Dyslalia, dysarthria, rhinolalia are pathological conditions associated with the functioning of the vocal apparatus. Let us consider in more detail what rhinolalia is, what are the features of this disorder, in which a person's ability to produce sounds suffers. In addition, pathology affects the timbre of the voice. The reason for this is the anatomical, physiological imperfections of the organs necessary for speaking.
General definition
Like dyslalia, rhinolalia is a condition in which there are certain problems with pronunciation, which is recorded in the name of the disease. The word is derived from the Greek roots: "nose" and "speech". If we turn to the origins and rules of word formation, we can translate the term into Russian as “speech with a nasal tinge”. It used to be customary to talk about tongue-tiedness, a general collective concept that included rhinolalia and other disorders. From this term gradually began to leave in the second half of the pastcenturies. Previously tongue-tied was also called dysarthria and dyslalia, problems with speaking, the cause of which is hearing loss.
Modern doctors consider different forms of rhinolalia. There is a collective term "mechanical dyslalia", which includes all the variety of this pathological condition and dyslalia. Over time, scientific works have appeared that propose to consider separately mechanical disorders with different specific features. A distinctive feature of rhinolalia is a combination of voice impairment and articulation. This disrupts the ability of a person to pronounce vowels and consonants. The ability to produce sounds is affected, while the pathology affects the voice, the pronunciation becomes nasal.
Types and categories
Forms of rhinolalia are classified, focusing on the features of the pathological development of the organs responsible for a person's ability to speak. The doctor analyzes anatomical defects, evaluates how the palate and pharynx close. It is customary to distinguish a combined form, closed and open. Based on the etiology, all cases are divided into functional and organic.
Closed pathology
With a closed type of violation, nasal resonance is below normal - this can be seen at the moment when a person makes sounds. Exhalation is always directed through the mouth, regardless of the sounds that the patient pronounces. Speech with this type of rhinolalia especially attracts attention with the peculiarities of the sound of nasal sounds, since without resonance they turn into mouth sounds. For example, instead of "m" a person says "b","n" is replaced by the sound "d". If articulation were normal, the nasal and pharyngeal closure would be open, allowing air to enter the nasal cavity. Due to the substitution of sounds, the conceptual speech apparatus suffers significantly. It is possible to cover the passage for a certain percentage. This creates peculiar combinations and combinations of sounds produced by man. Trying to pronounce "m", the patient pronounces "mb", "n" turns into "nd".
Except for consonants, there is an incorrect pronunciation of vowels. Some tones are inaccessible to a person, due to which speech sounds poor. Vowel sounds are blurred, unnatural, and speech sounds monotonous.
Where did it come from?
As studies have shown, a closed rhinolalia is possible in case of organic disorders, due to which the space of the nose changes, an obstacle appears for the penetration of a jet of air into the cavity of the organ. There is a possibility of functional palatine disorders. There may be a pathology of the curtain of the sky, the valve of the pharynx, which is responsible for the penetration of the air flow into the nasal cavity. A classification system was introduced that combines the causes of rhinolalia, it follows the division of all factors into functional and organic.
Organic causes are possible if the cavity of the nasopharynx, nose has undergone changes relative to the standard ones due to the specifics of human anatomy. To eliminate the defect, it is necessary to operate on the patient, getting rid of the obstruction in the cavity. Thus, the patency is restored, the person can speak normally. Having eliminated the cause, a person gets the opportunity to breathe freely,speech defects disappear. In the absence of significant improvements after the operation, it is necessary to take a course of classes with a speech therapist. The program is the same as for functional deviations.
Organic Type: Species
Based on the characteristics of rhinolalia, cases of a closed type of organic nature are divided into anterior and posterior. The first is provoked by chronic rhinitis, in which the nasal mucosa grows. The cause may be polyps and tumor processes in the nasal cavity, a change in the properties of the septum. The posterior form is possible if the nasopharyngeal cavity becomes smaller, for example, due to tissue growth.
