correspondence between the size of the palatal defect and the degree of speech distortion. The compensatory techniques that children use to produce sounds are too diverse. Much also depends on the ratio of the resonating cavities and on the variety of their configuration features of the oral and nasal cavities. There are factors that are less specific, but also influence the degree of intelligibility of sound pronunciation (age, individual psychological properties, socio-psychological, etc.). The speech of a child with rhinolalia is generally unintelligible.

M. Momescu and E. Alex showed that the spoken speech of children with cleft palate contains only 50% of the information compared to the norm; the ability to transmit a child’s speech message is halved. This causes serious communication difficulties. Thus, the mechanism of disorders in open rhinolalia is determined by the following:

1) the absence of a velopharyngeal seal and, as a result, a violation of the opposition of sounds on the basis of oronasal;

2) a change in the place and method of articulation of most sounds due to defects of the hard and soft palate, flaccidity of the tip of the tongue, lips, retraction of the tongue deeper into the oral cavity, high position of the root of the tongue, participation in the articulation of the muscles of the pharynx and larynx.

Peculiarities of oral speech of children with rhinolalia in many cases are the cause of deviations in the formation of other speech processes.

Written speech

The pronunciation features of children with rhinolalia lead to distortion and immaturity of the phonetic system of the language. Therefore, the sound images accumulated in their speech consciousness are incomplete and are not dissected for the formation of correct writing. Secondarily determined features of the perception of speech sounds are the main obstacle to mastering correct writing.
The connection between writing disorders and defects in the articulatory apparatus has various manifestations. If by the time of training a child with rhinolalia has mastered intelligible speech, can clearly pronounce most of the sounds of his native language, and only a slight nasal tone remains in his speech, then the development of sound analysis necessary for learning to read and write is proceeding successfully. However, as soon as a child with rhinolalia experiences additional obstacles to normal speech development, specific errors in writing appear. Late onset of speech, a long absence of speech therapy assistance, without which the child continues to pronounce obscure, distorted words, lack of speech practice, and in some cases reduced mental activity affect all of his speech activity.

Dysgraphic errors that are observed in the written work of children with cleft palates are varied.

Specific for rhinolalia are replacements of “p”, “b” with “m”, “t”; "d" to "n" and reverse replacements "n" - "d"; “t”, “m - “b”, “p” are due to the lack of phonological opposition of the corresponding sounds in oral speech. For example: “will come” - “will receive”, “gave” - “cash”, “lily of the valley” - “lannysh” , "ladnysh", "og" - "fire", etc.

Omissions, substitutions, and the use of extra vowels are identified: “in the canopy” - “in the blue”, “kreltsa” - “porch”, “gribimi” - “mushrooms”, “gulucote” - “dovecote”, “prshel” - “came” .

Substitutions and mixtures of hissing and whistling “zelezo” - “iron”, “whirled” - “whirled” are common.

Difficulties in using affricates are noted. The sound “ch” in writing is replaced by “sh”, “s” or “zh”; “sch” to “ch”: “hide” - “hide”, “shchulan” - “closet”, “shitala” - “read”, “serez” - “through”.

The sound "ts" is replaced with "s": "skvores" - "starling".

Mixtures of voiced and voiceless consonants are characteristic: “correct” - “correct”, “in the portfolio” - “in the portfolio”.

It is not uncommon to make mistakes by missing one letter from the sequence: “rasvel” - “bloomed”, “konatu” - “room”.

The sound “l” is replaced by “r”, “r” by “l”: “cooked” - “failed”, “swimmed up” - “swam”.

The degree of writing impairment depends on a number of factors: the depth of the defect in the articulatory apparatus, the characteristics of the child’s personal and compensatory abilities, the nature and timing of speech therapy, and the influence of the speech environment.

It is necessary to carry out special work, including the development of phonemic perception with a simultaneous impact on the pronunciation side of speech. Correction of speech disorders in children with rhinolalia is carried out differentially depending on age, the state of the peripheral part of the articulatory apparatus and the characteristics of speech development in general.

The main differentiating indicator for placing children in speech therapy institutions is the development of speech processes. Preschool children with phonetic speech disorders are provided with speech therapy assistance on an outpatient basis, in a children's clinic or in a hospital (in the postoperative period). Children with underdevelopment of other speech processes are enrolled in specialized kindergartens in groups for children with phonetic-phonemic or general speech underdevelopment.

School-age children with severe phonemic perception disorders receive help at speech centers at secondary schools. However, they constitute a specific group due to the severity and persistence of the primary defect and the severity of the writing impairment.

Therefore, correctional interventions in special schools are often more effective for them.

School-age children with rhinolalia, who have general speech underdevelopment, are characterized by insufficient development of vocabulary and grammatical structure.

Its causes are different: narrowing of social and speech contacts of children due to a gross defect in sound speech, late onset, complication of the main defect with manifestations of dysarthria or alalia.

Speech errors reflect a low level of mastery of language patterns, a violation of lexical and syntactic compatibility, and a violation of the norms of the literary language. They are due, first of all, to the small amount of speech practice. The children's vocabulary is not precise enough in its use, with a limited number of words denoting abstract and general concepts. This explains the stereotypical nature of their speech, the replacement of words with similar meanings.
In written speech, typical cases are the incorrect use of prepositions, conjunctions, particles, errors in case endings, i.e. manifestations of agrammatism in writing. Substitutions and omissions of prepositions, merging of prepositions with nouns and pronouns, and incorrect division of sentences are common.

