Rhinolalia is a condition characterized by defects in the structure of the nasopharyngeal organs, as a result of which there is a distortion of the pronunciation of speech sounds, namely, a disorder of articulation and sound formation of varying degrees of severity. In the vernacular, this condition is called “nasal”, that is, all sounds acquire a characteristic nasal sound. Often the condition is complicated by underdevelopment — both the lexical side of speech and its grammatical component. Another common complication is various psychological disorders, as well as difficult socialization of patients with rhinolalia.
The content of the article:
Classification of rhinolalia and its etiological causes
Symptoms and clinical manifestations of rhinolalia
Differential diagnosis of rhinolalia
Measures for the correction of rhinolalia
Prevention and medical prognosis of rhinolalia
Rhinolalia
According to statistics, children suffer from this disease much more often than older patients. In addition to various deviations from the norm of acoustic parameters, patients have various deviations of aerodynamic conditions in speech formation. Since special conditions arise, the speech apparatus is forced to adapt to them, as a result of which variable pronunciation distortions arise.
Classification of rhinolalia and its etiological causes
According to the nature of pathological disorders of palatopharyngeal closure, the following forms of pathology can be distinguished:
closed rhinolalia, which occurs due to a reduced nasal resonance due to a number of physiological reasons;
open rhinolalia, which is characterized by the free simultaneous passage of an air jet through the nose and mouth.
Among the etiological causes of this pathological condition, the main organic and functional disorders can be distinguished. So the most common causes of the closed form of rhinolalia are functional disorders of palatopharyngeal closure or organic disorders of the nasal space.
The organic causes of the occurrence of closed rhinolalia include various diseases or changes that lead to poor nasal patency and difficult nasal breathing. Among such reasons , the following can be distinguished:
chronic hypertrophy of the posterior inferior shells of the nasal mucosa;
adenoid growths;
nasal polyps, etc.
Functional closed rhinolalia is often noted in children and is observed with normal nasal patency.
The causes of open rhinolalia can also be organic or functional. Organic causes can be divided into congenital and acquired. Congenital open rhinolalia of organic origin in most clinical cases occurs due to cleavage of the soft or hard palate, which is congenital in nature. The acquired form of open rhinolalia occurs due to paralysis of the soft palate or when, for various reasons, an opening occurs between the oral and nasal cavities.
Functional open rhinolalia is observed in children with sluggish articulation. In addition, it often develops in children with hysteria, sometimes it has the character not so much of an independent defect as of an imitative defect.
The organic causes of open rhinolalia include congenital non-fusion of the face and palate, namely:
cleft upper lip;
cleft of the upper lip and alveolar process;
cleft of the soft or hard palate;
submucosal cleft palate, etc.
The above pathologies occur even in the prenatal period and are the result of the negative impact on the fetus of various external and internal factors. Such factors include taking various medications (usually hormonal), infectious diseases of the mother during pregnancy, mental shocks of the pregnant woman, alcohol, smoking and a combination of several factors at the same time.
In this case, the severity of rhinolalia will depend on the size and shape of the birth defect.
Symptoms and clinical manifestations of rhinolalia
With open organic rhinolalia, caused by various congenital anomalies, the baby suffers from vital functions such as breathing and nutrition from the very first hours of his life. As a rule, the sucking reflex in such children is preserved, but feeding becomes difficult, since the child does not take the breast, and when artificially fed, the mixture flows out through the nose, as a result of which the newborn does not receive the nutrients he needs and is significantly behind in development. Since nasal breathing is impaired, such children often suffer from chronic inflammatory diseases of the respiratory system, which causes the development of rhinolalia. Among other things, congenital palatine clefts are accompanied by various malocclusion disorders, which only contributes to problems with speech. This is often due to the fact that in such children, the preservation of intelligence varies from the norm to very significant developmental delays.
The development of speech — both in the pre-linguistic period and in the period of speech development — proceeds abnormally. There is no characteristic babble. Or it’s very quiet, barely discernible. The child begins to pronounce the first words at the age of more than 2 years, his speech is illegible and indistinct, it is difficult for others to understand.
With open organic rhinolalia, all sounds have a pronounced nasal tinge, the child has impaired articulation and pronunciation of sounds. All consonants are more like the sound of “x”, they cannot be distinguished from each other. The voice is quiet and deaf. Trying to pronounce sounds correctly, the child uses a facial apparatus or strains the muscles of the lips, wings of the nose or tongue, which only aggravates the situation.
