Open rhinolalia. Rhinolalia. Definition. Background: Types of clefts with open organic rhinolalia

For welding 16.02.2024

For welding

Test on rhinolalia

Topic: “Types of rhinolalia and their features.”

Plan:

Concept of rhinolalia
types of rhinolalia

open

functional
organic
types of clefts
developmental features of children with clefts

closed
mixed

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 Latin nasus - 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 experiences separation of the nasal cavity from

oral. 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

There are various forms of rhinolalia.

^ OPEN RHINOLALIA

With the open form of rhinolalia, oral sounds become nasal. The timbre of the vowels and, ы, у, 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 formed in the oral cavity due to incomplete closure of the nasal cavity.

L and r sound rhinophonically. 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.

To define an open For rhinolalia, there are different methods of functional research.

The simplest one is the so-called Gutzmann test. The child is forced

alternately repeat the vowels a and i, while either closing or opening the nasal passages. With the open form, there is a significant difference in the sound of these vowels. With the nose pinched, sounds, especially and, are muffled and at the same time the speech therapist’s fingers feel a strong vibration on the wings of the nose.

Can be used 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.

^ TYPES OF OPEN RHINOLALIA:

1. 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.

2. Organic open rhinolalia can be acquired or congenital.

A) Acquired open rhinolalia is formed with perforation of the hard and soft palate, with scar changes, paresis and paralysis of the soft palate.

The cause may be damage to the glossopharyngeal and vagus nerves, injuries, tumors, etc.

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

(The degree of shortening of the soft palate can be established by direct measurement of the distances between the incisal edge of the upper central incisors and the posterior wall of the pharynx and between the incisal edge of the same incisors and the posterior edge of the soft palate. There is no need to use special devices or, as some authors recommend, a curved relief with wire. You can use an ordinary spatula or a graduated ruler. By comparing segments of a straight line (chord) instead of segments of the corresponding arcs, it is unlikely to make a big mistake. The difference between the obtained values will indicate the degree of insufficiency (shortening) of the soft palate, which depends on the shape of the cleft, degree of underdevelopment of the palatal plates.

If you press the soft palate backwards and upwards with a spatula, stimulating its movements during phonation and swallowing, you can make sure that the posterior edge of the soft palate does not reach the posterior wall of the pharynx, as is normal. This can also be verified by observing the reflex movements of the soft palate when the instrument irritates the mucous membrane of the root of the tongue or the back wall of the pharynx.)

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 otorhinolaryngologists, psychoneurologists and speech therapists. Clefts are among the most common and severe malformations.

The frequency of birth of children with clefts varies among different nations, in different countries and even in different regions of each country, 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 pathology 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:

Biological factors (influenza, mumps, rubella measles, toxoplasmosis, etc.);

Chemical factors (pesticides, acids, etc.); - endocrine diseases of the mother,

Mental trauma and occupational hazards.

There is information about the effects of alcohol and smoking.

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

The presence of a congenital cleft lip or palate is a common feature of many 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 allocated from parents microsigns of cleft lip and palate:

A groove on the palate or uvula of the soft palate,

Cleft palate,

Asymmetrical tip of the nose, asymmetrical arrangement of the bases of the wings of the nose.

Types of cleft palates.

Congenital cleft palates can be of various shapes and lengths. The mildest degree of cleft defect has the appearance of indentation of the mucosa; sometimes only the muscles and bone can be separated while the mucosa is preserved.

Cleft palates are often a continuation of the lateral cleft lip and alveolar process, and are located between the frontal and maxillary processes.

A cleft palate can spread along the entire length of the palate or occupy individual parts of it, so it is customary to distinguish between incomplete and complete cleft palates.

^ Incomplete clefts called non-through- they can involve only the uvula or uvula and the soft palate or partially the hard palate and end behind the incisive foramen.

Full or through crevices They are called those in which the gap from the hard palate extends to the alveolar process and upper lip.

The cleft palate from the incisive foramen to the posterior nasal spine can be unilateral or bilateral.

With a unilateral cleft, the vomer on one side is connected to the palatine process, on the other there is a gap through which the nasal and oral cavities communicate. If the left half of the palatine plate is connected to the vomer, then there will be a right-sided cleft; if the right half, then there will be a left-sided one. With a bilateral cleft, both nasal cavities communicate with the oral cavity, and the lower edge of the vomer remains free in the middle of the cleft and is located at the level of the unfused palatine plates, less often - above them. Clefts of the uvula and soft palate are always located in the midline.

^ According to the morphological characteristics of the clefts, they are divided into:

Congenital clefts of the upper lip:

1. congenital hidden cleft of the upper lip (one- or two-sided);

2.congenital incomplete cleft of the upper lip;

a) without deformation of the skin-cartilaginous part of the nose (one- or two-sided);

b) with deformation of the skin-cartilaginous part of the nose (one- or two-sided);

3. congenital complete cleft of the upper lip (unilateral or bilateral).

^ Congenital cleft palate:

1. cleft soft palate:

a) hidden (submucosal);

The most difficult to detect is a submucosal (submucosal), or hidden, cleft.

