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Disorder of pharynx — Clinical Guidelines

Overview

Hypernasality is a condition characterized by an excessive amount of nasal resonance during speech, often resulting from velopharyngeal dysfunction. It affects the quality of speech, making it sound overly nasal.

Diagnosis

Key Diagnostic Criteria: Increased nasalance scores measured using tools like the Nasometer 1.

Recommended Tests: Nasalance scores, Nasality Severity Index 2.0 (NSI 2.0) 2, acoustic analysis of formant regions 4.

Grading: NSI 2.0 shows excellent reliability with ICC values of 0.84 in adults and 0.77 in children, indicating consistent measurement 2.

Management

First-Line Treatments: Articulatory adjustments to reduce hypernasality 3.

Adjunctive Treatments: Use of instruments like the Nasal Resonometer for real-time assessment and treatment monitoring 5.

Special Populations

Pediatrics: Voice focus adjustments can be effective in children, though individual responses may vary 1.

Elderly: No specific data provided in the abstracts.

Comorbidities: No specific guidance provided for managing hypernasality in the context of comorbidities.

Key Recommendations

Utilize articulatory adjustments to mitigate hypernasality, supported by perceptual and acoustic improvements 3 (Evidence: Moderate).

Employ the Nasality Severity Index 2.0 for reliable assessment of hypernasality severity, considering its excellent test-retest reliability 2 (Evidence: Strong).

Incorporate real-time monitoring tools like the Nasal Resonometer for ongoing evaluation and treatment efficacy 5 (Evidence: Expert opinion).

References

1 Santoni C, Thaut M, Bressmann T. Immediate effects of voice focus adjustments on hypernasal speakers' nasalance scores. International journal of pediatric otorhinolaryngology 2020. link 2 Bettens K, Wuyts FL, D'haeseleer E, Luyten A, Meerschman I, Van Crayelynghe C et al.. Short-term and long-term test-retest reliability of the Nasality Severity Index 2.0. Journal of communication disorders 2016. link 3 Rong P, Kuehn D. The effect of articulatory adjustment on reducing hypernasality. Journal of speech, language, and hearing research : JSLHR 2012. link) 4 Kataoka R, Michi K, Okabe K, Miura T, Yoshida H. Spectral properties and quantitative evaluation of hypernasality in vowels. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 1996. link 5 Birch M, Humphries C, Stock C. Nasal resonometer: an instrument for the assessment and treatment of hypernasality. Journal of biomedical engineering 1991. link90026-4)

Disorder of pharynx