Duke's noseI recently had a preschool child referred to me for articulation and possible hypernasality issues. Mom was actually spot on in our initial phone conversation, telling me what sounds were misarticulated and of those, which ones were compromised¬†by nasal emission. I was preparing for the evaluation and came upon a very helpful outline for my testing, “Resonance Disorders and Nasal Emissions, Evaluation and Treatment Using ‘Low Tech’ and ‘No Tech’ Treatments,” in ASHA LEADER magazine. I printed out the content on evaluation and used it to record the child’s responses.

I quickly learned that his hypernasality was not due to velopharyngeal incompetence (VPI) or insufficiency (since he produced high pressure consonants and vowels with no nasality) but was rather “velopharyngeal mislearning when there is hypernasality or nasal emission due to faulty articulation. This can occur due to pharyngeal or nasal articulation of certain sounds. Abnormal articulation can cause phoneme-specific nasal emission, usually on sibilant sounds.” He matched that as he made his /s, f, th/ with nasal emission. I had brought straws and a mirror to detect any nasal emission but they weren’t needed as he repeated an /s/ in isolation, closed his lips tight and blew air out his nose.

The article for ASHA LEADER is also good for taking quotes to give to parents to explain their child’s resonance pattern and the why behind it.