Hyponasal Speech in Adults - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Hyponasal speech is a resonance defect that occurs due to an obstruction or defect in the nasal cavity. It causes the speech sound through very little air escaping from the nasal cavity. As a result, the sound of the speech appears as if a person is talking with a running or stuffy nose. The condition usually arises from the inflammation or enlargement of adenoids and various other defects of the nasal cavity. Hyponasal speech defects resulting from various factors in children can be corrected through multiple treatment options and corrective surgeries right after birth to resolve anatomical defects. In addition, a professional speech therapist can be consulted to analyze the case and suggest various treatment plans apart from surgical interventions. The condition is mainly diagnosed and treated during childhood but may also persist in adulthood.

What Are the Causes of Hyponasal Speech in Adults?

Hyponasal speech can occur for various reasons, including the mouth's shape and size and air movement through various parts of the oral cavity. Hyponasal speech is usually caused due to some blockage in the nasal cavity, which might occur from a sinus infection, cold, or allergies. In addition, it can also be caused due to any permanent structural problem, including adenoids or tonsils, nasal polyps, and deviated septum.

One of the significant causes of hyponasal speech is velopharyngeal dysfunction (VPD), caused by a defect in the velopharyngeal valve. Velopharyngeal dysfunction (VPD) can be of various types, such as:

• Velopharyngeal mislearning occurs when the child cannot control air movement through the mouth and throat.

• Velopharyngeal insufficiency occurs due to structural defects like a short soft palate.

• Velopharyngeal incompetence occurs due to the inability of the valve to close properly because of some movement defects.

Hyponasal speech defects can also arise from the following conditions:

• Cleft Palate - The congenital disability occurs when the newborn’s mouth does not form properly during pregnancy. The defect is usually corrected up to the first year of life, but in most cases, it continues to cause velo[pharyngeal dysfunction post-surgery.

• Adenoid Surgery - In this procedure, the glands behind the nose are surgically removed. This can leave ample space in the posterior part of the nose, which causes the air to escape through the nose. The condition is temporary and usually resolves after a few weeks post-surgery.

• Neurological Disease or Brain Injury - Traumatic injury to the brain and neurological diseases such as cerebral palsy can inhibit the soft palate in the mouth from moving correctly.

• Short Palate - This condition can cause space between the palate and soft palate, thus causing air to escape.

• DiGeorge Syndrome - This is a chromosomal abnormality in the body that affects the development and growth of various body parts, especially in the head and neck region.

• Mislearning - This is a condition in which a child cannot produce speech correctly.

What Are the Symptoms of Hyponasal Speech in Adults?

The various symptoms of hyponasal speech in adults include

• Loss of taste and smell.

• Runny or stuffy nose.

• Bad breath.

• Cough.

• Snoring.

• Nasal discharge.

• Headache.

• Sore throat.

• Troubled breathing through the nasal cavity (nose).

• Pain around cheeks, eyes, and forehead.

In addition, a person with hyponasal speech can experience symptoms such as

• Escaping air from the nasal cavity while pronouncing a combination of sounds like sh, ch, and s.

• Pronouncing the consonants requiring high air pressure, such as k, p, and t.

How Is Hyponasal Speech in Adults Diagnosed?

The diagnosis of hyponasal speech is made by evaluating the velopharyngeal sufficiency, and examining nasal, and oral cavity. A team of doctors, including a prosthodontist, otolaryngologist (ENT), and surgeon are involved in making the diagnosis for hyponasal speech. The diagnosis is made in the following ways:

Speech Screening:

• The doctor analyzes the consistency and severity of symptoms and sounds affected with the help of a speech therapist.

• Type and presence of articulation errors in a person.

• The speech therapist also performs an oral exam to rule out structural defects such as cleft palate, lip, enlarged tonsils, etc.

Hearing Screening:

• The doctor may also rule out any hearing loss defect that may be the cause of hyponasal speech.

In addition, various other methods are used to detect hyponasal speech in a person. These include

• Pressure-flow technique.

• Cinefluoroscopy method but this technique can cause radiation exposure and is mainly used in young children of three to four years.

• Use of a nanometer to calculate the ratio of nasality.

• Nasopharyngeal endoscopy method.

• The mirror can also be held below the nose to diagnose nasal air emission and look for fogging while pronouncing certain consonants.

How Is Hyponasal Speech in Adults Treated?

Hyponasal speech can be treated in the following ways:

Medicinal Treatment - Antihistamine, steroids, and decongestant nasal sprays can cure inflammation and relieve nasal congestion from a deviated septum, sinus infections, allergies, and polyps. Sinus infections can be treated with antibiotics as well.

Surgery - Many structural defects that cause hyponasal speech can be treated with surgical methods. These include:

• Septoplasty can treat deviated nasal septum.

• Removal of adenoids or tonsils.

• Endoscopic surgery can be used to remove polyps in the nasal cavity.

• Corrective surgeries up to one year of age for cleft palate defects.

• Sphincter pharyngoplasty and Furlow palatoplasty treat short soft palate.

Speech Therapy - This can be helpful pre or post-surgery. The therapist for speech-language evaluates a person's speech and then recommends a suitable treatment approach. In this speech therapy, a person learns how to move the jaw, tongue, and lips to produce the correct sound. Speech therapy is effective only with regular practice, as suggested by the speech therapist. To improve speech quality, a person can vocalize, sing, and talk continuously. The adults are also made to learn volume and pitch control, altering the placement of the tongue, auditory and biofeedback, and nasal vs. oral production during speech therapy.

What Are the Complications Associated With Hyponasal Speech?

The complications are as follows:

• Nasal obstruction.

• Sleep apnea.

• Sinusitis.

• Aspiration pneumonia.

• Snoring.

• Flap separation.

• Postoperative bleeding.

• Sphincter pharyngoplasty can cause complications such as nasal obstruction, difficulty blowing the nose, and snoring.

Conclusion

Hyponasal speech can be heard like a blockage sound from the nasal cavity. Therefore, a person must consult a doctor immediately. The defect can be treated as early as detected, and many nasal cavity conditions can be treated with timely attention and diagnosis. Various factors are mostly treated during childhood, but hyponasal speech can also be present in adults. Therefore, they must follow the doctor’s advice and strictly follow the treatment regime to improve speech quality.