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…
By Pam Marshalla
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…
By Pam Marshalla
Q: My 4th grade client substitutes a nasal snort for his sibilants. Have you written about this? The escape of nasal sound on the sibilants is fairly common and has been called by various terms in the traditional literature––nasal lisp, nasal snort, recessive s-lisp, and nasal stigmatism. Peterson-Falzone and Graham (1990) used the phrases phoneme-specific nasal emission and posterior nasal frication to describe nasalized sibilants. I have written a whole chapter about how to work with resonance problems like this…
By Pam Marshalla
Q: My client had a tonsillectomy and adenoidectomy but she still sounds stuffy and nasal. Mom says she has always sounded this way. Suggestions? Voice is a very difficult topic for those of us who do not specialize in it. Many clients do not change their voice and resonance patterns after surgery because the “old voice” is just what they are used to. It’s the way they always have sounded. It’s them. Therapy intends to change that vocal quality. Unfortunately…
By Pam Marshalla
Q: I am working with a child 2;6 who substitutes /n/ or /m/ for many other consonants. We have worked with words she says often, and she can make the correct sounds in words with a model, but talking on her own she just sounds like she is whining. Two-year-olds can be so variable, and what looks like something very severe can turn out to be nothing. She simply may be jargoning, and her jargon happens to sound like whining. …
By Pam Marshalla
Q: How do you teach a child to blow his nose? This has worked for me a few times- Teach them to pant in-and-out though the mouth. Then teach them how to sniff in and out through the nose. Once they can get the air moving in and out through the nose, teach them to push breathe more deeply with each sniff in and out. Gradually put more emphasis on the outgoing air. Gradually make the outward sniff a blow…
By Pam Marshalla
Q: I am seeing two elementary age brothers with a history of enlarged tonsils and adenoids that are not significant enough to warrant surgery according to the ENT. Both are difficult to understand because of their resonance issues. We are working on R and L with limited progress. I don’t know where to go with them. Speech is starting to impact reading and writing. A child with mild-to-moderate upper respiratory problems and minor articulation errors is one of the most…
By Pam Marshalla
Q: You mentioned orthodontic referral in one of your lectures on the lisps and R. I am wondering if you also refer to ENTs for issues relating to and resulting from mouth breathing. I follow standard practices in SLP. Therefore I refer clients to orthodontics when there are indications that a dental malocclusion may exist, and when it seems to be interfering with sound production. I refer clients to an ENT when there are indications that there may be upper…
By Pam Marshalla
Q: I have a client who makes a nasal sound for L and R. He has no other nasal problems. What can I do? This is all a matter of ear training. This is a client who can move his velum, but he has a habit of lowering it when he makes certain sounds, in this case, L and R. In other words, the client does not have a velo-pharyngeal insufficiency or incompetency. He simply has a habit of lowering…
By Pam Marshalla
Q: I read your explanation on how to teach a child to say R without nasality. I used a tube to help him as you suggested, and he now understands the difference between oral and nasal sounds. However, he still cannot produce the vocalic /r/ without it sounding hypernasal. I have tried everything and I was wondering if you have any suggestions! You have to tell him NOT to say R. Instead, have him say his nice oral vowel with…