Elimination of rhinolalia

The effectiveness of speech therapy to eliminate rhinolalia depends on the condition of the nasopharynx and the age of the child. An important factor is the child’s ability to distinguish a nasal voice from a normal one.

Speech therapy sessions with the child must begin in the preoperative 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 directed oral exhalation is produced. All this taken together creates favorable conditions for increasing the effectiveness of the operation and subsequent correction. 15-20 days after surgery, 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, limited motor component of speech lead not only to the abnormal development of its sound side, but in some cases to a deeper systemic disorder of all its components.

As the child ages, the indicators of speech development worsen (compared to the indicators of normally speaking children), the structure of the defect is complicated by impairment of various forms of written speech.

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

Parents should be fully aware that surgical treatment does not ensure normal speech, but only creates full-fledged anatomical and physiological conditions for the development of correct pronunciation.

It is also necessary to encourage parents to consolidate all achieved results every day.

It often happens that the somatic weakness of a child with rhinolalia, the presence of a speech defect causes constant anxiety in parents, anxiety about any reason, the need for excessive care of the baby, and distrust in his capabilities.

Your child is not alone:
birth rate and causes

Congenital clefts of the upper lip and palate - this is how the developmental defects, formerly known as “cleft lip” and “cleft palate,” should be called. Today, more than ever in the past, humanity is experiencing the consequences of adverse factors on itself and its children. Their influence on the developing fetus is much more dangerous than on an adult. That is why in Russia, 1 out of 500-1000 newborns are born with a cleft lip and palate. In 75% of cases, facial clefts are an isolated fetal malformation. In this case, as a rule, in a family of healthy parents, a child with a cleft lip and palate appeared for the first time.

Why? The reasons are varied. It is usually impossible to establish the exact cause in each specific case. Known provoking factors are presented today in two groups:

1. Environmental factors.
Intrauterine infections. The most dangerous are cytomegalovirus infection, herpes type I and II, toxoplasmosis, rubella, influenza, viral hepatitis, chlamydia, syphilis, mycoplasmosis and other sexually transmitted infections, especially in the acute phase.
Chemical (aniline dyes, petroleum products, synthetic rubber, substances used in the production of plastics, viscose fibers) and physical agents (ionizing radiation, high temperature of industrial premises).
Medicines (folic acid antagonists, vitamin A, cortisone, barbiturates, cytostatics). Their teratogenic effect (causing malformations in the fetus) has been proven.
However, there are other drugs about which we have insufficient information. Alcohol, smoking and drugs. Future parents often do not think about their harmful effects on the embryo. However, it has been proven that the risk of having a child with a cleft lip and palate in a smoking mother is 25% higher than in a non-smoking mother.
Old age of parents, unfavorable socio-economic conditions.

2. Hereditary factors.
The risk of having a child with a cleft lip and palate among the population is quite low (~0.002%). However, if one of the parents or a previous child has this pathology, the risk of having a second baby with this disease is ~2-5%. The risk of recurrence of the pathology increases significantly (up to ~13-14%) if a cleft lip and palate is diagnosed in two family members (both parents or one parent and one child) and is ~20-50% in the rare case when this defect occurred in both parents of the baby and one of their children.
Particular attention should be paid to hereditary syndromes. Hereditary syndromes are diseases represented by a set of certain developmental defects transmitted from generation to generation. The number of syndromes that include cleft lip and palate is quite large - about 300. That is why, when a child is born with any type of this pathology, consultation with a geneticist is necessary. Parents have the right to receive reliable information about the prospects for the child’s development, the possible outcomes of subsequent pregnancies in a particular marriage and preventive measures.
Important: a combination of a number of signs - a transverse cleft of the face, parotid appendages and a malformation of the auricle, OR a congenital cleft of the upper lip and palate and congenital fistulas/cysts of the lower lip - indicates the presence of a hereditary syndrome in the baby. In this case, consultation with a geneticist is mandatory!

Prenatal diagnosis and prevention of rhinolalia. My recommendations for future parents

The most reliable information about the health status of a developing baby can be obtained by performing an ultrasound diagnostic examination. By the end of the 12th week of pregnancy, the formation of the baby’s face is almost completely completed, so this period (11-12th week of pregnancy) is the optimal time for performing an ultrasound.

Hereditary syndromic pathology in the fetus can be excluded by studying the chromosome set of the fetus as a result of chorionic villus biopsy (11-12th week) or studying amniotic fluid through amniocentesis (16th week of pregnancy). These manipulations are carried out according to the recommendations of an obstetrician-gynecologist and geneticist and have strict indications.

Note! The purpose of an ultrasound examination is to identify fetal malformations and features of the course of pregnancy. The 11-12th and 23-24th weeks of pregnancy are the optimal times for it. Today, this study can be performed in three-dimensional mode, which can significantly increase its effectiveness.

A general way to prevent the birth of a child with any developmental defects is family planning, which is based on a number of certain conditions:

The favorable age for a woman to give birth to a child is 18-35 years.

Treatment of all sexually transmitted infectious diseases before pregnancy - for both spouses.

Health improvement for spouses before pregnancy.

Avoiding bad habits before and during pregnancy.

Elimination or limitation of harmful production factors, reasonable use of medications during pregnancy.

Careful medical monitoring during pregnancy with the necessary diagnostic examination.

Taking vitamins with a high content of folic acid for 3 months before conception and during the first trimester of pregnancy.