To identify it, you should pay attention to the back surface of the palate, which, when exaggeratedly pronouncing the sound “a” with the mouth wide open, is slightly retracted in the shape of a small triangle. The mucous membrane in this area is thinned and has a paler color.

b) incomplete;

c) full

2. clefts of the soft and hard palate:

Hidden;

Incomplete;

3. complete cleft of the alveolar process, hard and soft palate:

one-sided;

bilateral

4. complete cleft of the alveolar process and the anterior part of the hard palate:

a) incomplete (one- or two-sided)

b) full (one- or two-sided)

Among newborns with cleft lip and palate, boys always predominate (0.79 boys and 0.59 girls per 1000 newborns). Palate disorders can be combined with cleft lips. Partial clefts occur several times more often than complete ones, and one-sided ones more often than two-sided ones (according to M.D. Dubov). Clefts are usually combined with various dentofacial deformities. The duration and volume of treatment measures depend on the severity of the congenital pathology, since long-term coordinated treatment by a surgeon and an orthodontist is required. Surgical treatment of children with nonunion of the upper lip and palate is carried out in several stages. Non-union of the lip, depending on the form of the defect and the state of the child’s body, is operated on within a period of 10 days to one year. Surgeries on the palate are usually performed up to 5 years.

Work to eliminate residual defects of the upper lip, nose and palate deformities is carried out between the ages of 7 and 14 years.

Surgical treatment alone is not enough for the complete rehabilitation of the majority (about 75%) of children with cleft lip and palate. These patients need help from a number of specialists (dentists, orthodontists, orthopedists, otorhinolaryngologists, speech therapists, neurologists, etc.). They are provided with assistance within the framework of a system of dispensary observation and treatment.

^ Features of the development of children with clefts

According to condition 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 lies in the dysfunction of 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 onlysound side of speech, various structural components of speech suffer to varying degrees.

In oral speech, impoverishment and abnormal conditions for the prelinguistic development of children with rhinolalia are noted. Due to a violation of the 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 air leakage through the nasal passages and thus do not receive auditory reinforcement in children. Babbling activity gradually

decreases.

Not only the articulation of sounds suffers, but also the development prosodic 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 speech development 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 organs of articulation during production sounds;

High elevation of the root of the tongue and its shift in

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 phonetic design of oral speech are violations of all oral speech sounds due to the connection of the nasal

resonator and changes in aerodynamic phonation conditions. The sounds become nasal, that is, the characteristic tone of the consonants changes.

In addition, the specific coloring of some consonant sounds (usually posterior palatal ones) is revealed due to the connection of the pharyngeal resonator. Pharyngealization, i.e. additional articulation due to tension in the walls of the pharynx, occurs as

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:

omission of the initial consonant (“ak, am” - so, there); neutralization of dental sounds according to the method of formation;

replacing plosives with fricatives;

whistling background when pronouncing hissing sounds or vice versa (ssh or shs);

absence of vibrant r or replacement with sound s during strong exhalation;

the imposition of additional noise on nasal sounds (hissing, whistling, aspiration, snoring, larynx, etc.)

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). In some cases, hypercorrection phenomena are noted, i.e., movement of articulation to the anterior

zones. 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. There are too many different compensatory techniques that

used by children to produce sounds. Much also depends on the ratio of the resonating cavities and on the variety of individual configuration features

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 child’s ability to transmit a speech message is halved. This causes serious communication difficulties.

^ Thus, the mechanism of violation when open

rhinolalia is defined as follows:

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

2) a change in the place and method of articulation of most sounds due to defects of the hard and soft palate, laxity 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.

^ Features of oral speech Children with rhinolalia in many cases are the cause of deviations in the formation of other speech processes.

Features of the letter. The pronunciation features of children with rhinolalia lead to distortion and immaturity of the phonemic 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 additional obstacles to normal speech development arise in a child with rhinolalia, specific writing disorders 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 to rhinolalia are substitutions p, b, m, t, d to n and reverse substitutions k - d, t, m - b, p, due to the lack of phonological opposition of the corresponding sounds in oral speech. For example: will come -

“will accept”, dal - “cash”, lily of the valley - “lannysh”, “ladnysh”, fiery - “fire”, etc.

Omissions, substitutions, and the use of extra vowels are identified: “in the shade” - in blue,

“kreltsa” - porch, “gribimi” - mushrooms, “gulucote” - dovecote, “prshel” - came.

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

Difficulties in using affricates are noted. The sound h in writing is replaced by sh, s or z; shch on h: “hiding” - hiding, “shulan” - 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 portvel” - in a briefcase.

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

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

^ The degree of writing impairment depends on a number of factors : the depth of the defect in the articulatory apparatus, the personality characteristics and compensatory capabilities of the child, the nature and timing of speech therapy intervention, 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, condition of the peripheral part of the articulation

apparatus and on 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 special kindergartens in groups for children with phonetic-phonemic or general speech underdevelopment.