Functional type
This variant of the pathology is diagnosed if the studies do not allow to establish the presence of organic damage that could cause incorrect pronunciation of sounds. Work with the patient shows that the soft palate works too actively, is constantly in an elevated position and does not allow the air stream to enter the nasal cavity, due to which it is forced to pass only through the mouth. A closed functional type usually leads to a more pronounced violation of the timbre of the voice and the ability to pronounce sounds. A similar disorder is more often detected in children who have neurotic disorders. The root cause is the defeat of the central nervous system, that is, the soft palate is actually he althy. There is a high level of frequency of occurrence of this class of rhinolalia. Not everyone knows what it is, so many simply do not recognize the pathological condition.
Possiblea situation where organic rhinolalia was provoked by adenoids, but the person underwent an operation to remove them, and after the event, the ability to speak normally was not restored. This is also considered a functional disorder. To cope with it, you need to practice corrective work. Violation is recognized as central. Only a course of cooperation with a speech therapist is not always enough. Usually the patient is also consulted by a neurologist.
Open Type
As follows from medical practice, an open rhinolalia is much more common than a closed one. Usually, the pathological condition can be explained by a violation of the separation of the oral and nasal cavities. The air passes through a rather weak stream, when speaking, it simultaneously exits through the mouth and through the nose. This leads to a change in the timbre of the spoken, a resonance is formed. Nasal sounds become especially pronounced in sound.
There is a possibility of a congenital disorder if the patient has a cleft lip from above, pathology of the palate. There may be an acquired form of the disorder associated with injuries, muscle paralysis, and a tumor process. Rhinolalia can be provoked by scar formations, paresis.
Functional variety
Such an open rhinolalia is possible with hypokinesis of the palate and insufficiency of functioning, while obvious organic disorders cannot be detected. As work with the patient shows, during phonation, the rise is insufficient. This often happens if the impulses of the nervous system are weaker than normal, the patient's muscular system is sluggish. Rhinolalia may be due to the inability to control speech due to hearing loss.
The functional open type is currently less common than the organic type. This is more common in people with a weakened physical condition. The predominant percentage falls on reduced muscle tone.
Combined type
Sometimes sounds made during rhinolalia allow us to suspect a mixed form of pathology. It is diagnosed if there are factors due to which there are signs of both a closed type of pathology and an open one. Speech disorders are determined by which disorder dominates. With the combined type, air is partially “lost” through the nasal cavity. Along with this, the resonance is less than the norm, which is why the acoustic parameters of the spoken are violated, articulation is lost, and the voice timbre changes.
Cleft palate and childhood
In the vast majority of cases, facial, palatine defects observed in a child from birth are explained by exogenous or endogenous factors that affected the embryo during its intrauterine development. Pathogenic factors are possible. The most important are those that influenced the gestation period from 7 to 9 weeks - it is during this period that the jaw system and face are formed.
There is a wide variety of forms of palatine clefts. The appearance of one type or another is determined by a specific factor and the period of its influence on the fetus, as well as the degree to which normal development is disturbed. In the medical literature on what rhinolalia is, this is a pathological conditionconsidered from the point of view of the causes that provoke facial defects, problems with labial and palatine clefts. Genetic aspects are usually the first to attract attention. The heredity of anomalies is a question considered by numerous authors, but so far it has not been possible to definitively identify all aspects of the situation.
Causes and consequences
As studies have shown, the appearance of palatine and labial clefts largely depends on biological factors. The works of scientists involved in the definition of what rhinolalia is, this phenomenon (the fact of the influence of a maternal disease on the embryo she carries) is considered quite versatile. A relationship with the transferred influenza has been established. Rubella and malaria may play a role. There is a possibility of rhinolalia in a child if the mother during pregnancy was ill with toxoplasmosis, mumps, paratyphoid. There are certain dangers associated with bacillus infestation that causes dysentery and typhoid fever.
Chemical aggressive phenomena can play their role. Provoke rhinolalia can be household contact with gasoline and chlorine, other compounds that are widely used in everyday life. Poisonous chemicals, acids and phenolic substances, as well as formaldehydes and nitric oxides are dangerous. From year to year, the negative impact of the environment is becoming stronger, due to air pollution. The deterioration of the environment leads to an increase in the birth rate of children with defects. This is largely due to radiation exposure. There are cases when children with clefts were born to people who had previously receivedlarge dose of radiation. After the accident at the Chernobyl nuclear power plant, the percentage of those born with clefts, which led to rhinolalia, in those areas that were affected by radiation, increased significantly.
