Nasalness and its elimination

M. E. Khvattsev. "Speech therapy work with children of preschool age"
Publishing house "Uchpedgiz", M., 1961
Given with some abbreviations

Causes, essence and types of nasality. Nasal speech in a preschooler is very rare. However, the educator must be able, at least in milder cases, to help the child. Children with severe forms of nasality are placed in special kindergartens.
There are two types of nasality: open and closed.
open nasality. The expiratory stream during speaking passes with all sounds not only through the mouth, but also through the nose. Along with the nasality, the incorrect pronunciation of many sounds is also observed. As a result of such violations, speech sometimes becomes completely incomprehensible.
Such nasality is caused by congenital longitudinal cleft palate (soft, sometimes hard, up to upper jaw and lips) or insufficient length of the soft palate and uvula (they cannot completely close the passage to the nose).
Both cases are due to various troubles during pregnancy. This is organic smut.
It happens that the soft palate does not rise due to paralysis as a result of diphtheria and other diseases. Usually, after diphtheria, the paralysis, and with it the nasality, gradually disappear. But this is not always the case.
Small mobility of the palate is observed in some physically weakened children. Deafness or severe hearing loss also often causes nasality: children do not hear their own nasality, and therefore do not try to raise the soft palate during speech. Occasionally there is nasal imitation. Such types of nasality are called functional.
closed nasality. The passage through the nose is closed either by painful growths in the nose and nasopharynx (polyps, adenoids), or by mucus in chronic rhinitis. Therefore, the voice-expiratory jet can only pass through the mouth. Without nasal resonance, the voice becomes muffled and somewhat nasal (as in a cold).
Sounds m and n or not pronounced at all, replacing accordingly b and d(baba instead of mom, dash instead of ours, bde de dado, poor guy has dasborg), or with incomplete closure of the nasal cavity m and n pronounced unclear, sometimes distorted (mbamba - mother, ndash - ours).

Nasal elimination technique

With open nasality, the most important thing is to teach the nasal one to exhale through the mouth. To do this, it is proposed to inflate cheeks, soap bubbles, blow out the fire of candles, blow off various gizmos from the table. To develop the flexibility of the soft palate, it is useful to play yawning (“I want to sleep”), to teach to swallow milk, tea, jelly in possibly smaller portions (“droplets”), and also to swallow saliva (“I want to eat”).
The second important point is the accustoming of such a child to speech slow, loud, jerky, emphatically clear, with a wide opening of the mouth. At first, it is useful for the child to strongly beat each syllable with his hands, straining the muscles of the whole body. Simultaneously with these well-known techniques, the shortcomings in the pronunciation of individual sounds are also eliminated.
In some cases, you first have to direct the air into the mouth, pinching the nose with your fingers. It is useful to exercise such children in a clear whispered speech: increased articulation reduces nasality.
At the same time, auditory differentiation develops: the child is taught to distinguish between his nasal voice and a clear one. First, the child listens to the voice of the educator, who speaks either purely or nasally, and then determines whether the educator speaks well or badly.
Such exercises are especially useful for functional nasality. The elimination of open nasality requires a long and systematic work.
In the case of a cleft palate, the nasal person should first be sent to a doctor who will prosthetize or operate on the gap.
With closed nasality, the main thing is surgery or treatment. When after that the air can freely pass through the nose, teach the child to breathe first with closed mouth, and then in the same position of the mouth, pronounce a long m, after which it is merged with a puff sound m with vowels: m-a, m-o. Further pronounced ma, mo. Thereafter: a-m, o-m, am, om, ma, mo, finally, words with m. Sound pronunciation is taught in the same way. n(but with an open mouth and always after assimilation m).

What it is?

Air jets change their normal course and speech becomes slurred, sounds are distorted. With rhinolalia, the sound of some sounds completely changes: “m” starts to sound like “b”, and the letter “n” becomes like “d”.

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

This is how nasal sounds are created. When the tongue is tense, it closes the nasal passage and the air goes through the mouth. With a normal voice without nasality, the uvula muscle tenses up when pronouncing almost all sounds except "m" and "n".

When nasality occurs, the air does not have the opportunity to pass through the nose, and we create these sounds exclusively with the "mouth", without the participation of the nasal cavity.

Kinds

Types of vileness:

closed;
open;
mixed.

Closed-type nasality is the result of poor patency in the nasal cavity and is called rhinophonia or palatophony. Nasal is called open, in which sounds pass not only through the mouth, but also through the nasal passage.

With a mixed form, there is nasal obstruction and a weakened palatopharyngeal closure.

