Nasal speech (hypernasality) and nasal air emission (air escaping down the nose when talking) happen when the back of the soft palate (roof of the mouth) does not fully close against the upper walls of the throat (pharynx) during speech, leaving the nasal cavity open.
A speech pathologist can assess and diagnose nasal speech, and plan the best treatment.
Signs and symptoms of nasal speech
If your child has nasal speech or nasal air emission, from the time that they start talking their voice may sound as though they have a blocked nose. They may mispronounce some words, especially words containing consonants such as 'm'.
When to see a doctor
If you are concerned about your child's speech, see your child's GP or paediatrician. They will be able to refer you to a speech pathologist, who can assess your child's nasal speech.
The speech pathologist may take an audio and/or video recording, which is used to measure sound coming from your child's mouth and nose during speech.
After the recording, your child may need more tests to determine how well the soft palate and back and sides of their throat (called the pharyngeal walls) are working during speech. These tests are called videofluoroscopy and nasendoscopy.
Videofluoroscopy
A videofluoroscopy is a special type of X-ray that records moving images of your child's mouth and throat while they speak. It also records the sound of your child's voice.
Before a videofluoroscopy, your child can eat and drink as usual. You are encouraged to stay with your child during the procedure.
Your child will sit on a chair near an X-ray machine and have a microphone attached to their clothing. They may need to have a small amount of barium liquid put into their nose so that the roof of the mouth and the walls of the throat are seen more clearly on the X-ray.
This does not hurt, but your child may taste it.
The speech pathologist will help your child say a list of words and sentences. This takes about 30 seconds.
The results from the test will be sent to your child's doctor, who will discuss them with you at your child's next appointment.
Nasendoscopy
During the test, a thin tube will be gently passed into your child's nostril and then further backwards so that it sits over the soft palate and walls of the throat. The tube has a bright light and is linked to a camera and computer.
Before the test, the doctor will examine your child's mouth and nose and then spray a small amount of local anaesthetic into one of their nostrils. This will make their nose feel numb and help them feel more comfortable during the test. However, the tube may still feel a
little uncomfortable, especially if your child's nose is particularly narrow or crooked.
Sometimes, the tube will be passed a little further down your child's throat so that their voice box (larynx) can be seen. This is usually done when a child also has a 'husky' voice, which is sometimes due to vocal nodules (little hardened lumps on the vocal cords).
After the test, the tube is removed from the nose. Your child's nose and throat will feel a little numb for about 15 minutes. It is better for them not to eat or drink (especially avoid hot food or drinks) until the numbness has gone away.
The results from the test will be sent to your child's doctor, who will discuss them with you.
Treatment for nasal speech
The results of the videofluoroscopy and/or nasendoscopy will be used to determine the best treatment option for your child. Treatment may involve:
- speech therapy, to help your child pronounce difficult sounds properly
- surgery, to help the soft palate close against the walls of the throat
- using a special dental plate, which may avoid the need for surgery.
Key points to remember
- Nasal speech and air escaping down the nose when talking happen when the soft palate does not work properly with the walls of the throat during speech.
- A videofluoroscopy involves X-ray imagery of your child while they say a list of words and sentences.
- A nasendoscopy involves a thin tube with a light and camera being passed into your child's nostril.
- Treatment for nasal speech may include speech therapy, surgery or a special dental plate.
For more information
Common questions our doctors are asked
At what age can these tests be done?
Videofluoroscopy can be done from the age of three years, as
long as your child is able to copy words and sentences. A nasendoscopy is
usually done on children over four years old, but sometimes younger
children can manage it. Young children usually sit on an adult's lap
during the test.
How much radiation will my child be exposed to in the videofluoroscopy?
Before the test, the radiographer will calculate
how much radiation is safe. This is based on your child's height and
weight. Then they will measure the amount of radiation exposure
during testing to make sure they never go over the safe limit.
Reviewed by The Royal Children's Hospital Speech Pathology department. We acknowledge the input of RCH consumers and carers.
Reviewed August 2018.
This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.
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