Dyslalia, dysarthria, rhinolalia are pathological conditions associated with the work of the vocal apparatus. Let us consider in more detail what rhinolalia is, what are the features of this violation, in which the 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 formed from Greek roots: “nose” and “speech”. If you look at the origins and rules of word formation, you can translate into the Russian term as "speech with a nasal tinge." Previously, it was customary to talk about tongue-tied tongue, a general collective concept that included rhinolalia and other disorders. From this term gradually began to depart in the second half of the last century. Earlier, dysarthria and dyslalia, problems with speaking, the cause of which is hearing loss, were also called tongue-tied.
Modern doctors are considering different forms of rhinolalia. There is a collective term “mechanical dyslalia”, which includes all the diversity of this pathological condition and dyslalia. Over time, scientific papers appeared suggesting that mechanical disturbances with different specific features should be considered separately. A distinctive feature of rhinolalia is a combination of voice disturbance and articulation. In this case, the person’s ability to pronounce vowels and consonants is impaired. 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 the person's ability to speak. The doctor analyzes anatomical defects, evaluates how the palate and pharynx are closed. 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 noticed at the moment when a person makes sounds. The exhalation is always directed through the mouth, regardless of the sounds that the patient speaks. Speech with rhinolalia of this type especially draws attention to the peculiarities of the sound of nasal sounds, since without resonance they turn into oral. For example, instead of “m”, a person says “b”, “n” is replaced by the sound “d”. If the articulation were normal, the nose and throat shutter would be open, due to which air could penetrate the nasal cavity. Due to the substitution of sounds, the conceptual speech apparatus suffers significantly. Perhaps covering the passage by a certain percentage. This creates peculiar combinations and combinations of sounds made by a person. Trying to pronounce “m”, the patient says “mb”, “n” turns into “nd”.
In addition to consonants, there is an incorrect pronunciation of vowels. Some tones are inaccessible to a person, due to which speech is poor. Vowel sounds are blurred, unnatural inherent, they sound monotonous.
Where did it come from?
Studies have shown that closed rhinolalia is possible in the case of organic disorders, due to which the space of the nose changes, and there is a barrier to the penetration of a stream of air into the body cavity. There is a likelihood of functional palatine disorders. There may be a pathology of the palate of the palate, the pharyngeal valve, responsible for the penetration of air flow into the nasal cavity. A classification system was introduced that combines the causes of rhinolalia, it follows the separation of all factors into functional and organic.
Organic causes are possible if the nasopharyngeal cavity, nose has undergone changes relatively standard due to the specifics of human anatomy. To eliminate the defect, it is necessary to operate on the patient, eliminating the obstruction in the cavity. Thus, patency is restored, a 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 with a speech therapist. The program is the same as with 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 can 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 the proliferation of tissues.
Functional type
This variant of the pathology is diagnosed if studies do not allow to establish the presence of organic damage that could cause the 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 a stream of air 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 are characterized by neurotic disorders. The root cause is the defeat of the central nervous system, that is, the soft palate is actually healthy. A high level of frequency of occurrence of this class of rhinolalia is noted. What this is, far from everyone knows, so many people simply do not recognize the pathological condition.
A situation is possible when organic rhinolalia was provoked by adenoids, but the person underwent surgery to remove them, and after the event, the ability to speak normally did not recover. It is also considered a functional impairment. 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, open rhinolalia occurs much more often than closed. Usually, the pathological condition can be explained by a violation of the separation of the oral cavity and nose. The air flows in a rather weak stream, when speaking, it simultaneously exits through the mouth and through the nose. This leads to a change in the tone of the spoken, a resonance is formed. Nasal sounds become especially pronounced in sound.
There is a likelihood of a congenital disorder if the patient has a cleft on the lip above, a pathology of the palate. There may be an acquired form of the disorder associated with injuries, muscle paralysis, and a tumor process. Rhinolalia can cause scarring, paresis.
Functional variety
Such open rhinolalia is possible with hypokinesis of the palate and lack of functioning, while it is not possible to detect obvious organic disorders. As work with the patient shows, with 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. Rinolalia can be attributed to the inability to control speech due to hearing impairment.
Functional open type is currently less common than organic. More often this is observed in people with a weakened physical condition. The predominant percentage falls on decreased muscle tone.
Combined type
Sometimes the sounds made during rhinolalia make it possible 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 what kind of impairment dominates. With the combined type, the air is partially "lost" through the nasal cavity. Along with this, the resonance is less than normal, which is why the acoustic parameters of the pronunciation are disrupted, articulation is lost, and the voice timbre changes.
Palatine clefts and childhood
In the overwhelming majority of cases, facial, palatal 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.
A wide variety of forms of palatine clefts are known. 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 impaired. In the medical literature on what rhinolalia is, this pathological condition is considered from the point of view of the causes that provoke facial defects, problems with labial and palatine clefts. Usually, genetic aspects are the first to draw attention. The heredity of anomalies is a question considered by numerous authors, but so far it has not been possible to finally identify all aspects of the situation.