Causes

The most common causes of a nasal voice 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 by rhinolalia:

swelling of the nasopharynx;
hypertrophy and edema of the turbinates;
pathological enlargement of the nasopharyngeal tonsils (adenoids);
the appearance of mucus in the nasal cavity (runny nose);
congenital curvature of the nasal septum;
the habit of pronouncing words incorrectly due to a hearing defect (deafness);
tertiary syphilis;
various injuries.

Diagnostics

Nasalness can be self-diagnosed. To do this, close your mouth tightly and try to sing a melody. If you felt air trickles from the side of your lips, then rhinolalia does not threaten you. Another way to check is to pronounce all the letters of the alphabet with a pinched nose, except for "m" and "n".

At the first sign of nasal congestion, contact your doctor immediately. Depending on the symptoms and external examination, he will prescribe the necessary comprehensive examination and tests. When examining a speech therapist, the structure and work of the speech apparatus is studied, the quality of breathing is checked during a conversation.

With open rhinolalia, the Gutzmann method is used, the essence of which is the pronunciation of the vowel sounds "a" and "and" with alternate closing and opening of the nasal passages. Then the pronunciation of all other vowels is examined.

Establishing the cause of nasality depends on the following factors:

the duration of the disease;
nature of sound defects;
past and chronic diseases.

It is often very difficult to identify the true cause of nasality, here it is necessary to consult a number of specialists: a surgeon, a phonator, an endocrinologist, a neurologist or a speech therapist.

The most common types of examination are radiography of the nasopharynx, pharyngoscopy and electromyography. If necessary, you need to become a general and detailed analysis of blood and urine.

Treatment

Treatment for nasal congestion depends on the disease that caused it.

If nasality is caused by a runny nose and nasal congestion, then nasal drops or sprays can be used: Nazivin, Galazolin, Sanorin, Tizin, Otrivin, etc.

If the cause is more serious, serious surgical intervention may be required: elimination of the anatomical defect, installation of a pharyngeal arbiturator, surgical correction of the deformity of the nasopharynx.

If necessary, remove polyps, adenoids and tumors. After the operation, it is necessary to massage the scars of the palate, to monitor the correctness of the palatopharyngeal closure.

In addition, physiotherapy, psychotherapy and long-term treatment by a speech therapist are used. The surgeon only eliminates the cause of nasality, but only a speech therapist can teach the correct pronunciation of sounds.

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

The exercise

With open and closed rhinolalia, articulation exercises for the tongue should be performed:

The tongue should be pulled down to the chin and fixed in this way for 5-10 seconds.
To make fluctuations with a protruding tongue from one corner of the mouth to another.
Open your mouth wide, stick out your tongue and rotate in a circle, imitating the hands of a clock.

The second set of exercises for the treatment of nasality:

Exercise according to the method of Emelyanov. Pronounce the vowels in the following order "waaee". At the sound of "y" make a good yawn.
Sing vocal exercises and your favorite songs to the sounds "u", "o", "u".
"Yawn". Make yawning movements several times. This exercise is very effective for proper breathing.
Sounds "mu" and "nu". Say these words slowly, separating the letters: "m, y, n, y."
Drink water in very small sips. This stimulates the rise and tension of the tongue.

With open nasality, very it is important to learn how to breathe correctly. For this you need to perform simple exercises: puffing cheeks, soap bubbles, imitate blowing out fire.

When eliminating nasality, it is necessary to teach the patient to speak abruptly, very clearly, slowly, opening his mouth wide. It is important to be able to distinguish the correct pronunciation of sounds from the wrong one.

If the child is small, parents should do the massage:

Clean pad of index finger right hand the boundary between the hard and soft palate is rubbed to stimulate the reflex contraction of the muscles of the nasopharynx.
Repeat this action when the child says the letter "a".
Perform zigzag exercises from the left edge of the palate border to the right and in the opposite direction.
The index finger makes light pressing and pushing movements of the soft palate.

Massage should not be carried out immediately after eating, as it can cause a gag reflex.

Treatment of nasality in children should be carried out carefully and in a timely manner, with a neglected form, speech defects can cause isolation, nervousness and even anger in a child.

Usually, nasality requires long-term treatment and great efforts from both the speech therapist and the parents.

Prevention

To prevent the occurrence of nasality and further complication, the following recommendations must be followed:

monitor the condition of the nasopharynx, with the slightest change, you should consult a doctor;
avoid colds and viral diseases;
pay attention to how you pronounce individual sounds and words;
if surgical intervention is necessary, do not delay, otherwise the consequences of such a delay can be very serious for health;
avoid hypothermia and observe correct mode day.