School-age children with severe phonemic perception disorders receive help at speech therapy centers in general education

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 primarily due 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, cases of incorrect use of prepositions, conjunctions, particles, errors in case endings, i.e. manifestations of agrammatism in writing, are typical. Substitutions and omissions of prepositions, merging of prepositions with nouns and pronouns, and incorrect division of sentences are common. Among some factors that influence the results of correction (the age at which the operation was performed, its quality; the age at which speech therapy training began; duration of training), the factor of cooperation with the child’s family also stands out. The speech therapist instructs parents about the correction techniques used and recommends a significant part of well-developed exercises for systematic use at home.

^ 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 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 muffling of individual tones in the nasopharyngeal and nasal cavities. In this case, vowel sounds acquire an unnatural connotation in speech.

^ Reason for closed form - 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(rhinophony): front closed- with obstruction of the nasal cavities, rear 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 It 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.

At organic closed rhinolalia First of all, the causes of nasal obstruction 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 manifest itself, resort to the same exercises as for functional disorders.

^ 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 cause is a combination of nasal obstruction and insufficiency of the palato-pharyngeal 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.

^ Conclusions and problems:

Elimination of pathological nasalization of the voice in rhinolalia, despite the variety of techniques used, presents a certain difficulty. It is determined primarily by the severity of the defect and the nature of the surgical intervention, which does not always achieve a good anatomical and functional effect.

Restoring timbre is complicated by the fact that with congenital clefts of the hard and soft palate, the mechanism of voice formation suffers, since the innervation of the soft palate affects the function of the vocal folds. Corrective work requires influence on the entire system of voice and speech formation. Pathophysiological studies that reveal the characteristics of breathing, phonation and articulation in this population expand the understanding of the structure of the defect and allow the choice of more substantiated and targeted methods of speech therapy work. Particularly important are early preventive and comprehensive corrective measures, which can weaken the development of the defect and contribute to the speedy social rehabilitation of persons with congenital anomalies of the palate.

Literature:

S.N. Shakhovskaya “Speech Therapy” M, Vlados, 2003.
Dmitrieva V.S. "Congenital cleft palate and their surgical treatment." Printing house of the Peoples' Friendship University named after Patrice Lumumba.
Guide Edited by G.I. Lazyuka Human teratology. Publishing house "Medicine" Moscow 1990.
Becker K.P. "Speech therapy", M, 1981
Reader, ed. Volkova, Seliverstova.
“Speech therapist’s dictionary”, Seliverstov V.I.

Rhinolalia in its manifestations differs from dyslalia in the presence of an altered nasal timbre of the voice.

With preserved articulation of sounds, when there are only violations of the nasal resonance of the voice, they speak of rhinophony.

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 in, the strongest - with s. 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.

OPEN RHINOLALIA

With the open form of rhinolalia, oral sounds become nasal. The timbre of the vowels u 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.

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 o and and, while the nasal passages are either clamped or opened. With the open form, there is a significant difference in the sound of these vowels. With the nose pinched, sounds, especially and, are muffled and at the same time the speech therapist’s fingers feel 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 sign of functional open rhinolalia is a more pronounced violation of the pronunciation of vowel sounds. With consonants, the velopharyngeal closure is good.

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.

Causes of clefts

Facial clefts are defects of complex etiology, i.e. multifactorial defects. In their occurrence, genetic and external factors play a role or their combined action in the early period of embryo development (E. M. Nemchinova, 1970; V. M. Messina, 1971; G. V. Kruchinsky, 1974; Yu. M. Vernadsky et al. .). There are biological factors (influenza, mumps, measles rubella, toxoplasmosis, etc.); chemical factors (pesticides, acids, etc.); endocrine diseases of the mother, mental trauma and occupational hazards. 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 lip and palate have been identified in parents: a groove on the palate or uvula (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.

The following classification is currently accepted.

Congenital clefts of the upper lip: hidden cleft, incomplete cleft: a) without deformation of the skin-cartilaginous part of the nose; b) with deformation of the skin-cartilaginous part of the nose.

Complete cleft.

Congenital cleft palate:

1) cleft of the soft palate: hidden (submucosal); incomplete; full;

2) clefts of the soft and hard palate: hidden; incomplete; full;

3) complete cleft of the alveolar process, hard and soft palate: unilateral; two-sided;

4) complete cleft of the alveolar process and the anterior part of the hard palate: unilateral; bilateral.

The most difficult thing for a speech therapist to detect is a submucosal (submucosal), or hidden, cleft. To identify it, you should pay attention to the back surface of the palate, which, when pronouncing the sound a in an exaggerated manner with the mouth wide open, is slightly retracted in the shape of a small triangle. The mucous membrane in this area is thinned and has a paler color.

Depending on the nature and severity of the pathology, outpatient observation or hospitalization is recommended for children. An important link is orthodontic care, which is provided from infancy.

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.

Not only the articulation of sounds suffers, but also the development of the prosodic elements of speech.

The mechanism of the disorder 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 oral-nasal;

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

Features of writing. The pronunciation features of children with rhinolalia lead to distortion and immaturity of the phonemic 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.