Causes and consequences
Studies have shown that the appearance of palatine and labial clefts is largely dependent on biological factors. The work of scientists involved in determining what rhinolalia is, this phenomenon (the fact of the influence of a maternal disease on the embryo she carries) is considered quite versatile. The relationship with the transferred flu. Measles rubella and malaria can play a role. There is a chance of rhinolalia in the child if the mother was ill with toxoplasmosis, mumps, paratyphoid during pregnancy. There are certain dangers associated with stick invasion, which causes dysentery and typhoid fever.
Chemical aggressive phenomena can play a role. Household contact with gasoline and chlorine, other compounds that are widely used in everyday life, can provoke rhinolalia. Hazardous chemicals, acids and phenolic substances, as well as formaldehydes and nitric oxides. From year to year, the negative impact of the environment is becoming stronger, due to air pollution. Environmental degradation 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 crevices were born in people who had previously received a large dose of radiation. After the Chernobyl accident, the percentage of births with clefts that led to rhinolalia significantly increased in those areas that were exposed to radiation.
Factors and consequences
Often, correction of rhinolalia is required for children whose parents abused alcohol, drugs, and tobacco products. The influence on the anatomical features and the probability of abnormal development of the fetus of drugs is known. Especially dangerous are heat-reducing drugs, seizures, parasites, and a number of antibiotics. Pregnant women should not take hydrocortisone-containing formulations, psychotropic and sedatives. Vitamin complexes, hormonal preparations, artificial hormones can become the cause of 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 was established that the probability of abnormal development is higher than 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 will know from his own experience what rhinolalia is. This phenomenon threatens the baby if the mother's diet was poor in copper and zinc. Magnesium, manganese are very important. Clefts can form with a lack of vitamins, and with their excess intake. Especially dangerous is the saturation with retinol.
Versatile phenomenon
Scientists involved in the correction of rhinolalia, at present, cannot come to one opinion as to how strongly the social situation influences the likelihood of deviations in the child. Presumably, stress, mental trauma suffered by the mother can cause the formation of crevices in the fetus. Certain risks are associated with everyday disorder, a sharp impact on the psyche of a woman, problems in the family. So far, it has not been possible to fully evaluate how this factor is really significant.
There is a high probability of rhinolalia, if during the period of pregnancy a woman has impaired functioning of the endocrine, circulatory system and kidneys. Risks associated with anemia, exhaustion and gynecological diseases. Up to 20% of all cases do not find an explanation. Presumably, a previously transferred abortion plays a role, bearing two fruits at once, the age of the parents and what kind of child the woman has in her account.
Treatment features
With congenital rhinolalia, corrective measures begin with surgery. Currently, there is no consensus on what is the optimal timing for the intervention. In general, the practice is such that scientists are trying to identify the earliest possible time for correction, while striving to minimize undesirable consequences. So, too early a surgical intervention can cause a very narrow jaw from above or a violation of the structure of the rows of teeth.
When forming a cleft on the lip, the child is prescribed an operation for 2-3 months of life, if there are no contraindications. Interventions in the sky are organized at different times, much depends on what kind of operation needs to be done. Typically, surgeons take patients 2-3 years old, if the teeth come out, the roots fell into place. After the rehabilitation period, the child is sent to a speech therapist for classes. Rinolalia is corrected comprehensively, the intervention of a doctor alone is often not enough to exclude a defect.
Features of the 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 delayed - sometimes for a fairly long time. Often it is necessary to operate the child in several stages. Before the operation, obturates are used, changing them if necessary. Usually this is due to the growth of the baby and, as a result, a change in the size of the cleft.
The operation is prescribed to adjust the anatomical structure, and at the same time, the functionality of the organs with which people talk. However, only the operation, no matter how it goes, the speech does not normalize, because by the time of its implementation the child already has some patterns, pronunciation skills, sound formation. The kid needs to be re-educated and adapted to the updated anatomy - for this it is necessary to practice special exercises. Rinolalia is well corrected by classical breathing exercises developed by Strelnikova. You can use almost any sets of exercises, but do not overload the patient too much, especially at first.
Correction: what are the approaches?
If rhinolalia is detected, it is worth contacting a speech therapist. Sometimes psychologists come to the rescue. A specialist with a pedagogical education works with the child, helping him to create the correct speaking patterns based on the characteristics of the deviation. In addition, a dentist can be involved in the work.
Respiratory gymnastics in getting rid of rhinolalia has proven itself long 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, ease the course of ischemia and get rid of stuttering.
In order to minimize the problems of rhinolalia, if there are prerequisites for it and subject to physiological, anatomical defects, it makes sense from an early age to work with a child using a special teaching methodology. Adults help the baby to control the voice. The Orlova method has been developed, aimed at forming a normal voice with 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 mental state of the child, who are characterized by voice disorders.