This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Getting Rid of Hypernasality
By Pam Marshalla
Q: My client produces some vowels with nasality. Do you know how to get rid of this problem?
Old-fashioned articulation texts (pre-phonology) used to contain large sections, even whole chapters, on how to do this. Let me give you one method to get you started. This one is central to all the rest because it uses a simple biofeedback procedure.
Getting rid of nasalization is mostly a matter of ear training. The following represents the way that therapists like Alexander Graham Bell and Charles Van Riper did this. This is good old-fashioned articulation therapy.
Van Riper called these types of things “phonetic placement techniques” and modern therapists have called them “oral motor” (meaning “mouth movement”) techniques. This is all the same thing.
Discover Oral and Nasal Airflow
- Start with any phoneme that the client can make with good oral airflow—Say S, or T, or L, or Y.
- Have him make this sound as he always does as he holds one end of a tube up to his mouth. Place the other end at his ear. Let him hear that the sound is coming out his mouth.
- Next, have him hold the tube up to his nose as he makes the phoneme, and let him hear that the sound is NOT coming out his nose.
- Now repeat this procedure with the nasal consonants–– M, N, Ng.
- Teach him that some sounds come out the mouth, and others come out the nose. Make a simple consonant chart to demonstrate this. Teach him that ALL the consonants come out the mouth except M, N, and Ng.
- Now make a list of all the vowels as he understands them––A, E, I, O, U, and sometimes Y–– and teach him that ALL the vowels come out the mouth.
Discover the Problem
- Use the tube to explore the vowels your client is making with nasal airflow when he should be using oral airflow.
- Help him understand that he is making the sounds through his nose when he should be making them through his mouth.
- Encourage careful listening and discrimination of oral and nasal airflow. Help him understand the problem.
Learn Oral/Nasal Control
- Have the client learn to control oral and nasal airflow.
- Have him hold the tube at his nose and ear, and have him make a nice oral sound, like S. Then tell him to “Make it come out your nose.” Most kids with average or above IQ can learn this type of thing. They can drive their good oral phoneme out through their nose on purpose.
- Now have him practice this sound back and forth between oral and nasal. Again, most kids can learn this if they have the intellectual capacity.
- Now work on his nasalized vowel. Have him make it “out your nose” and then “out your mouth.” For example, sequence “Ah” and “Ng” so the client is practicing “Ah-Ng-Ah-Ng-Ah-Ng.”
- Progress to syllables and words, and eventually phrases, sentences, and paragraphs. Continue to use the tube as needed.
The hollow tube is very important in this work. It will amplify the client’s speech sounds, and it will teach him exactly where the airstream is exiting his speech mechanism. There are many other tools that can be used, such as a PVC elbow joint, a RapperSnapper (I love these!), a toy stethoscope, or SuperDuper’s Elephone.
All of this information and more will be found in my upcoming publication, The Marshalla Guide: A Topical Anthology of Speech Movement Techniques for Motor Speech Disorders and Articulation Deficits, hopefully scheduled for publication in 2016 😀
5 thoughts on “Getting Rid of Hypernasality”
How could one adapt this to a 17 year old teen with DiGeoge Syndrome in high school? We are not supposed to use any intraoral devices. Thanks.
Thank you for your comment. Following Pam Marshalla’s passing in 2015, OMI Board Chair Robyn Merkel-Walsh MA, CCC-SLP, COM, helps us answer blog questions. Here is her reply:
I’m confused as to why you cannot use an intraoral device. Sometimes schools make blanket statements such as this with no backing from the county, state, or board policy, and I usually tell SLPs to fact check before accepting such a policy. Or, is this a temporary rule in relation to the Coronavirus?
The tool Pam was showing is a “toobaloo.” It does not go in the mouth but rather near it and can be disinfected. This is also a technique that’s useful when there is not a physical reason for the resonance issue or a residual issue after a cleft or VPI was repaired. I suggest you read the full sections on resonance in Pam’s new book The Marshalla Guide for other options without the use of tools of this rule can’t be modified in your work setting.
Hello, I have a little girl who only produce the /s/ and /z/ sound through her nose, making it sound very snorty. She didn’t had a cleft or anything. She had a follow up with an ENT who said everything is normal.
I have a 5th grade student who only had an /r/ concern when she began therapy …parents deny any indicators of cleft or sub-mucous cleft, and are reluctant to visit an ENT…she has a mild degree of ADD/ADHD..whenever she approaches a post vocal /r/, she becomes hyper-nasal on that part of the word only…thoughts anyone?
Hi, Same here. Wondering if you have had success with re-directing her airstream, orally. Unfortunately, I’ve made little progress with this.