Problems with speech are also reflected in auditory perception and the ability to phonetically analyze reversed speech. In addition, due to the limited communication with peers, such children have a rather poor vocabulary and have problems with writing. The combination of such changes can lead to the fact that in a child with open organic rhinolalia, speech therapists are forced to state a general underdevelopment of speech. At the age when the child begins to realize his defect, various mental disorders and related layers join the changes on the part of the speech apparatus: isolation, irritability, shyness, etc.
In patients with open functional rhinolalia, the pronunciation of vowel sounds suffers to a greater extent. Such a child pronounces consonants well enough, which is associated with a palatopharyngeal closure that is quite sufficient for this. With closed functional rhinolalia, as a rule, only the timbre of the voice suffers, which acquires an unnatural, dull, “dead” shade.
Closed organic rhinolalia is characterized by distortion of consonant sounds. The child often changes the sound of “m” to the sound of “b”, “n” to “d”, etc. With this form of pathology, nasal breathing is difficult, and therefore the child constantly breathes through the mouth, which leads to the fact that such children are susceptible to various inflammatory diseases of the upper respiratory tract, and also often suffer from chronic forms of bronchitis and pneumonia, which have a recurrent course.
Differential diagnosis of rhinolalia
Diagnosis of rhinolalia, as a rule, is not difficult for specialists, but certain problems arise when determining the type of rhinolalia. In order for such a differential diagnosis to become effective, the patient needs to be examined by the following narrow specialists:
otolaryngologist;
defectologist;
speech therapist;
neurologist;
orthodontist;
phoniatra;
pediatrician, etc.
Examination by specialized specialists allows you to identify the etiology of the disease, to characterize the nature of pathological changes as accurately as possible and the severity of all symptoms. The following instrumental diagnostic methods are important:
radiography of the nasopharynx;
rhinoscopy;
electromyography;
pharyngoscopy, etc.
These techniques allow you to visualize the nature of pathological changes and their severity in each individual patient.
Of course, the most significant is the examination by a speech therapist, who, using a number of progressive techniques, will be able to evaluate the following parameters:
the structure of the articulatory apparatus;
his mobility;
voice disorders;
parameters of physiological and phonation respiration, etc.
To diagnose open rhinolalia, Gutzman’s technique is used, which is based on the fact that the patient pronounces the sounds “a” and “i” alternately, and the doctor opens and closes the nasal passages. In the presence of pathological changes, the vibration of the wings of the nose is very clearly felt, and when the nasal passages are clamped, the sounds are significantly muffled. Thus, it is possible to diagnose the open form of rhinolalia.
Measures for the correction of rhinolalia
Rhinolalia correction should have a comprehensive approach. As a rule, congenital anomalies of the facial skull structure are subject to surgical correction. Congenital defects are eliminated with the help of plastic surgery. Such operations are aimed at restoring the anatomical structure of the nasal and pharyngeal organs, as well as eliminating cosmetic defects. In addition, some patients need surgical interventions for the removal of nasal polyps, adenoids and other pathological formations that interfere with normal nasal breathing. It also requires correction of bite and deformities of the upper jaw by an orthodontist. In addition, general restorative procedures and rehabilitation of ENT organs are necessary, which is necessary to prevent hearing impairment.
Speech therapy correction aimed at eliminating rhinolalia includes:
formation of the correct operation of the articulation apparatus;
normalization of breathing — both in the physiological and in the speech aspect;
pronunciation correction;
solving problems with phonetic perception, if any;
elimination of nasal voice timbre;
prevention of dysgraphy;
consolidation of free communication skills;
work on increasing vocabulary;
control of general speech development, etc.
The combination of these measures allows you to socialize the child and restore, to some extent, speech functions. Among other things, a child suffering from rhinolalia needs the help of psychologists.
Prevention and medical prognosis of rhinolalia
Systematic and sufficiently long-term correction allows us to assume positive dynamics during the course of the disease. At the same time, the material intended for correction must correspond to the age of the child, be accessible and understandable for perception.
The effectiveness of treatment depends on the following factors:
how timely is the therapy started;
the presence of concomitant pathologies;
degrees of compensatory capabilities;
features of the child’s personality and the preservation of intelligence;
the quality of the performed surgical interventions, etc.
Of decisive importance is the speech environment and the willingness of parents to help the child in all available ways. The results of the work can be evaluated by the degree of normalization of speech function and by the absence of nasal speaking.
Functional rhinolalia has a very favorable medical prognosis. Prevention consists in avoiding factors that can provoke the presence of birth defects in a child even in the prenatal period. If such defects of the speech apparatus still occur, then their timely correction is necessary.
Systematic fulfillment of all doctors’ prescriptions and speech therapy classes allow us to count on good treatment results.