CLOSED RHINOLALIA

Closed rhinolalia occurs when physiological nasal resonance is reduced during the production of speech sounds. The strongest resonance is for nasal sounds m, m, v, n. When pronounced normally, the nasopharyngeal seal remains open and air penetrates directly into the nasal cavity. If there is no nasal resonance for nasal sounds, they sound like oral b, b, d, d ". In speech, the opposition of sounds on the basis of nasal-non-nasal has disappeared, which affects its intelligibility. The sound of vowel sounds also changes due to the muffling of individual tones in the nasopharyngeal and nasal cavities. At the same time, vowel sounds acquire an unnatural shade 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.

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 velopharyngeal contact of functional and organic origin.

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.

Rhinolalia(nasality) - a change in voice timbre, distortion of the pronunciation of sounds as a result of disruption of the normal participation of the nasal cavity in the process of speech formation.

During phonation, a pathological change in the resonance of the nasal cavity occurs. With pathological exhalation, the air stream is either directed into the nose with all speech sounds (open rhinolalia), or the passage into the nasal cavity is always closed, even when nasal sounds are pronounced (closed rhinolalia).

You can determine nasality:
- aurally
- when bringing a mirror to your nose (if, when pronouncing words without nasal sounds, the mirror fogs up - open nasality;

When pronouncing words with nasal sounds, the mirror does not fog up - closed).

It is important to distinguish paresis of the soft palate from functional nasality; this can be done as follows:
- the child opens his mouth, while the specialist presses the root of the tongue with a spatula. If the soft palate reflexively rises to the back wall of the pharynx, we can talk about functional nasality, but if the palate remains motionless, we are talking about nasality of organic origin due to paresis of the soft palate.

The child lies on his back and speaks in this position. If the nasal sound disappears, then we can assume paresis of the soft palate (the nasal sound disappears due to the fact that when lying on the back, the soft palate passively falls towards the back wall of the pharynx).

Causes of rhinolalia can be divided into:
organic and functional central or peripheral
congenital and acquired

Organic central character:

Brain hemorrhages, traumatic brain injuries, brain nutrition disorders, central or peripheral paralysis, extrapyramidal disorders leading to disruption of the innervation of the muscles of the soft palate and causing paresis and paralysis.

Organic peripheral

May be congenital or acquired:
- shortened soft palate
- lack of a small tongue
- shortened or bifurcated soft tongue
- polyps, adenoids, tumors, deviated nasal septum, hypertrophy of the nasal mucosa, palate injuries, consequences of operations and diseases (perforations, scar changes)
- cleft palate and lip of various sizes and shapes

Functional central

Cause hyper- and hypotrophy of the palate, i.e. its improper functioning (can be observed after mental shocks, in neurotic disorders, as consequences of operations)

Functional peripheral

Disorders of respiratory processes, habitually drooping soft palate (for example, after post-diphthyria paresis, after adenotomy, surgical injuries), imitation of the nasal speech of others, disease of the eustachian tube, neuromuscularly associated with the soft palate, defects in auditory control.

Types of congenital clefts.

Cleft palate (varied by size and location):
- through (one- and two-sided). Nonunion involves the lips, alviolar process, hard and soft palate. Bilateral clefts run on either side of the middle of the hard palate

Non-through (complete and incomplete). In case of non-through complete non-union it reaches the area of the incisive foramen; in case of incomplete ones, it does not cover the incisive foramen and may be insignificant in size. Non-through clefts can also be one- or two-sided

Submucosal (non-through, submucosal, hidden). With these clefts, there is underdevelopment of the plates of the palatine bones, underdevelopment of the muscular system of the soft palate with sufficient development of the mucous membranes.

Cleft lips:
partial- nonunion only in the edge of the lip, does not reach the lower nasal opening
full- clefts affect the lower part of the nasal opening and often the anterior edge of the floor of the nasal passage
The nature of the damage depends on the time of exposure to harmful factors.

Classification of rhinolalia.

Currently, there are 3 main forms of rhinolalia:
open
closed
mixed

General sign open rhinolalia : the passage into the nasal cavity, for one reason or another, remains open, as a result of which all sounds are pronounced with a nasal connotation.

General sign closed rhinolalia : the passage to the nasal cavity is always closed, including for nasal sounds, the voice has a dull tint, as with a runny nose.

At mixed rhinolalia There is a combination of manifestations characteristic of open and closed rhinolalia.

Open rhinolalia.

It is characterized by defective articulation and the acoustic effect of nosalization of speech sounds. During speech, the air stream passes simultaneously through the mouth and through the nose, as a result of which nasal resonance occurs when pronouncing all sounds. An abnormal acoustic effect is created by a specific timbre of the voice. Within the framework of open rhinolalia, organic and functional rhinolalia can be distinguished.

Organic open rhinolalia: most often is a consequence of congenital defects of the palate - clefts. Clefts cause partial or complete connection of two resonator cavities - the mouth and nose. During speech, the direction of the air stream during the formation of sounds is disrupted. A specific nasal acoustic effect occurs.