Speech therapy training

Speech assessment

At the age of 2.5 - 3 years, a speech therapist who specializes in teaching children with congenital cleft palates can assess the state of the child’s speech. During a standard examination, the speech therapist determines: the type of physiological breathing, phonation exhalation, and the position of the tongue in the oral cavity. To assess the method and place of sound formation, speech therapy tests available for a child of this age are used, based on the pronunciation of certain words. It is their sound set (P, B, T, K, A, O, I, U) that allows us to determine the presence of compensatory grimaces and assess the severity of nasalism (hypernasalization) and nasal emission (air leakage). Thus, in the presence of speech pathology, its clear diagnosis can be carried out. The diagnosis was made: rhinophonia - indicates a speech disorder, characterized by an increase in the nasal resonance of the voice, rhinolalia - including, in addition to the above, incorrect sound formation.
In some cases, when older patients with speech disorders (previously operated on in other medical institutions and having experience in speech therapy training) come to the clinic, in addition to speech therapy examination, nasopharyngoscopy is performed. This is a method for objectively assessing the functional state of all structures of the velopharyngeal ring, which makes it possible to diagnose velopharyngeal insufficiency and determine the tactics for further treatment of the child.

Stages and methods of speech therapy training

Speech therapy training begins at the age of 2.5 - 3 - 3.5 years when the child is prepared and able to concentrate his attention during the lesson. The course of speech therapy training includes daily one- or two-time sessions with a highly qualified speech therapist in a clinic or hospital setting. Classes are carried out according to the methodology of speech therapy training.

At the initial stage, the speech therapist develops an individual approach to each child, during conversations he gets an idea of ​​the range of his interests, personality traits, establishes personal contact, indicates the need for speech therapy classes and confidence in their results. It is especially important that the child hears his own sound substitutions and perceives the need to reproduce them correctly. Articulation gymnastics is carried out simultaneously or sequentially with psychotherapeutic sessions. Its main goal is to activate and restore the correct functioning of all components of the articulatory apparatus (upper and lower jaws, tongue, neck muscles, larynx and vocal cords) and exclude compensatory mechanisms from the process of sound formation. An important section of articulatory gymnastics is the activation of the soft palate through active gymnastics. A special place in the classes is given to breathing exercises to obtain a long oral exhalation under the control of the movements of the diaphragm and abdominal press.

After adequate preparation of the articulatory apparatus, voice exercises begin: vocal gymnastics, singing songs, using games that develop the pitch of the voice. During speech therapy classes, work is done on the production of sounds and then their automation at the level of syllables-words-sentences-phrases-coherent speech, the strength and timbre of the voice develops.

Note: Optimal is the active participation of parents during speech therapy classes; this will allow, during the period between training courses, not to lose the skills acquired by the child, repeat a significant part of the exercises at home and control the child’s pronunciation.

The duration of one course of speech therapy training is at least 3 weeks, at the time of completion of which the effectiveness of training and the dynamics of speech restoration are assessed. The full training cycle includes 3-4 full courses, after which nasopharyngoscopy is performed. In the absence of positive dynamics during speech therapy training, in accordance with clinical data and the results of nasopharyngoscopy, the maxillofacial surgeon and speech therapist of the center decide on the possibility of continuing speech therapy training or on the need to eliminate velopharyngeal insufficiency surgically and determine the optimal method of surgical intervention.

Cautions for Parents

Note: A variety of teaching methods have been proposed for children with various speech disorders. However, do not try to use these techniques on your own! The best option for solving your baby’s problems is to consult a highly qualified specialist in this field, who will adequately assess the state of your child’s speech and determine when and how to work with your baby, which exercises should be done first, and which should not be used at all!

Early and correct determination of the tactics of speech therapy training for your child is at least half the success in the difficult process of restoring his speech.

The formation of phonetically correct speech in preschool children with a congenital cleft palate is aimed at solving several interrelated problems:
1) normalization of “oral exhalation,” i.e., the production of a long-lasting oral stream when pronouncing all speech sounds, except nasal ones;
2) development of correct articulation of all speech sounds;
3) elimination of the nasal tone of the voice;
4) developing the skills of differentiating sounds in order to prevent defects in sound analysis;
5) normalization of the prosodic aspect of speech;
6) automation of acquired skills in free speech communication.

Solving these specific problems is possible by taking into account the patterns of mastering correct pronunciation skills.
When correcting the sound aspect of speech, the acquisition of correct sound pronunciation skills goes through several stages.

The first stage - the stage of "pre-speech" exercises - includes the following types of work:
1) breathing exercises;
2) articulation gymnastics;
3) articulation of isolated sounds or quasi-articulation (since isolated pronunciation of sounds is atypical for speech activity);
4) syllabic exercises.
At this stage, motor skills are mainly trained on the basis of initial unconditioned reflex movements.

The second stage is the stage of differentiation of sounds, i.e., the education of phonemic representations based on motor (kinesthetic) images of speech sounds.

The third stage is the stage of integration, i.e. learning the positional changes of sounds in a coherent utterance.
The fourth stage is the stage of automation, that is, the transformation of correct pronunciation into normative, so familiar that it does not require special control on the part of the child himself and the speech therapist.

All stages of sound system acquisition are ensured by two categories of factors:
1) unconscious (through listening and reproduction);
2) conscious (through the assimilation of articulatory patterns and phonological characteristics of sounds).

The participation of these factors in the acquisition of the sound system varies depending on the age of the child and the stage of correction.

In preschool children, imitation plays a significant role, but elements of conscious assimilation must be present. This is due to the fact that the restructuring of a strong pathological skill of nasal pronunciation is impossible without activating all the child’s personal qualities, focusing on correcting the defect and without consciously assimilating new acoustic and motor stereotypes of speech sounds. Corrective tasks have a certain difference depending on whether plastic surgery has been performed to close cleft or not, although basic types of exercises are used both preoperatively and postoperatively.