Factors and consequences
Often, correction of rhinolalia is required for children whose parents abused alcohol, drugs, tobacco products. The influence on the anatomical features and the likelihood of abnormal development of the fetus of medications is known. Heat-reducing drugs, convulsions, parasites, and a number of antibiotics are considered especially dangerous. Pregnant women should not take compounds containing hydrocortisone, psychotropic and sedatives. Vitamin complexes, hormonal preparations, and artificial hormones can cause improper embryo formation. Uncontrolled medication significantly increases the likelihood of a baby being born with abnormalities in the structure of the organs responsible for generating sounds.
It has been established that the probability of abnormal development is above average if the mother did not receive the necessary nutrients and microelements during the gestation period. The consequence of this may be the formation of cracks, which means that the child learns from his own experience what rhinolalia is. This phenomenon threatens the baby if the mother's diet was poor in copper and zinc. Magnesium and manganese are very important. Clefts can also form with a lack of vitamins, and with their excessive intake into the body. Saturation with retinol is especially dangerous.
Versatile phenomenon
Rhinolalia correction scientists are not currentlycan agree on how much the social environment affects the likelihood of a child having a deviation. Presumably, stress, mental trauma suffered by the mother can cause the formation of clefts in the fetus. Certain risks are associated with everyday disorder, a sharp impact on the psyche of a woman, problems in the family. It has not yet been possible to fully assess how significant this factor really is.
Rhinolalia is highly likely if during pregnancy the functioning of the endocrine, circulatory system, and kidneys was disrupted in a woman. Risks are associated with anemia, malnutrition and gynecological diseases. Up to 20% of all cases do not find an explanation. Presumably, a previous abortion plays a role, bearing two fetuses at once, the age of the parents and what kind of child the woman has.
Features of treatment
With congenital rhinolalia, corrective measures begin with surgery. At present, there is no consensus on the optimal timing for intervention. In general, the practice is such that scientists are trying to identify the earliest possible correction time, while trying to minimize undesirable consequences. For example, surgery carried out too early can cause a very narrow jaw on top or a violation of the structure of the rows of teeth.
When a cleft lip is formed, a child is prescribed surgery at 2-3 months of life, if there are no contraindications. Interventions in the sky are organized at different times, much depends onwhat kind of operation needs to be done. Usually surgeons take patients 2-3 years old, if the teeth have come out, the roots have fallen into place. After the rehabilitation period, the child is sent to a speech therapist for classes. The rhinolalia is corrected in a complex way, the mere intervention of a doctor is often not enough to exclude a defect.
Features of operation
When planning an operation, it is necessary to assess the general condition of the child. If the baby is physically very weak, the intervention is postponed - sometimes for quite a long time. Often it is necessary to operate on a child in several stages. Obturators are used before the operation, changing them if necessary. This is usually due to the growth of the baby and, as a result, a change in the size of the cleft.
The operation is prescribed to correct the anatomical structure, and at the same time the functionality of the organs with which people speak. However, only an operation, no matter how it goes, does not normalize speech, because by the time it is carried out, the child already has some patterns, pronunciation skills, and the formation of sounds. The baby needs to be re-educated and adapted to the updated anatomy - for this it is necessary to practice special exercises. Rhinolalia is well corrected by classical breathing exercises developed by Strelnikova. You can use almost any set of exercises, but do not load the patient too much, especially at first.
Correction: what are the approaches?
If rhinolalia is detected, you should contact a speech therapist. Sometimes psychologists come to the rescue. A specialist with a pedagogical education works with the child, helping him create the correct speaking patterns based on the characteristics of the deviation. In addition, a dentist may be involved in the work.
Respiratory gymnastics in getting rid of rhinolalia has proven itself for a long time and well. This approach is used by both doctors of our country and foreign specialists. Due to dynamic exercises, it is possible to exclude not only rhinolalia, but also asthma, alleviate the course of ischemia and get rid of stuttering.
In order for the problems of rhinolalia to be minimal, if there are prerequisites for it and subject to physiological, anatomical defects, it makes sense to work with a child from an early age using a special teaching method. Adults help the baby control his voice. Orlova's method has been developed, aimed at the formation of a normal voice in common types of rhinolalia. It is based on the experience of speech therapists and popular corrective techniques, while taking into account the nuances of the child's mental state, which is characterized by voice disorders.