Rhinolalia with cleft palate is characterized by a unique set of symptoms:

- change in the position and activity of the tongue. The entire body of the tongue is pulled back (sinks toward the pharynx), the root and back are raised upward (high tone is noted), the tip of the tongue is usually poorly developed and paretic. The reason for these changes is that children experience feeding difficulties from the first day of life. The child sucks the root tongue, straining his facial muscles. Later, these difficulties persist: children instinctively hold the root of the tongue up, if possible covering the cleft with it when eating and breathing, as a result of which the root of the tongue hypertrophies, the tip of the tongue develops weakly, and is passively retracted into the depths of the oral cavity. Only elementary, undifferentiated movements of the tongue are available to the child. Changing the position of the tongue is a kind of adaptation of the child to his condition.
- Disturbances in the activity of the muscles that move the soft palate. The movements of the soft palate are defective not only during speech, but also during the acts of chewing and swallowing. The soft palate does not perform its main function: the separation of the nasal and oral cavities, its closure with the posterior wall of the pharynx is not carried out.
- Changes in the interaction of muscles of the entire peripheral part of the motor analyzer. Disturbances in the interaction of articulatory and facial muscles: altered movements of the facial muscles in the process of articulation, the presence of synkinesis. In some cases, tic-like movements of the facial muscles are noted. The interaction between the articulatory and respiratory muscles is also disrupted.

Features of speech breathing: accelerated, superficial, rapid. This is due to the fact that the amount of air exhaled through the nose increases to 74% of the total exhaled air. Speech exhalation is uneven, unevenly distributed throughout the spoken word or phrase. The smoothness and direction of exhalation and rhythmic speech breathing suffer.

It should be noted that inhalation through a cleft causes frequent colds in such children.

Up to 80% of children with organic open rhinolalia suffer from hearing loss. This is associated with frequent colds, runny noses, and inflammation of the eustachian tube, leading to ear diseases.

With organic open rhinolalia, all sounds are pronounced with a nasal connotation. The vowel sounds are the most defective, since they require the strongest velopharyngeal seal. The articulation of consonants shifts posteriorly, the sounds are distorted, acquiring a hoarse tint. A large number of sound substitutions are characteristic, and the substitute sounds are also distorted. Consonant sounds that require the highest oral pressure are disrupted. Thus, organic open rhinolalia caused by clefts is characterized by a number of pathological changes in the function of the articulatory apparatus. The most striking of them is the defective position of the tongue in the oral cavity and disruption of the muscular interaction of the entire articulatory apparatus.

Due to hearing loss and unclear articulation, children with open rhinolalia often experience underdevelopment of phonemic hearing; a secondary consequence of this may be difficulties in mastering the sound structure of words. This can also lead to underdevelopment of children’s vocabulary, inferior grammatical structure of speech, i.e. OHP syndrome.

With organic open rhinolalia, secondary psychological layers may be observed: the child begins to realize the defectiveness of his speech, begins to be embarrassed by it, which can cause isolation, speech negativism, and specific behavioral characteristics.

Functional open rhinolalia: a speech defect can be caused by hypokenesis of the soft palate, due to frequent diseases of the nasopharynx, weakness of nerve impulses or general muscle lethargy, impaired control of one’s own speech with reduced hearing, imitation of nasal speech. Sometimes functional open rhinolalia can occur after organic open rhinolalia has been overcome, in such cases the soft palate is habitually drooping. Also, this form of rhinolalia can occur during hysteria, in this case its peculiarity is its incoming nature. With hysteria, temporary stress nasal sounds may occur due to incoming hysterical paralysis. Functional open rhinolalia is less common than organic rhinolalia.

Closed rhinolalia : caused by the direction of speech exhalation only through the mouth when pronouncing all speech sounds. With closed rhinolalia, the articulatory and acoustic characteristics of nasal sounds and voice timbre suffer. Closed rhinolalia is a consequence of a defect in the nasopharynx or nasal cavity (hypertrophy of the nasal mucosa, hypertrophy of the soft palate, etc.).

There are two forms of closed rhinolalia:
organic
functional

Closed Organic Rhinolalia caused by defects in the areas of the pharynx, nose, and nasopharynx. The forms of closed organic rhinolalia are differentiated depending on the location of the defect:
anterior closed organic rhinolalia. Causes: hypertrophy of the nasal mucosa due to chronic runny nose, polyps and tumors of the nasal cavity, deviated nasal septum.
Posterior closed organic rhinolalia. Causes: mechanical obstacles in the nasopharynx (adenoid growths, fusion of the soft palate with the posterior wall of the pharynx, growth of the pharyngeal azygos tonsil). Such children are characterized by constant mouth breathing and a half-open mouth.

Functional closed rhinolalia : caused by hyperfunction of the soft palate, which blocks the path of the air stream through the nose. This form occurs with undisturbed nasal breathing and good nasal patency. Hyperfunction of the soft palate can be caused by the results of surgery to remove the adenoids, deficiencies in auditory control, and imitation of the nasal speech of others. With this form, the voice has a dull, deathly tint. Mixed rhinolalia: caused by air leakage through the nose with a pathologically reduced nasal resonator. As a result, the articulatory-acoustic characteristics of all sounds suffer, and the timbre of the voice is significantly distorted. In this form, there is a combination of factors causing open and closed rhinolalia. The nature of the speech defect depends on the predominant disorder. With this form, the nasal tone of the voice is clearly audible and there are no nasal sounds.