Forecast

Nasalness at any age requires long and regular practice. The course of treatment of rhinolalia is usually quite long, here you should not expect a quick result. But at correct staging Diagnosis and competent therapy nasality responds well to treatment.

Children's ENT doctor

Conducts reception, examination and consultation of children with hearing impairment and inflammation of the respiratory tract. Constantly improves his qualifications in the field of otolaryngology. Also attends scientific conferences for the practical treatment of patients.

Causes nasality in the absence of a runny nose can lie in:

deviated septum (symptoms of this can appear at any age); vasomotor rhinitis; development of sinusitis or frontal sinusitis; adenoiditis (mainly in children); rhinolalia (logopedic disorder, characteristic of preschool children); the formation of polyps or tumors of various nature in the nose; chronic hypertrophic rhinitis, in which there is a thickening of the mucous membrane of the nasal cavity.

Also, nasality may be present in the initial stages of the development of acute respiratory infections or an allergic reaction, accompanied by swelling of the mucous membrane of the nasal cavity. But if more than a week you continue talk through your nose without a runny nose, you should contact the ENT and look for the causes of this phenomenon among those listed above.

Certain pathologies can not only annoy and cause poor health, but also greatly affect a person’s voice. Many people are familiar with this unpleasant sensation, when, due to the nasal voice, it is difficult for others to understand you, because some of the sounds disappear and speech becomes slurred.

This phenomenon often occurs with a runny nose and disappears when it is cured. However, if a patient comes to the doctor with a complaint: “The nose is breathing, but I am talking through the nose!”, Then this is already a reason to take care of health seriously. Therefore, further we will talk about the causes of this phenomenon and how to eliminate it.

Causes of nasal voice

Roughness is a fairly common occurrence.

Before dealing with why a person speaks through the nose, we first briefly consider what this pathological phenomenon is.

Nasal (rhinolalia)- incomplete violation of the voice (dysphonia), expressed in a sound defect in the pronunciation of sounds.

Appears due to excessive or insufficient resonance of the nasal cavity.

reference. Nasalness does not allow air to pass through the nose, as a result, a person recreates sounds exclusively with his mouth, the nasal cavity does not participate.

As a result, speech becomes slurred, and sounds are distorted, especially "m" and "n".

It is worth noting that nasality is divided into several varieties, each of which has certain characteristics:

open- sounds have the ability to pass not only through the mouth, but also through the nasal cavity; closed- the patency of the nasal cavity is impaired, due to which it is completely closed for the passage of sounds and air; mixed- characterized by obstruction of the nose and a weakened palatopharyngeal closure.

Rhinolalia is divided into several varieties depending on the nature of the violation of the patency of sounds and air.

The reasons for the complaints "I speak through the nose" can be divided into two groups. The first group includes the following:

Poor palate movement. Defects of the soft or hard palate. wrong shape language in pronunciation. Congenital or acquired curvature of the nasal septum. Injuries of a different nature.

The second group includes ailments accompanied by such a violation in the voice:

nasality after and during a runny nose; hypertrophy and swelling of the turbinates; adenoids; polyps; tumor formation in the nasopharynx; tertiary syphilis.

In addition, nasality can be observed in the absence of any pathologies. It may be due to the habit of pronouncing words incorrectly due to the presence of hearing impairments (deafness or hearing loss).

Having determined the causes of this condition, let's move on to considering the question of how not to speak through the nose, that is, to eliminate this unpleasant voice defect.

How to get rid of disgust

Experts say that it is possible to eliminate almost all cases of this defect, but one cannot do without medical help.

Therapeutic measures depend on the type of ailment that provoked the development of nasality.

If the cause was a common rhinitis, then nasal drops or a spray to relieve nasal congestion will come to the rescue: Nazivin, Otrivin, Sanorin, etc.

In addition, washing the nasal cavity with products based on sea water or conventional saline solutions, which have proven themselves well in the treatment of the common cold (Aquamaris, Aqualor, Quicks).

If the cause is more serious, the doctor may prescribe an surgical intervention to do the following:

Elimination of anatomical defect. Correction of the deformity of the nasopharynx. Correction of a deviated nasal septum. Installation of a pharyngeal arbitrator. Removal of tumors, adenoids, polyps.

After surgical intervention, it is necessary to massage the scars of the palate and monitor the correctness of the palatopharyngeal closure.

In addition, an additional course is assigned physiotherapy, psychotherapy, as well as classes with a speech therapist.

Reference. The surgeon is able to eliminate only the cause of rhinolalia, after which a speech therapist takes over, who can teach how to correctly pronounce sounds.