Before the operation, the following tasks are solved:
1) release of facial muscles from compensatory movements;
2) preparation of the correct pronunciation of vowel sounds;
3) preparation of correct articulation of consonant sounds accessible to the child.

After surgery, correction tasks become much more complicated:
1) development of mobility of the soft palate;
2) elimination of incorrect arrangement of articulation organs when pronouncing sounds;
3) preparation of the pronunciation of all speech sounds without nasal connotation (with the exception of nasal sounds).

The following types of work are specific for the postoperative period:
a) massage of the soft palate;
b) gymnastics of the soft palate and the back wall of the pharynx;
c) articulation gymnastics;
d) voice exercises.

The main goal of these exercises is to:
- increase the strength and duration of the air stream exhaled through the mouth;
- improve the activity of articulatory muscles;
- develop control over the functioning of the velopharyngeal seal.

The main purpose of soft palate massage is to knead scar tissue.

Massage should be carried out before meals, in compliance with hygienic requirements. It is carried out as follows. Stroking movements are made along the suture line back and forth to the border of the hard and soft palate, as well as left and right along the border of the hard and soft palate. You can alternate stroking movements with intermittent pressing ones. Light pressure on the soft palate when pronouncing the sound “a” is also useful. The mouth should be wide open.

Gymnastics of the soft palate

1. Swallowing water or simulating swallowing movements. Children are offered to drink from a small glass or bottle. You can drip water from a pipette - a few drops at a time. Swallowing water in small portions causes the highest rise of the soft palate. A large number of successive swallowing movements lengthens the time during which the soft palate is in the upward position.

2. Yawning with your mouth open.

3. Gargling with warm water in small portions.

4. Coughing. This is a very useful exercise, since coughing causes a vigorous contraction of the muscles of the back of the throat. When coughing, a complete closure occurs between the nasal and oral cavities. By touching the larynx under the chin with your hand, the child can feel the palate rise.

5. The child is trained to cough voluntarily on one exhalation from 2-3 repetitions to more. During the exercise, the palate should remain closed with the back wall of the pharynx, and the air should be directed through the oral cavity. It is advisable for the child to cough with his tongue hanging out for the first time. Then coughing is introduced with arbitrary pauses, during which the child is required to maintain the closure of the palate with the back wall of the pharynx. By performing this exercise, children master the ability to actively lift the soft palate and direct the air stream through the mouth.

6. Clear, energetic, exaggerated pronunciation of vowel sounds in a high tone of voice. At the same time, the resonance in the oral cavity increases and the nasal tint decreases. First, the abrupt pronunciation of the vowel sounds “a”, “e” is trained, then “o”, “u” with exaggerated articulation.

7. Next, they gradually move on to clearly pronouncing the sound series “a”, “e”, “u”, “o” in different alternations. In this case, the articulatory pattern changes, but exaggerated oral exhalation remains. When this skill is strengthened, they move on to smoothly pronouncing sounds. For example: a, uh, o, y_______, a, y, o, uh_______.

8. Pauses between sounds increase to 1-3 s, but the elevation of the soft palate, in which the passage to the nasal cavity is closed, must be maintained.

9. The exercises described above give positive results in the preoperative period and after surgery. They should be carried out continuously over a long period of time. Systematic exercises in the preoperative period prepare the child for surgery and reduce the time required for subsequent correctional work.

10. To develop correct sonorous speech, it is necessary to work on correct breathing. It is known that rhinolalics have a very short, wasteful exhalation, in which the air comes out through the mouth and nasal passages. To develop the correct oral air stream, special exercises are performed in which inhalation and exhalation through the nose alternate with inhalation and exhalation through the mouth, for example: inhalation through the nose - exhalation through the mouth; inhale - exhale through the nose; inhale - exhale through the mouth.

With the systematic use of these exercises, the child begins to feel the difference in the direction of the air stream and learns to direct it correctly. This also helps to develop the correct kinesthetic sensations of movements of the soft palate.

It is very important to constantly monitor your child while performing these exercises, since at first it may be difficult for him to feel air leaking through the nasal passages.
Control techniques are different: a mirror, cotton wool, or strips of thin paper are placed at the nasal passages.

Blowing exercises also contribute to the development of the correct air stream. They need to be carried out in the form of a game, introducing elements of competition. Some of the toys are made by children themselves with the help of their parents. These are butterflies, pinwheels, flowers, panicles, made of paper or fabric. You can use strips of paper attached to wooden sticks, cotton balls on strings, light paper figures of acrobatics, etc. Such toys should have a specific purpose and be used only in classes on teaching correct speech.

Many parents make the mistake of buying balloons and accordions, inspired by the advice of a speech therapist, and giving them to their child for constant use. Children are not always able to inflate a balloon without preparatory exercises and often cannot play the harmonica because they do not have sufficient force to exhale through the mouth. Having failed, the child becomes disappointed in the toy and never returns to it.

Therefore, you need to start with easy, accessible exercises that give a clear effect. For example, children can blow out a candle first from a distance of 15-20 cm, then from a further distance. A child with weak oral exhalation may blow the cotton wool from his palm. If this fails, you can close his nostrils so that he feels the correct direction of the air stream. Then the nasal passages are gradually freed. This technique is often useful: light lumps of cotton wool (unpressed) are inserted into the nasal passages. If the air is mistakenly directed into the nose, they pop out and the child becomes convinced that his actions were wrong.