Closedness

Difficulty eating

Voice change

Breathing problems

Violation of sound pronunciation

Writing disorders

Underweight in newborns

Unnatural speech

The need for mouth breathing

Involuntary eye fluctuations

Drooping of the upper eyelid

Facial clefts

Tendency to colds

Poor vocabulary

Quiet speech

Dull voice

Rhinolalia is a pathology in which the pronunciation of sounds in particular, and speech in general, is disrupted and distorted. This is a rather rare disorder, which is diagnosed in 1-2 children per 1000. This type of speech defect can be either congenital or acquired, which is why the predisposing development factors will also differ.

The disease has specific symptoms that parents cannot ignore. The main symptoms are considered to be slurred or inexpressive speech, late pronunciation of the baby’s first words, as well as a large number of psychological signs.

In the vast majority of cases, establishing the correct diagnosis is not a problem, but difficulties may arise in determining the type of disease. It is against this background that diagnosis is complex and includes consultation with specialists from various fields of medicine.

Treatment in children is often based on conservative methods, but in some forms of the disease surgical intervention is mandatory.

Etiology

The pathogenesis of the disease lies in the improper interaction between the nasal cavity and the oropharynx. This causes the air to flow in the wrong direction during the formation of sounds, causing the pronunciation to be distorted.

The causes of the congenital form of the disease are presented:

violation of the integrity of the soft or hard palate, which in the medical field is called “” syndrome;
cleft jaw or upper lip - this disorder is commonly known as “cleft”;
defects of the soft palate, namely its shortening;
pathologies of the small tongue - this includes its complete absence or, conversely, bifurcation;
clefts of the hard palate, which are hidden.

In addition, severe illnesses suffered by a woman during pregnancy in the first trimester can cause primary rhinolalia. Such diseases include:

and other infectious processes.

An important role in the occurrence of such a disorder of speech function is also played by:

exposure to toxic substances on the body of a pregnant woman;
the expectant mother's addiction to drugs, alcohol or nicotine - not all female representatives, having learned that they are expecting a child, consider it necessary to get rid of harmful addictions;
frequent stressful situations to which pregnant women are exposed;
the occurrence of endocrine disorders before or during pregnancy.

It is worth noting that the above defects that provoke the occurrence of rhinolalia are formed in the fetus in the early stages of intrauterine development, namely in the seventh or eighth week.

It is also believed that burdened heredity plays an important role. There is a high probability of a child developing such a speech disorder if one of the parents has:

cleft lip or palate;
asymmetry of the tip of the nose;
asymmetry of the wings of the nose.

The mechanisms of development of acquired rhinolalia will be dictated by the type of disease. For example, the development of secondary open organic rhinolalia will be promoted by:

cicatricial deformations of the palate;
conditions such as paralysis or paresis of the soft palate;
compression by the tumor of nerves such as the vagus and glossopharyngeal.

Open functional acquired rhinolalia develops against the background of:

previous intervention for excision of adenoids;
paresis of the soft palate caused by diphtheria.

Closed rhinolalia of an organic nature often occurs due to a wide range of anatomical changes in the nose or nasopharynx. It follows from this that the sources can be

located in the nasal cavity;
the appearance of benign neoplasms or polyps;
hypertrophy of the nasal mucosa;
malignant tumors in the nose;
formation of an unpaired tonsil.

The functional form of closed rhinolalia is represented by such an etiological factor as high tone of the soft palate. This condition is expressed in the fact that a full flow of air through the nose is impossible. This violation may occur due to:

adenoidectomy, i.e. surgery to excise the adenoids;
various deviations of neurological origin;
banal copying of the nasal speech of surrounding people.

Classification

Rhinolalia, the definition of which is the incorrect functional relationship of the nasal cavity and oropharynx, has several varieties.

The main classification divides this disease into two forms:

open rhinolalia– air passes through the mouth and nose at the same time;
closed rhinolalia– differs in that the air does not pass through the nose, which is caused by the presence of an obstruction in the nasal cavity or in the nasopharynx area. This causes the sounds “m” and “n” to be significantly distorted. In addition, vowels undergo changes, namely, they lose their tonality and sonority;
mixed rhinolalia– signs of the two above forms are present, and the child’s voice takes on a nasal sound.

It is noteworthy that open rhinolalia is diagnosed several times more often than the closed or mixed type of the disease.

For reasons of occurrence, both open and closed rhinolalia are:

organic. For the open form, the occurrence is caused by congenital, less commonly acquired defects of the oropharynx or nasal cavity. The closed type of the disease causes deformation of the nose;
functional– functional open rhinolalia is caused by a previous illness of the nasopharynx. In the closed version of the disease, the air flow is directed through the mouth, and predisposing factors are often represented by neurological disorders.

In addition, there are the following types of rhinolalia:

front– in the vast majority of cases, it is expressed against the background of expansion, which is why they lead to blocking of the choana;
back– develops due to polyps or a deviated nasal septum.

Symptoms

The structure of the speech defect in rhinolalia, i.e., the symptoms of the disease, will differ somewhat depending on its type.

