Hypernasality

Hypernasality is a resonance disorder in which excessive nasal sound is heard during the pronunciation of vowels and voiced consonants. It occurs when the velopharyngeal port, the opening between the mouth and nasal cavity, does not close properly during speech, allowing air and sound to escape into the nasal passages. The result is a voice that may sound nasal, thinned, or muffled, and it can affect intelligibility and listener perception.

Causes of hypernasality are typically categorized as organic, functional, or mixed. Organic causes include velopharyngeal insufficiency due to anatomical deficits such as cleft palate, submucous cleft, or after surgical or traumatic changes. Velopharyngeal incompetence or mislearning can arise from neuromuscular disorders (for example cerebral palsy, muscular dystrophy) or motor speech disorders that impair coordination of the velopharyngeal mechanism. Functional hypernasality refers to resonance anomalies without obvious structural problems, often related to speech motor control. In some cases, hypernasality coexists with hyponasality on other sounds, depending on airflow patterns.

Assessment involves perceptual evaluation by trained clinicians, instrumental measures such as nasometry to quantify nasal resonance (nasalance), aerodynamic and acoustic analyses, and imaging or endoscopic assessment (nasopharyngoscopy, videofluoroscopy) to visualize velopharyngeal closing. Management is typically multidisciplinary, combining speech therapy to improve velopharyngeal function and resonance with surgical or prosthetic interventions when indicated. Surgical options include velopharyngeal insufficiency procedures such as pharyngeal flap or sphincter pharyngoplasty; prosthetic devices like a palatal lift can aid those unsuitable for surgery. Early diagnosis and individualized treatment plans improve outcomes.