You can also blow on light plastic toys floating in water. A good exercise is to blow through a straw into a bottle of water. At the beginning of the lesson, the diameter of the tube should be 5-6 mm, at the end - 2-3 mm. As the water blows, it begins to bubble, which captivates small children. By looking at the “storm” in the water, you can easily estimate the strength of the exhalation and its duration. It is necessary to show the child that the exhalation should be smooth and long. It is good to mark the time of “seething” on an hourglass.

You can invite children to blow on balls or pencils lying on a smooth surface so that they roll. You can organize a game of soap bubbles. There are a lot of similar exercises. The more difficult of them is playing wind instruments. The speech therapist must keep in mind that breathing exercises quickly tire the child (they can cause dizziness), so they must be alternated with others.

At the same time, children are given a series of exercises, the main goal of which is to normalize speech motor skills.

It is known that children with rhinolalia develop pathological articulation features due to anatomical and physiological conditions.

Features of articulation are as follows:
1) high elevation of the tongue and its displacement deep into the oral cavity;
2) insufficient labial articulation;
3) excessive participation of the root of the tongue and larynx in the pronunciation of sounds.

Elimination of these articulation features is an important link in the correction of the defect. This is achieved through so-called articulatory gymnastics exercises that develop the lips, cheeks, and tongue.

Exercises for cheeks and lips:

1) inflating both cheeks at the same time;
2) puffing out the cheeks alternately;
3) retraction of the cheeks into the oral cavity between the teeth;
4) sucking movements - closed lips are pulled forward with the proboscis, then return to their normal position (jaws are closed);
5) grin: lips stretch strongly to the sides, exposing both rows of teeth up and down;
6) “proboscis” followed by a grin with clenched jaws;
7) grin with opening and closing of the mouth, closing of the lips;
8) stretching the lips with a wide funnel with the jaws open;
9) stretching the lips with a narrow funnel (imitation of whistling);
10) retraction of the lips into the mouth, pressing tightly against the teeth with the jaws wide open;
11) imitation of rinsing teeth (the air presses heavily on the lips);
12) lip vibration;
13) movement of the lips with the proboscis left and right;
14) rotational movements of the lips with the proboscis;
15) strong puffing of the cheeks (air is retained in the oral cavity by the lips).

Tongue exercises:

1) sticking out the tongue with a shovel;
2) sticking out the tongue with a sting;
3) protruding the flattened and pointed tongue alternately;
4) turning the strongly protruding tongue left and right;
5) raising and lowering the back of the tongue - the tip of the tongue rests on the lower gum, and the root either rises or falls;
6) suction of the back of the tongue to the palate, first with the jaws closed, and then with the jaws open;
7) the protruding wide tongue closes with the upper lip, and then retracts into the mouth, touching the back of the upper teeth and palate and bending the tip upward at the soft palate;
8) suction of the tongue between the teeth, so that the upper incisors “scrape” the back of the tongue;
9) circular licking of the lips with the tip of the tongue;
10) raising and lowering a wide protruding tongue to the upper and lower lips with the mouth open;
11) alternately bending the tongue with a sting to the nose and chin, to the upper and lower lips, to the upper and lower teeth, to the hard palate and the floor of the oral cavity;
12) touching the upper and lower incisors with the tip of the tongue with the mouth wide open;
13) hold the protruding tongue with a groove or boat;
14) hold the protruding tongue with a cup;
15) biting the lateral edges of the tongue with the teeth;
16) resting the lateral edges of the tongue on the upper lateral incisors, while grinning, raise and lower the tip of the tongue, touching the upper and lower gums;
17) with the same position of the tongue, repeatedly drum the tip of the tongue on the upper alveoli (t-t-t-t-t);
18) make movements one after another: tongue with a sting, cup, up, etc.

The listed exercises should not be given all in a row!

Each small lesson should consist of several elements:
- breathing exercises,
- articulation gymnastics,
- training in pronouncing sounds.

Working on sounds requires a lot of attention and effort.

1. Usually the production of sounds begins with the sound “a”. The tongue is at rest, the mouth is wide open. When making a sound, the tongue is slightly retracted, the lips are pushed forward; When making the sound “u”, the lips are pulled out with tension into a tube, and the tongue is pulled back even more. When making the sound “e,” the tongue rises slightly in the middle part, the mouth is half-open, and the lips are stretched. These sounds are easy to pronounce by imitation; the main task in their production is to eliminate the nasal connotation. Initially, sounds are practiced in abrupt, isolated pronunciation with a gradual increase in the number of repetitions per exhalation, for example:
a o u e
a a o o u u e e
a a a o o o u u e e e

With each pronouncement, control over the direction of the air stream is necessary. To do this, the child holds a mirror or light cotton wool near the wings of the nose. Then the child is trained in repeating vowels with pauses, during which he learns to keep the soft palate in a raised position (he needs to be shown the correct position of the soft palate in front of a mirror). Pauses are gradually increased to 2-3 s. Then you can move on to smooth pronunciation.

2. The production of consonant sounds begins with the sounds “f” and “p”. When pronouncing the sound "f", the tongue lies calmly at the bottom of the mouth. The upper teeth lightly bite the lower lip. A strong oral exhalation breaks this stop and forms a jerky “f” sound. Air leaks are checked using a mirror or cotton wool.

Exercises for setting and consolidating sounds should be carried out in large quantities and in a variety of combinations. A good technique that facilitates the introduction of sounds correctly pronounced in an isolated position into independent speech is singing. During singing, the closing of the soft palate and the back wall of the pharynx occurs reflexively, and it is easier for the child to concentrate on articulating sounds.