For example, the following symptoms will be characteristic of an open form of pathology:

respiratory dysfunction;
difficulties when feeding an infant or feeding children over two years of age on their own;
underweight of the newborn;
the presence of congenital facial clefts;
drooping upper eyelid;
quiet speech;
involuntary oscillatory eye movements;
hyperreflexia;
– children often pronounce their first words at the age of two years;
the appearance of grimaces during communication;
a meager vocabulary, which makes it even more difficult to verbally describe what is happening in a child’s life;
irritability and withdrawal;
increased susceptibility to illnesses such as pneumonia or.

The characteristics of the closed form of rhinolalia include the following clinical manifestations:

change in voice timbre;
disturbance in the pronunciation of nasal sounds;
difficulties when communicating with strangers;
unnaturalness and dullness of the voice;
the need for constant breathing through the mouth;
tendency to colds;
development of asthenic syndrome;
violation of writing, which is expressed in or;
insufficient vocabulary compared to peers of a similar age category.

Diagnostics

A child with rhinolalia and the expression of the above symptoms should be taken for consultation with a speech therapist. However, due to the fact that such a disorder can develop against the background of a large number of various factors, the following specialists also take part in the examination of the patient:

maxillofacial surgeon;
neurologist;
otolaryngologist;
orthodontist;
phoniatrist;
speech pathologist;
psychologist.

Primary diagnosis includes:

studying the medical history and life history of the patient - this also takes into account information regarding the course of pregnancy. This will enable the clinician not only to establish the cause of the disease, but also to determine its type;
Conducting a thorough physical examination to identify external abnormalities, such as a cleft lip or cleft palate.
detailed interview with parents or adult patient.

Speech therapy examination is based on assessment of:

articulatory apparatus, in particular its structure and mobility;
breathing - physiological and phonation;
voices and pronunciation of all sounds;
state of reading and writing - determined in school-age children.

Sometimes instrumental examinations may be required to establish the etiological factor, among which are:

Laboratory tests of blood and other human biological fluids have no diagnostic value.

Treatment

Correction of rhinolalia will be completely dictated by the type of course of such a speech defect.

In cases of diagnosing an organic type of pathology, elimination of anatomical defects is indicated, which is performed using:

use of a pharyngeal obturator;
surgical correction of facial deformities - this includes uranoplasty, velopharyngoplasty and cheiloplasty;
removal of adenoids and nasal polyps;
excision of pharyngeal tumors;
septoplasty.

Therapy for functional rhinolalia is based on:

physiotherapeutic procedures;
psychotherapy;
long-term work of a speech therapist with a patient.

In addition, the treatment also involves:

speech therapy massage - features of speech therapy work include finger massage of some parts of the hard palate and vibration massage of the soft palate;
breathing exercises;
articulation exercises.

The most effective articulatory gymnastics exercises are:

“boa constrictor” - in this case the tongue is rolled into a tube and slowly poked out of the mouth. Number of repetitions – seven times
“needle” - the mouth is closed, and the tongue must touch the inner surface of each cheek in turn;
“clock” - open the mouth wide, fold the tongue into a tube and make circular movements with it;
“liana” - the tongue is hung to the chin and held in this position for about five seconds;
“metronome” - the mouth is wide open, and the tongue is moved from one corner of the mouth to the other;
“take-off and landing” - differs from the previous exercise in that the tongue is pulled as far as possible towards the nose, after which it is lowered as far as possible to the chin.

If the correction of such a disorder required an operation, then after the intervention the work of a speech therapist is mandatory, regarding the peculiarities of sound production for rhinolalia in new anatomical conditions for the patient.

It is best to start corrective work with a doctor as early as possible, so that by the time the child turns 12–15 years old, he can achieve positive results from therapy.

Rhinolalia is a speech disorder expressed in a disorder of articulation and phonation of speech sounds.

With rhinolalia, sound articulation and phonation differ significantly from the norm. With normal phonation, during the pronunciation of all speech sounds except nasals, a person separates the nasopharyngeal and nasal cavities from the pharyngeal and oral ones. The cavities are separated by the velopharyngeal closure, which causes contraction of the muscles of the soft palate, lateral and posterior walls of the pharynx. When articulating nasal sounds, the passage into the nasal cavity remains open, the stream of exhaled air enters not the oral cavity, but the nasal cavity, resonates in it and gives the sounds a nasal connotation. Simultaneously with the movement of the soft palate during phonation, a thickening of the posterior wall of the pharynx occurs (Passavan roller). This promotes contact between the posterior surface of the soft palate and the posterior wall of the pharynx. During speech, the soft palate continuously lowers and rises to different heights. The degree of elevation and force of closure of the velopharyngeal muscle varies with the articulation of different sounds and speech rates. With rhinolalia, articulation is impaired due to movements of the soft palate, tongue and lips. With normal pronunciation of nasal sounds m’; m; n'; n the air stream should flow freely into the space of the nasal resonator. In other cases, velopharyngeal closure should occur.

