Several questions have come in recently about how to get rid of hypernasality on a specific phoneme, particularly the hypernasal R and the nasal snort on one or more of the sibilants. I’d like to address these questions together…

We are talking about clients who produce nasal emission on one or more specific phonemes in the absence of more generalized hypernasality. These clients sniff, snort, or allow some nasal sound to escape during production of their error phoneme(s). Peterson-Falzone and Graham (1990) used the phrase phoneme-specific nasal emission to describe this error.

Treatment methods for these problems can be organized into four categories: Enhance biofeedback, manipulate speech, adjust supportive structures, and facilitate velopharyngeal movement. For the purposes of this blog post, let’s discuss biofeedback methods for these are the easiest to employ and they require the least amount of background information.

Enhancing Biofeedback

To enhance biofeedback means to provide some means of making the nasal and oral experiences more obvious to the client so he can be taught how to change them.

I like to start with correct sounds before I move on to the client’s error. For example, if the client is nasal on R, do not start with R. Start with an oral sound and a nasal sound like Ah and Ng. That way he can learn to recognize oral airflow and nasal airflow with phonemes he can do perfectly. Teach him “Ah comes out your mouth” and “Ng comes out your nose.” That way the client will learn the concept before he has to learn how to control the process.

Auditory Feedback

Tubes and other tools are used to enhance auditory feedback during phoneme rehearsal. This is an old classic method that has been used for more than a century. For example, Scripture (1912) used a rubber tube in this training. One end of the tube is held at the client’s nose and the other end is placed at the client’s ear. The client listens to his incorrect nasal sound. Then the nasal end is brought to client’s mouth so he can listen to his oral sound. Comparisons are made between oral and nasal sound. Today’s therapists use a vinyl tube, Toob-a-loo, SuperDuper Elephone, a pvc elbow joint, and other hollow tubes.

Visual Feedback

Objects are used to help clients visually understand the difference between oral and nasal airflow:

• Gestures: Most therapists use gestures to teach oral and nasal airflow. The simplest way to do this is to point to the mouth for oral sounds and to the nose for nasal sounds.
• Lightweight objects: The method discussed the most often in traditional articulation texts is to suspend or hold a lightweight object such as a string, tissue paper, feather, or bit of cotton in front of the nose or mouth. The object moves when air exits the nose or mouth when phonemes are produced.
• Breath indicators: Therapists have used specialized tools to help clients visually understand nasality ever since Scripture described a “breath indicator” he made in 1912. Modern therapists now use the professionally designed SeeScape.
• Mirrors and metal spoons: Cold mirrors and metal spoons are classic ways to visualize the escape of air through the nose. Place the mirror or spoon under the client’s nose to observe the breath clouding that occurs with nasal exhalation. Show the smudge to the client and explain that it means air is coming out his nose. Mirrors and spoons are used during an initial diagnostic session to assess the problem, and during direct therapy to teach the client how to change. “That air is coming out your nose. See if you can make it come out your mouth.”
• Nasometer: A nasometer is an instrument with a tube that fastens to the nose that is used to read the nasal escape of air. It has been shown to be an excellent tool for providing visual feedback about oral-nasal resonance and nasal emission (Kummer and Lee, 1996).
• Accelerometers: An accelerometer is a small electronic devise that can be affixed to the side of the nose to detect nasal vibration during production of speech. It is being investigated as a potential tool in research and for biofeedback during therapy (Thorp, Virnik, and Stepp, 2013).
• Computer programs and apps: Some computer programs have proven to be valuable tools for visual feedback regarding oral and nasal resonance. For example, Fletcher and Higgins (1980) found that their system provided useful visual feedback for clients with hearing impairment. Therapists who know of apps for this purpose could please leave sugestions in the comments.

Tactile Feedback

A variety of classic methods can be used to employ the tactile system in the process of biofeedback regarding phoneme-specific nasal emission:

• Feel nasal vibration: The most common traditional way to do this is to have the client place one of his fingers alongside his nose so he can feel the nasal vibration that occurs there when a phoneme is made with nasality. This is the basic motokinesthetic technique that was used extensively throughout the 20th century (Young and Hawk, 1955). “Hold the child’s finger on the side of your nose as you say the sound correctly and incorrectly to contrast. Then hold his finger against his own nose and have him prolong the sound” (Hanson, 1983, p. 201).
• Feel airflow: Place the client’s fingers right on the bottom of his nose to loosely plug the nares from below.   The client will feel the vibration of voice or the stream of air as the target phoneme exits the nose. Have the client do this loosely enough that the nasal sound still can escape. Voiced nasal sounds cause a stronger more obvious feeling of vibration of the nares, and oral sounds should be void of this feeling.
• Puff of air: Another way to pique tactile awareness of nasal airflow is to provide a quick and gentle puff of air shot into the nasal cavities. Use a nasal bulb or a squeeze bottle, and have the client shoot a gentle puff of air himself for safety. Place a pleasantly scented cotton ball inside the squeeze bottle to make the activity more amusing, or use several scents in different bottles for fun. Keep in mind that the olfactory mechanism habituates to odor very quickly, and that it is just the initial one or two gentle shots that jolt a client’s attention to the scent of the airflow.

References

• Fletcher, S.G., & Higgins, J. M. (1980). Performance of children with severe to profound auditory impairment in instrumentally guided reduction
of nasal resonance. Journal of Speech and Hearing Disorders, 45, 181-194.
• Kummer, A. W., & Lee, L. (1996). Evaluation and treatment of resonance disorders. Language, Speech, and Hearing Services In Schools, 27, 271-281.
• Peterson-Falzone, S. J., & Graham, M. S. (1990). Phoneme-specific nasal emission in children with and without physical anomalies of the velopharyngeal mechanism. Journal of Speech and Hearing Disorders, 55, 132-139.
• Scripture, E. W. (1912). Stuttering and Lisping. New York: Macmillan.
• Thorp, E. B., & Virnik, B. T., & Stepp, C. E. (2013). Comparison of nasal acceleration and nasalance across vowels. Journal of Speech, Language, and Hearing Research, 56, 1476-1484.
• Young, E. H., & Hawk, S. S. (1955) Moto-Kinesthetic Speech Training. Stanford: Stanford.