Lessons with a speech therapist

What to do if you speak through your nose when the examination did not reveal any pathologies?

The speech therapist will form the correct pronunciation of sounds

Perhaps it's just a habit that has been forming for a long time.

Here, classes with a speech therapist will help eliminate the nasality, including the following exercises:

articulation and breathing exercises; speech therapy massage of the soft and hard palate; correct pronunciation and phrasing.

Articulation gymnastics is suitable for both open and closed rhinolalia and includes the following exercises:

Pull the tongue down to the chin and fix in this position for 5-10 seconds. Perform movements with a protruding tongue from one corner of the mouth to another. Open your mouth wide, stick out your tongue and make circular rotations with your tongue.

In addition, the speech therapist teaches the patient to breathe correctly (with open rhinolalia). To do this, the patient is invited to perform fairly simple exercises:

puff out cheeks; blow soap bubbles; simulate blowing out a fire.

Against this background, there is a parallel work on the correctness of speech, which consists in pronouncing certain combinations of sounds. Such exercises are performed both with a speech therapist and are given to the patient as homework.

Conclusion

Speaking through my nose after a cold is a circumstance that worries many people, judging by the number of such statements on the forums. However, there is nothing wrong with this. This is just a residual phenomenon of the transferred disease, which eventually disappears.

But if nasality appears for no apparent reason, in the absence of a runny nose or a cold, then this circumstance is a reason to contact a specialist.

Most often, the precursors of temporary nasality are a runny nose and a cold. This symptom is neutralized by complex treatment.

Excitement and misunderstanding in parents causes a distortion of the timbre of the voice while maintaining the natural drainage of the sinuses. Therefore, the question remains how and with what to treat if the child speaks through the nose, but there is no snot, and the nose breathes?

What is vileness?

As a result of excessive or weak resonance in the nasal cavity, a defect in sound pronunciation is formed - nasality (the identical names are rhinolalia, palatolalia). The reason for the change in speech in children is the failure of the functioning of the speech center.

Diversification of the resonator function has three forms:

closed. The catalysts of the sound defect are organic changes in the nasal or nasopharyngeal region, which provoke the congestion of the ENT organ, the lack of natural communication of the air-bearing anastomoses with the external environment; open. Pathological changes in the timbre of the voice appear when the back palate lags behind the back wall of the pharynx, as a result, a gap is formed for the penetration of air masses into the nasal cavity; mixed. It is characterized by obstruction of the nasal canals and a weakened palatopharyngeal closure.

Nuance! Violation of sound pronunciation goes through 4 stages of development, where with each subsequent phase, the severity of nasal and dyslalia increases.

Main reasons

The reasons for the development of rhinolalia are very diverse, the main list is reduced to the following factors:

pathological growths of epithelial cells (polyps); inflammation of the oropharynx; rhinopharyngitis (outflow of snot along the back of the throat); mucosal vasoconstruction due to the use of drugs; congenital defects of the nasal passages; the ingress of foreign bodies into the sinuses; curvature of the nasal septum; nose injuries; physiological congestion in newborns.

The manifestation of a sound defect requires medical attention. On examination, the speech therapist examines the anatomical features of the speech apparatus, the quality of breathing, the nature of sound defects, and the course of the pathology.

With the right diagnosis and treatment, nasality responds well to treatment.

The main task of a specialist- identify and eliminate the irritant by a conservative method or surgically.

How and how to treat nasality without snot

Therapy of palatolalia is determined by the etiology of the pathogen. If, a child’s nose is ringing due to a violation respiratory system, then the danger is infection of the bronchi and lungs. With nasal congestion, along with the air inhaled by the mouth, infections penetrate the body, affecting healthy organs and systems.

Oxygen starvation inhibits brain activity, inhibits the work of functional units of the body. To prevent negative consequences, the migration of the disease to chronic form, it is important to carry out a correction in the early stages of the manifestation of pathology.

For reference! For complete visualization clinical picture the doctor prescribes instrumental research methods: X-ray, electromyography, pharyngoscopy.

The causes of a temporary change in the timbre of the voice include inflammation of the accessory sinuses, swelling of the mucous membrane, when there is a sign of nasality, but there is no runny nose. The frontal and maxillary sinuses are involved in the formation of the color of the sound. With injuries of the nose, against the background of viral diseases, the air cavities become inflamed, sinusitis or frontal sinusitis develops.

Treatment for maxillary sinusitis includes complex problem solving. An important condition for active recovery is the irrigation of the nasal cavity.

