Nasal disorder

Classification according to ICD-10
R49.2	Rhinophonia (aperta) (clausa)
ICD-10 online (WHO version 2019)

A nasal disorder is present when there is an acoustically audible deviation in the physiological nasality of the respective phoneme .

In the literature, mostly for historical reasons, different terms are used for one and the same clinical picture. In addition to rhinolalia, rhinophonia, rhinophonolalia, palatophonolalia , dysglossia palatalis also appears. What these terms have in common is that they mainly reflect on the causes, effects or locations of the disturbance, the expression of the disturbed nasality, without this being certain in its unambiguity. Therefore, if possible, these terms should be avoided and the descriptive term nasality disorder should be used. A distinction is made between open nasal forms ( hypernasality ) and closed noses ( hyponasality ). With hypernasality there is an increased involvement of the nasal resonance spaces (typical with cleft palates ), with hyponasality there is less involvement (typical with a cold). Mixed nasalization (due to a combination of velum insufficiency and displacement of the nasal cavity) is rather rare.

physiology

→ Main article : "Physiological nasality" in the article Nasality

Diagnosis

Above all, medicine (especially the fields of phoniatrics and pediatric audiology , ENT, and oral and maxillofacial surgery ) deals with nasality disorders.

The subjective auditory impression is important. In addition to the general impression of spontaneous speech, special test sets with combinations of nasals and plosives , as well as various vowels , consonants and their connections are used. A semi-quantitative test that is easy to carry out is the Gutzmann test . It is based on the different closure of the velum in the vowels / a / (larger opening) and / i / (complete closure). With the Czermak plate , the nasal breakthroughs in breathing can also be recorded semiquantitatively when speaking. The nasal penetrations can be monitored with a phonendoscope . In addition to the procedures mentioned, medical practice uses nasometry as an objective and quantitative procedure. The determined nasalance values can be, for. Providing information about the velum function and the progress of the therapy, e.g. in (postoperative) therapy (e.g. of LKG patients), can be used therapeutically by means of auto-feedback. In some regions of Germany, normal values ​​for nasalance have been determined.

An organic examination of the organs involved is carried out to assess the genesis:

1. Inspection of the oral cavity with assessment of the soft palate function (lifting with phonation of / a /), the Boenninghaus test (strength of the palatal arch activity )
2. Examination of the nose to assess the nasal passages and the nasal septum (rhinoscopy using a nasal speculum and rigid endoscope )
3. Examination of the sinuses with sonography or X-ray examination
4. Examination of the nasopharynx . Of particular interest is the description of the degree of closure or opening or the movements of the soft palate . The gold standard is the (video-assisted) transnasally performed flexible endoscopy . In addition to the posterior sections of the nose and the nasopharynx, a differentiated assessment of the soft palate at rest, while swallowing and speaking can be carried out without impairing the subject. Three different basic closure patterns of the velopharyngeal closure can be classified: sagittal (movement of the soft palate backwards to the posterior wall of the pharynx), circular (involvement of the lateral pharyngeal walls ), coronal (predominantly lateral pharyngeal walls). Depending on the function of the soft palate to the primary, phyllogentically older, function of closing when swallowing or the secondary, more recent function of sound formation, different closure patterns can often be recognized.

At present, a further large number of technical, objective procedures exist and have been tested that can provide information about the degree of opening and the flexibility of the velum - e.g. B. electromagnetic articulography , high-frequency video cinematography, X-ray diagnostics / video fluoroscopy , electromyography , spectrography ( sonagram ), which are mainly used for research purposes.

causes

A basic distinction is made between two groups of causes:

• organic causes

Organic causes of impairments soft palate (velum) (v. A. Cleft as by malformations Velumspalte , cleft lip and palate ), paralysis, injury, tumors, as well as changes in the nasal cavity itself as deviated septum , nasal concha hyperplasia , malformations, tumors.

• functional causes

In the case of functional causes, the organic function of the system itself is in order; nasalizing is triggered by a consciously or unconsciously applied malfunction. In addition to psychological causes, z. B. a relieving posture after an operation in the area (often after tonsillectomy or adenotomy ).

therapy

In addition to, if possible, removal of the organic damage through an operation (closure of the gap formation, septoplasty, turbinate caustic) or surgical reduction of the distance between the velum and the posterior wall of the pharynx (velopharyngoplasty), "practicing" therapy methods come into play, in which the pathological airflow control is corrected an approximation of the physiological nasality is brought about.

Individual evidence

1. ↑ W. Reuter et al .: Objective nasality measurement - determination of the normal threshold. In: M. Gross (Ed.): Current phoniatric-pedaudiological aspects. 1997/98, Vol. 5. Median-Verlag, Heidelberg 1998, ISBN 3-922766-35-8
2. ↑ RJ Baken: Clinical Measurement of Speech and Voice. College Hill Press, 1987, ISBN 0-316-07833-6

literature

• Jürgen Wendler, Wolfgang Seidner, Ulrich Eysholdt: Textbook of Phoniatry and Pedaudiology . 4th edition, Thieme-Verlag, Stuttgart 2005, ISBN 3-13-102294-9
• Jenö Hirschberg: Velopharyngeal insufficiency. Folia Phoniatrica 1986; 38: 221
• Jenö Hirschberg, Manfred Gross: Velopharyngeal insufficiency with and without cleft palate. Median-Verlag, Heidelberg 2006, ISBN 3-922766-82-X
• U. Wohlleben: Functional therapy for patients with cleft lip and palate. In: Gerhard Böhme: language, speech, voice and swallowing disorders. Vol. 2: Clinic. Urban and Fischer, Munich 2001, ISBN 3-437-46961-4

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !