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Resonance disorders, cleft palate and velopharyngeal insufficiency
Hypernasality comes from inadequate closure between the soft palate and the pharyngeal wall, hyponasality from obstruction in the nose or nasopharynx; in cleft palate, a structural problem that is corrected surgically is separated from compensatory articulation habits that are treated with speech therapy.
Why it matters in the exam
Questions present a child with hypernasality, nasal air emission and /p/ and /b/ replaced by glottal stops, and ask for the likely cause (cleft palate); or a child with large adenoids and ask how speech sounds (hyponasal). Assessment tools are asked about too: a sentence with no nasal sounds reveals hypernasality, and a sentence loaded with nasal sounds such as "Menachem Maman..." reveals hyponasality.
Another recurring point is nasal air emission on one sound only (for example /ʃ/) with no structural problem: this is a learned error and not a palatal problem, so it is treated with articulation therapy rather than surgery, and you should not wait for it to disappear by itself. Children with cleft palate are also at high risk of middle ear fluid and hearing loss, so hearing follow-up is part of care.
Key points
- Hypernasality: inadequate palate-pharynx closure; hyponasality: nasal obstruction.
- Cleft palate: hypernasality, nasal emission and compensatory articulation such as glottal stops.
- Structure is fixed by surgery; articulation habits are fixed by speech therapy.
- Nasal emission on one sound with no structural problem: articulation therapy.
- A child with a cleft: hearing follow-up.
Summary table
| Condition | Mechanism | How it sounds | What is done |
|---|---|---|---|
| Structural velopharyngeal insufficiency (VPI) | Short palate, cleft palate or submucous cleft | Hypernasality, nasal air emission, weak pressure on consonants | Assessment by nasendoscopy or fluoroscopy; surgery or a prosthesis |
| Neurological velopharyngeal incompetence | Both pharyngeal branches of the vagus paralysed | Hypernasality | Palatal lift or surgery; dysarthria treatment |
| Compensatory articulation in cleft | Glottal stops, pharyngeal fricatives in place of oral consonants | Low intelligibility even after palate repair | Articulation therapy; surgery does not fix a habit |
| Nasal air emission on a specific sound | A learned error with no structural problem | Nasal emission on only one or two sounds | Articulation therapy, not surgery |
| Hyponasality | Large adenoids, a cold, nasal obstruction | Nasal sounds come out like /b/ and /d/ | Medical treatment of the obstruction |
| Sentence tests | A sentence with no nasal sounds; a sentence loaded with nasal sounds | The first exposes hypernasality, the second hyponasality | Compare with the nose pinched; nasometry |
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Sources
- ASHA Practice Portal, 2024 — Cleft Lip and Palate
- Kummer, Cleft Palate and Craniofacial Conditions: A Comprehensive Guide to Clinical Management, 4th edition (2020) — Resonance disorders and velopharyngeal dysfunction
- Peterson-Falzone et al., Cleft Palate Speech, 4th edition (2010) — Compensatory articulation
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.