Care Specialties & Departments
Physical Rehabilitation Program

Resonance disorder

What is a Resonance disorder?
In order to produce most speech sounds, the nose must be closed off from the mouth by using the soft palate (velum) and the walls of the throat (pharyngeal walls). If a child is unable to adequately close off the nose during speech it is called velopharyngeal dysfunction. Velopharyngeal dysfunction (VPD) includes velopharyngeal insufficiency and velopharyngeal incompetence (VPI).

Children with velopharyngeal dysfunction may present with the following concerns:

  • Speech that sounds overly “nasal,” as if the person is “talking through his/her nose.” This is called hypernasality.
  • Articulation errors such as:
    • “P” and “B” sounds more like “M,” “T” and “D” sounds more like “N”
    • Weak and deleted speech sounds due to air loss through the nose
  • Difficulty producing longer phrases because too much air is lost through the nose

What causes a resonance disorder?
The most common causes of a resonance disorder are cleft palate and submucous cleft palate. Other causes include a short soft palate, craniofacial abnormalities, adenoidectomy, enlarged or irregular shaped adenoids, mislearning, muscle weakness, velar paralysis and/or neurological disorders.

What to expect during a resonance disorder evaluation
During a 60-minute evaluation, the speech-language pathologist will collect information about your child’s medical history, developmental milestones and your current concerns. Depending on your child’s age and communication skills, the speech-language pathologist may also:

  • Listen to your child talk during play activities
  • Engage your child in conversation to see how they produce sounds in sentences
  • Ask your child to read short paragraphs
  • Administer standardized articulation testing, which typically involves your child naming a series of pictures.
  • Complete resonance assessment tasks such as asking your child to speak while plugging his/her nose or holding a mirror under his/her nose

Results and recommendations will be discussed at the end of the evaluation. If appropriate, speech therapy will be recommended and home activities will be discussed/demonstrated. In some cases such as if the soft palate is too short, speech therapy will not improve your child’s velopharyngeal closure. If this is the case with your child, the speech-language pathologist will work closely with your child’s otolaryngologist (ENT) and/or plastic surgeon to develop the best plan.

What to bring to a velopharyngeal dysfunction (VPD) evaluation:

  • Speech-language intake packet (PDF)
  • Copies of previous evaluations, including the IEP/IFSP if your child is receiving services through the Birth to Three program or school.
  • Copies of evaluations and possibly nasal endoscopy completed by your child’s ENT.

What to expect during velopharyngeal dysfunction (VPD) therapy
Based on the results of your child’s evaluation, therapy may be recommended to address velopharyngeal closure and speech sound errors. Therapy activities typically include working on sounds in simple syllables (ex. “up”) then progressing to more complex words (ex. “puppy”), phrases, sentences and ultimately conversational speech. Depending on your child’s age and abilities, activities may be completed during play or in more structured ways such as seated at a table.

At Children’s, we believe that it is very important for families to be involved in all aspects of their child’s care. Depending on the child’s needs, parents are encouraged to view the sessions via monitors, observation mirrors, or in the therapy room. In addition, your child’s speech-language pathologist will discuss progress, provide worksheets for home practice, and demonstrate beneficial therapy techniques to ensure maximum benefit is received from therapy.

For additional information on velopharyngeal dysfunction as well as diagnoses commonly associated with VPD, please click on the following links:

Children’s Patient and Family Education Materials:

Cleft Palate- Speech Development
Cleft Palate- Speech Glossary
Resonance Disorder