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Nasal Emissions Post Tonsillectomy

Rosalie Unterman ., Ph.D,CCC

August 8, 2005

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Question

I'm a school speech pathologist looking for suggestions on remediating articulation errors that are produced with nasal emission. The errors produced with nasal emission are s, z, sh, ch, j. The student's oral mechanism appears adequate for correct speech

Answer

Nasal emission upon production of s, z, ch, ch and j may be indicative of velopharyngeal insufficiency, or other conditions such as submucous cleft palate, allowing excessive air and/or resonance in the nasopharyngeal area. Since the child you are working with had a tonsillectomy/adenoidectomy 2 years ago, the possibility exists that the adenoids, and tonsils, had been creating sufficient mass to allow a somewhat short soft palate to establish contact with the pharyngeal wall, thus directing the airflow to the oral cavity (with articulator shaping of the appropriate sounds). Removal of this tissue may have removed the extra mass needed for full closure. This cannot be determined by a routine examination of the oral peripheral mechanism, and it may require a referral to a Craniofacial specialist, possibly for video nasoendoscopy, to assess potential structural issues. If, in fact, there is structural insufficiency, medical treatment may be called for.

Many instances of nasal emission, however, are due to articulatory errors. The child is not discriminating between oral and nasal resonance and may be directing the airflow inappropriately. A great deal of auditory training is needed to differentiate between correct oral production and nasality. Using the Nasometer or See Scape, or even a modified tube placed near the nostrils and leading to the ear may improve discrimination and self-evaluative skills. Specific articulatory techniques may include using straws to generate a "groove" in the tongue, thereby directing the airflow. Occlusion of the nostrils will increase the sensation of oral vs. nasal airflow. An additional technique is to begin with production of the "t", and slowly lower the tongue slightly to generate a "ts" sound. Gradually control can be increased to produce the "s" alone. This technique can be modified for the other phonemes listed.

This particular child may respond well to articulation therapy, but it is recommended that an ENT be consulted to rule out structural issues.

Dr. Rosalie Unterman has been a Speech-Language Pathologist for over 30 years. She is an Associate Professor and the Clinical Director at the Touro College Graduate Program in Speech-Language Pathology in Brooklyn, New York.


Rosalie Unterman ., Ph.D,CCC


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