Your doubts

From the moment your baby is born, you should absolutely know that his fate is in your own hands almost equally as in ours. By presenting information about the rehabilitation system for a child with a cleft lip and palate, I wanted to convince you of the reality of achieving good treatment results. Your child may have an attractive appearance, normal speech, and beautiful teeth and bite.

I advise parents

When consulting a child with a congenital cleft lip and palate in a particular medical institution, you should receive reasoned answers to a number of questions:
- What types of surgical intervention will your child undergo and at what age?
- What is the reason for the choice of this surgical treatment tactics?
- How many children with this pathology are operated on in this medical institution annually?
- How often are postoperative complications recorded (dehiscence of postoperative sutures, formation of palate defects)?
- What are the cosmetic results of treatment for children, presented in the form of photographs (immediate and distant) and how are deformities of the upper lip and nose eliminated in the future?
- What are the functional results of treatment: how often does typical speech pathology develop - rhinolalia and deformities of the upper jaw/occlusion?
- Is there a comprehensive rehabilitation system in this institution (speech therapist, orthodontist, ENT doctor, pediatrician, neurologist, pediatric anesthesiologist)? How long and how will it be carried out?

Literature

- Ermakova I.I. Speech correction for rhinolalia in children and adolescents. - M., 1984
- Ippolitova A. G. Open rhinolalia. - M., 1983
- Speech disorders in preschool children. Comp. R. A. Belova-David, B. M. Grinshpun. - M., 1969
- Chirkina G.V. Children with articulatory disorders. - M, 1969
- Speech therapy. Textbook for pedagogical institutes in the specialty “Defectology”, ed. Volkova L. S. - M: Education, 1989
- Soboleva E. A. Rhinolalia: general information about rhinolalia; classification of congenital cleft lip and palate; causes, mechanisms, forms of rhinolalia, etc. - M: AST Astrel, 2006

Rhinolalia is a speech disorder manifested in distorted pronunciation of sounds associated with defects in the structure and functioning of the speech organs.

Due to the incorrect structure, at the moment of sound formation, the air stream flows in the wrong direction, which leads to distortion of the pronounced sound. This function is provided by the muscles of the palate and the walls of the pharynx, which open or close the passage into the nasal cavity.

At the same time, the child’s voice may acquire a nasal quality - it seems as if he is speaking through the nose, or, if the air flows only through the mouth, the nasal sounds [m], [n] and vowels are distorted in speech - in this case they speak of a lack of nasal sound.

The consequence of rhinolalia is not only the distortion of sounds. Written speech is impaired, it is difficult for the child to master vocabulary and grammar, and psychological problems appear.

Types of rhinolalia

There is a common classification of rhinolalia into two types based on the reasons for its appearance: organic - when there is a violation of the structure of the speech apparatus, and functional - a violation of the functioning of the speech apparatus.

When rhinolalia occurs, disturbances can be observed in the nasal or oral cavity. Therefore, there are three types of rhinolalia: open, closed and mixed.

The open form is observed when the space between the oral and nasal cavities is constantly open, when air constantly flows through the nose. This results in all spoken sounds having a nasal connotation.

The open form is most common and has three subtypes:

1. Organic open rhinolalia occurs due to existing cleft palate, absence or bifurcation of a small uvula, shortened soft palate.
2. Organic open rhinolalia manifests itself due to the presence of paresis (incomplete paralysis) and paralysis of the soft palate.
3. Functional open rhinolalia.

Closed rhinolalia occurs when there is an obstruction that blocks the space for air flow through the nose. Therefore, the pronunciation of nasal sounds [m], [n], [m], [n] and vowels suffers.

Mixed rhinolalia is a combination of the two types listed above.

If a child is diagnosed with rhinolalia, regardless of the form of manifestation of the disease, parents should immediately seek help from specialists. The most favorable treatment prognosis is given with a functional form. Closed rhinolalia requires more time and effort, which can lead to getting rid of existing speech impediments.

Sometimes they talk about rhinophony. It refers to the excess nasal tone of the voice, which occurs when there is insufficient differentiation between the oral and nasal cavities during the pronunciation of sounds.

Causes

The causes of rhinolalia can be congenital or acquired. Congenital causes of rhinolalia apply to children who have:

• clefts (non-fusion) of the soft and hard palate (“cleft lip”, “cleft palate” and others);
• short soft palate;
• muscle formation above the root of the tongue;
• paralysis or paresis (weakening) of the soft palate, manifested in the difficulty of raising and closing the palate with the back wall of the pharynx;
• flaccidity of articulatory muscles, which occurs in frequently ill children.

Clefts can be through, which involve not only the palate, but also the upper lip. They are one-sided and two-sided. Non-full nonunions are complete, which means they reach the incisor area without affecting the lips. Incomplete clefts are characterized by the fact that non-union occurs in a small area, for example, only in the area of ​​the soft palate.

The acquired form of rhinolalia occurs with mechanical damage to the same areas and the face. In addition, the disease can develop due to tumor growths of the vagus and glossopharyngeal nerves.

For example, a functional open one appears in a person after surgery - removal of adenoids, various tumors and curvatures in the nasopharynx, with curvature of the nasal septum and the formation of polyps in the nasal cavity. In this case, the air practically does not enter the nose or enters there in insufficient quantities.

Closed rhinolalia can occur with adenoids, increased function of the muscles of the soft palate, which leads to isolation of the nasal and oral cavities from each other.