Washing the sinuses

Under adverse climatic and living conditions, the mucous membrane dries up, crusts form on its surface, which disrupt the drainage of the nose. Treatment pathological changes begins with mechanical cleansing of the sinuses from foreign agents, dust, accumulations of nasal secretions.

Important! Starting from the age of five, babies in the initial stages of the pathology undergo non-invasive vacuum drainage of the accessory sinuses.

Children over 4 years old the toilet of the nose is carried out using saline, saline or antiseptic drugs: Miramistin, Chlorophyllipt, Chlorhexidine.

Medicinal liquid washes the nasopharynx, flows freely through the opposite nostril, neutralizing pathogenic microflora. The procedure accelerates the process of regression, stops inflammation and swelling of soft tissues, and normalizes natural breathing through the nose.

Medical therapy

To prevent nasal nasality in a child, parents should monitor the condition of the nasopharynx, with minor deviations, consult a doctor

Treatment of such ENT diseases as mucosal edema, sinusitis, frontal sinusitis or sinusitis, which provoke the nasality of a child's voice, requires the use of drugs from different pharmaceutical groups:

vasoconstrictor. The main task is to restore nasal breathing, reduce hyperemia of soft tissues, normalize nasal secretion, aeration of the middle ear. The therapeutic regimen for children includes medicines based on phenylephrine - "Nazol Baby", "Nazol Kids", "Polydex", "Vibrocil"; antibacterial. It is prescribed for infectious etiology of inflammation to suppress the growth and reproduction of pathogens. In the treatment of the upper respiratory tract, antibiotics of the penicillin series (Amoxiclav), cephalosporins in tablets or injections (Ceftriaxone, Cephalaxin), azalides (Azithromycin) are used. Antimicrobial and anti-inflammatory activity have a wide range of intranasal agents - "Bioparox", "Isofra". Recovery rate varies 5 to 10 days taking into account the severity of the disease; antihistamines. In order to eliminate an allergic reaction or prevent its occurrence, hyposensitizing drugs are used to inhibit the production of histamine. Most often, children are prescribed "Loratadin" in syrup or tablets, "Kestin", "Terfenadin"; corticosteroid. Hormonal remedies reduce inflammation and swelling of the mucosa, thereby normalizing the sound of the voice, restore the activity of the ciliated epithelium. The preparations Nasonex, Flixonase, Avamis proved to be highly effective.

For reference! For the normalization of subfebrile indicators and relief pain children are prescribed "Aspirin", "Nurofen", "Paracetamol".

The conservative method is complemented by immunomodulatory drugs: Sinupret, IRS-19. They restore mucociliary clearance, form local immunity, accelerate the regeneration of the epithelium.

What to do if the child speaks through the nose, but there is no snot? There is a possibility that the problem lies in the pathology of the nasal passages. If suspicion of vasomotor rhinitis, hypertrophic rhinitis, or anatomical change in the nasal septum is confirmed, treat the disease conservative methods meaningless.

Surgically

To restore the tissue structure in case of polyposis or soft tissue hypertrophy prescribe gentle laser therapy, and correction of the nasal septum is possible only by surgery.

Treatment of adenoids, as a problem of nasality, begins with an increase in immune activity with vitamin complexes, symptomatic therapy and breathing exercises. With an increase in the pharyngeal tonsil with complete overlap of the nasal lumen the problem is solved by surgical removal of the tonsils.

Often nasality provokes hypothermia, acute respiratory viral diseases

Treatment and correction of the situation when the child breathes through the mouth, speaks through the nose, but there is no runny nose, starts with pathogen identification. With considering individual features The doctor draws up a medication regimen for the patient.

The task of parents- strictly follow the doctor's recommendations, create favorable conditions for the regression of pathology:

monitor the temperature and humidity levels in the room. Optimum temperature for daytime activities reaches the mark 20⁰С, for sleep should be 2-3 degrees lower; in extremely dry air use a humidifier. If there is no climate device in the house, you can hang wet towels on the battery or put containers filled with water; regularly ventilate the room, carry out wet cleaning; walk more often in the fresh air; provide balanced diet with an emphasis on vegetables, fruits, dairy products; increased drinking regimen to relieve intoxication of the body.

For reference! Plants help keep the humidity in the room.

Nasalness as a result of impaired drainage of the sinuses is provoked by powerful antigens: dust, pet hair, feather pillows. Therefore, special attention should be paid to cleanliness in the house.

Conclusion

The sound pronunciation defect cannot go away on its own, it requires drug treatment. To prevent complications, chronic course pathology when changing the timbre of the voice without producing snot, seek medical help immediately.