In modern speech therapy, several forms of rhinolalia are distinguished:

open rhinolalia
closed rhinolalia
mixed rhinolalia

The first works on rhinolalia were written by doctors. The purpose of the publication was the prompt restoration of the palatine platoon and the formation of the velum palatine. According to doctors, after the operation it is necessary to preserve the velum palatine, make it long enough and movable so that it can come into contact with the back wall of the pharynx. In their opinion, achieving this effect will ensure the ability to properly close the passage between the nasopharynx and the nose and create the prerequisites for eliminating the nasal tone of speech or eliminating it completely. Pirogov was one of the first doctors to operate on children with rhinolalia. Pirogov’s student Vorontsovsky proposed uranoplasty. The reason for the persistence of nasality after the operation was seen as secondary to shortening of the soft palate, tension in its width and lack of mobility. He argued that with daily exercises in pronunciation and reading under the supervision of specialists, speech becomes normal. Operations continued on the recommendation of Pirogov - Subbotin, Paikin. Despite the successes of surgeons, no one was able to obtain positive results in sound pronunciation in correcting an anatomical defect. At the beginning of the 20th century. It was concluded that uranoplasty in itself does not eliminate the nasal sound of the voice in rhinolalic patients. Limberg noted that the doctor’s task is to completely restore the shape and size of deformed organs and restore their functions. In addition to operations, there should be orthopedic treatment, orthodontic and speech therapy work. At the beginning of the 20th century. 2 directions were developed in pedagogical methods for eliminating oral speech disorders with open rhinolalia:

French
German

Both directions were based on the need to achieve voluntary (breathing) closure of the velopharyngeal seal, which is possible by ensuring mobility of the velum palatine.
The French direction (Monte, Porel-Maisonnet, Vedu) proposed a method for developing correct breathing and voice after surgery. Movements should be relaxed and combined with breathing.

German direction (Kez, Gutzmann, Freschelz) They suggested using electric and vibration massage after surgery, including classes on articulation and breathing training. The first 2-3 months after the operation, the falsetto voice was used more, and then they moved on to mastering the chest voice. The German school developed several proprietary methods:

method of Professor G. Gutzman. He developed a system of exercises to improve the velopharyngeal seal using an obturator and a nose clip. Fremels developed a series of articulatory exercises for staging and automation.
Rhinolalia has been studied for a long time in the theory of voice disorders, dyslalia, dysarthria due to the structure of speech pathology:

there is nosalization in speech
poor performance of speech motor skills
There are problems with sound pronunciation.

rhinophony
rhinolalia

With rhinophony, the nasal resonance of the voice increases, sound pronunciation is normal. With rhinolalia, sound pronunciation also changes. According to the WHO (World Health Organization) classification, rhinolalia and rhinophonia are classified as voice disorders. An unbalanced resonance provokes the development of all other pathological changes in the phonetic aspect of speech. With congenital cleft palate or velopharyngeal insufficiency, the nasal cavity becomes a paired resonator of the oral cavity. In accordance with the laws of acoustics, the oscillation frequency of this paired resonator is superimposed on the oscillation frequency of the fundamental tone. The acoustic spectrum of the voice changes. Additional elements of nosalization appear in it, the voice loses its sonority, flight, and becomes monotonous, dull, and nasal. With functional rhinolalia, only the acoustic side of speech is impaired; with rhinolalia, deviations in the aerodynamic conditions of speech formation are added to the defect:

changes in the direction of air flow in the mouth and nose
decreased air pressure in the mouth

Etiology of rhinolalia.

Most often a congenital defect. The incidence of clefts varies in different countries and regions:

USA in 70s 20th century 0.7-2.5 per 1000 births
Russia in the 70s 20th century 0.6-1.2 1000 newborns

There is an increase in vice, the gender distribution is as follows: for every 3 men – 1 woman. The clefts can be one-sided. Unilateral are more common than bilateral. Unilaterals are more often observed on the left (70%) than on the right (21%). The remaining 8-9% are bilateral. Central clefts are extremely rare. Isolated cleft lip and cleft lip in combination with cleft palate are more often observed in men (67%). Women are 2 times more likely to have isolated cleft palates.

According to Ippolitova:

According to Khvattsev:

Khvattsev identified the principles of open and closed rhinolalia. Open rhinolalia is congenital rhinolalia, according to the same principles as Ippolitova’s. Open rhinolalia - acquired rhinolalia due to perforation at any age of the lip or palate; occupational hazards or injuries (people work in the forest), surgical interventions (tumor), diphtheria - complete or partial paralysis of the soft palate occurs. Closed rhinolalia - painful clefts in the nose and nasopharynx; chronic runny nose (tonselitis).

L. G. Paramonova:

Principles: congenital or acquired clefts of the soft and hard palate, lips: separation of the oral nasal cavity does not occur; short soft palate; absence of a small tongue or its bifurcation; paralysis and paresis of the soft palate; general laxity of the articulatory muscles (most often observed in physically weakened children after removal of adenoid growths, in combination with rhinolalia + dysarthria). The presence of adenoid growths, polyps and tumors in the nasopharynx, correction of the nasal septum, overgrowth of the nasal passages, increased function of the muscles of the soft palate.