Acquired rhinolalia in a child can appear when a woman in the early stages of pregnancy suffered from viral diseases (influenza, rubella, mumps, dysentery, toxoplasmosis), had endocrine disorders, took certain medications, alcohol and smoked during pregnancy. Some researchers note the hereditary nature of such anomalies (my grandparents had clefts).

In the video below, the doctor talks in great detail about the causes and treatment features of rhinolalia:

Symptoms of rhinolalia

The symptoms of the disease depend on its form.

With open rhinolalia, the child’s respiratory functions are impaired. Liquid food entering the cleft palate flows out through the nose, which significantly complicates the feeding process. In addition, the inhaled street air does not warm up to the required temperature, so children suffer from diseases such as otitis media, pneumonia, and bronchitis.

Due to open rhinolalia, children experience different types of developmental delays. For example, such a child begins to speak his first words late - usually after two years. Also, children have a pronounced nasal voice, making it difficult to pronounce sounds. Due to the fact that the root of the tongue is active during conversation, and not the tip, children pronounce most sounds deafly.

Closed rhinolalia is accompanied by rather unpleasant symptoms - mucus, formed in the upper respiratory tract, constantly flows down the back wall of the throat. Colds in this case rarely occur without snot, and the child has a chronic runny nose. Speech disturbances are also present. For example, a child pronounces the sound [b], but comes out [m].

According to many experts, speech defects lead to the development of asthenic syndrome and to some extent affect the child’s psyche; such children become withdrawn and have difficulty making contact.

• Such children are characterized by incorrect pronunciation of most vowels and consonants, their speech is slurred and inexpressive;
• Their voice is quiet, the timbre is dull and unnatural;
• If a child tries to carefully pronounce sounds, he begins to involuntarily grimace;
• At primary school age, such children always have problems with writing and reading.

Diagnosis of the disorder

As you can see, the symptoms of rhinolalia strongly overlap with many known diseases. Making a diagnosis is not as difficult as determining the type of disorder. To accurately diagnose the species, you need to consult a specialist. Examination of patients is carried out by various specialists in the field of medicine:

• maxillofacial surgeon;
• otolaryngologist;
• neurologist;
• orthodontist;
• speech therapist;
• orthopedist;
• psychologist.

Research methods depend on the form of rhinolalia. When identifying different types of rhinolalia, special attention is paid to x-rays of the nasopharynx.

The sooner a child is diagnosed with rhinolalia, the sooner treatment can begin. Correcting a neglected form is much more difficult.

During an examination by a speech therapist, a specialist assesses the structure of the articulatory apparatus, the pronunciation of sounds, the understanding and use of words, and the presence of agrammatisms in speech.

Rhinolalia (its open form) is diagnosed based on Gutzman's research, when when pronouncing the vowel sounds [a] and [i], the child alternately begins to close or open the nasal passages. In school-age children, the specialist also examines the processes of writing and reading, which clearly indicate the presence and level of the problem.

Correction methods

Treatment of rhinolalia includes a whole range of measures aimed at maximizing the elimination of speech defects.

If a child is diagnosed with congenital rhinolalia, then correction of the disorder begins with the elimination of defects of anatomical origin. From birth, such children begin to be fed using a tube, which is selected taking into account the characteristics of the cleft.

A special prosthesis, an obturator, is also made to close the nonunion. This prosthesis facilitates the processes of eating, breathing and speaking.

Late use of an obturator is less effective, since the child begins to develop incorrect tongue position with age. The obturator changes as the child grows and is used until the moment of surgical intervention, which, unfortunately, cannot be done without.

Maxillofacial disorders are subject to surgical intervention. Nasality with open rhinolalia is treated both before and after surgery.

As a rule, cleft lip surgery is performed at 2–3 months of a child’s life. Operations on the palate are carried out after two years, if the child has lost all his teeth. In weakened children, surgery is postponed to a later date or carried out in several stages.

Surgeries allow you to restore the integrity of the speech apparatus and the proper functioning of the palate.

Prevention and exercise

After the child has undergone all operations to eliminate visible defects on the face and problem areas of the palate, the treatment enters the second phase.

At the postoperative stage, specialists from various fields consolidate the achieved results and continue corrective work. Postoperative treatment includes:

• physiotherapy;
• orthodontics;
• psychotherapy;
• breathing exercises;
• speech therapy massage.

For example, a speech therapist and a speech pathologist carry out work aimed at the correct production of sounds, the formation of phonemic hearing, the expansion of vocabulary, the development of grammatical norms, attention, thinking, and memory.

The pronunciation of problematic sounds, mouth and nasal breathing is also performed. Efforts are aimed at getting rid of the nasal tone in the sound of the voice and forming a lexical-grammatical structure and phrasal speech.

In the video below you can see the work of a speech therapist and vocal teacher with a child who was diagnosed with rhinolalia:

Speech therapy massage is aimed at softening postoperative scars.

The exercises recommended by doctors should be carried out with the child independently and regularly, since skipping them can return his speech to the previous level of development. There are several generally accepted exercises for the tongue-cheek-lip area that are suitable for all types of rhinolalia:

• “Boa constrictor” - the child folds his tongue into a tube and then slowly sticks it out of his mouth;
• “Clock” - the mouth opens wide, and the tongue repeats the movement of the clock hands, moving across the lips in a circle;
• “Metronome” - the tongue moves from one corner of the mouth to the other to count, with the mouth wide open;
• “Liana” - you need to stick your tongue out of your mouth, trying to reach your chin;
• “Needle” - with your mouth closed, you need to touch the inner surfaces of your cheeks with your tongue one by one.

With proper treatment, constant interaction with a speech therapist and careful implementation of all recommendations, you can achieve good results in which the speech of a child with rhinolalia will be practically no different from the speech of his peers.

Anna Korobko
Consultation with a speech therapist “Nasal tone of voice and methods for its elimination in preschool children”

Doctors call it nasal syndrome vote and is classified as dysphonia - an incomplete disorder vote.

Air currents change their normal course and speech becomes slurred, sounds are distorted. With rhinolalia, the sound of some sounds: "m" starts to sound like "b", and the sound "n" becomes like "d".

A small red tongue, or in Latin - uvula, regulates air flow. You always see it when you open your mouth wide and make a sound "A". When the tongue hangs down, it is in a relaxed state and air flows freely into the nasal cavity.

This is how they arise « nasal sounds» . When the tongue is tense, it blocks nasal passage and air goes through the mouth. Under normal conditions voice without nasality, the uvula muscle tenses when pronouncing almost all sounds except "m" And "n".

Rhinolalia happens:

Closed;

Open;

Mixed.

Closed rhinolalia is the result of poor patency in nasal cavities and is called rhinophony or palatophony. Rhinolalia is called open rhinolalia, in which sounds pass not only through the mouth, but also through nasal passage.

In the mixed form, there is nasal obstruction and a weakened velopharyngeal seal.

The most common causes of rhinolalia are:

Poor mobility of the soft palate;

Incorrect form of the tongue during pronunciation;

Existing defects of the hard or soft palate.

Diseases that are accompanied rhinolalia:

Tumor nasopharynx;

Hypertrophy and edema turbinates;

Pathological increase nasopharyngeal tonsils(adenoids);

The appearance of mucus in nasal cavity(runny nose);

Congenital curvature nasal septum;

Habit of mispronouncing words due to hearing impairment (deafness);

Tertiary syphilis;

Various injuries.

Nasality can be diagnosed independently. To do this, close your mouth tightly and try to hum a melody. If you feel puffs of air coming from your lips, then rhinolalia is not a threat to you. Another way to check is to say while holding nose all the letters of the alphabet, except "m" And "n".

If you notice the first signs of nasality, consult a doctor immediately. Depending on the symptoms and external examination, he will prescribe the necessary comprehensive examination and tests. Upon examination speech therapist The structure and operation of the speech apparatus is studied, and the quality of breathing during conversation is checked.

For open rhinolalia it is used Gutzmann method, the essence of which is the pronunciation of vowel sounds "A" And "And" with alternate closing and opening nasal passages. Then the pronunciation of all other vowel sounds is examined.

Determining the cause of nasality depends on the following: factors:

Duration of the disease;

The nature of sound defects;

Past and chronic diseases.

It is often very difficult to identify the true cause of nasality; here it is necessary consult with a range of specialists: surgeon, phoniologist, endocrinologist, neurologist and speech therapist.

The most common type of examination is radiography nasopharynx, pharyngoscopy and electromyography.

Treatment for rhinolalia depends on the disease that causes it.

If the nasal tone is caused by a runny nose and nasal congestion, then this will cure otrinolaryngologist. If the cause is more serious, major surgery may be required. intervention: elimination anatomical defect, installation of a pharyngeal arbitrator, surgical correction of deformity nasopharynx. If necessary, polyps, adenoids and tumors are removed. After the operation, it is necessary to massage the scars of the palate and monitor the correct velopharyngeal closure.

Additionally, physiotherapy, psychotherapy and long-term treatment are used speech therapist. The surgeon is only eliminates the cause of nasality, but the correct pronunciation of sounds can only be taught speech therapist.

Classes with speech therapist for the treatment of nasality include articulation and breathing exercises, speech therapy massage of the soft and hard palate.

EXERCISES FOR ELIMINATING THE NASAL TONE OF THE VOICE

1. Imitation of chewing.

2. Yawning.

3. Coughing on one exhalation.

4. Inducing contraction of the root of the tongue, the posterior wall of the pharynx, and the soft palate with a spatula (end of spoon).

5. Drink water in small sips (or simulated swallowing).

6. Gargling with portions of warm water.

7. Spit while holding nose.

8. Blowing on cotton wool, a strip of paper.

9. Pronouncing vowels A E on a solid attack vote.

10. Singing together and stretching the vowels A O U in different keys (like a bear, fox, mouse):

One vowel at a time

Two vowels each

Combinations of three vowels

11. Overcoming exercises resistance:

We place our hand on the child's forehead. The child lowers head down overcoming resistance.

We hold our hand on the back of the child's head. The child throws back head back overcoming resistance.

We hold our hand under the child's jaw. The child opens his mouth against resistance.

The child sticks out his tongue and tries to pull it in, while the adult holds the child's tongue out of the mouth.

Publications on the topic:

Summary of the lesson “Voice power and speech breathing” for children of senior preschool age Goal: To develop the power of voice and speech breathing. Objectives: Activate the lip muscles; Work on the development of children's speech; Stay creative.

Consultation for parents. “Bad habits in children. Prevention and ways to eliminate them" Bad habits in children: prevention and methods of elimination A habit is an established way of behavior in certain situations. Habit.

Consultation “Organization and study of traffic rules with preschool children. Forms and methods of work" Dear Colleagues! I would like to present you with a consultation on the topic “Organization and study of traffic rules with preschool children. Forms and methods.

Methods and techniques for teaching preschool children Visual methods and teaching techniques Methods 1- Observation - the ability to peer into the phenomena of the surrounding world, notice the changes taking place.