Goal: Reduce Hypernasality and or Nasal Emissions in Speech

Long Term-Ultimate Goal:

The patient will demonstrate appropriate oral and nasal resonance during a 30 minute unstructured conversation in 2 speaking settings with no more than 2 instances of hypernasality.
Here’s a step-by-step process for starting out with treating hypernasality, or when the speech has too much of a nasal quality.

Download the No-Prep Therapy Kit:

We have a start-to-finish therapy kit that will give you everything you need to practice this skill in therapy and send home homework.  Click the packet below to open it.  Then, print it out and place it in the child’s notebook or binder.

Therapy Phases:

  1. Refer to ENT: All clients who exhibit voice issues should be referred to an ENT first to check the structures and functions and be cleared for therapy. If hypernasality is present, it may be secondary to a cleft palate and would need to be addressed first.
  2.  Discriminate Between Oral Vs. HypernasalThe client will be able to discriminate between appropriate oral resonance and hypernasality during speech after listening to a speaker (live or recorded) 85% of the time independently on 3 out of 4 data collection days.
  3. Technique Practice: After the effective technique has been identified in therapy, the client will practice that  technique.
  4. Oral Resonance in Vowels: The client will use oral resonance when saying vowels  80% of the time with no more than 2 cues on 3 out of 4 data collection days.
  5. Oral Resonance in Words: The client will use oral resonance in words  80% of the time with no more than 2 cues on 3 out of 4 data collection days.
  6. Oral Resonance in Phrases : The client will use oral resonance in phrases  80% of the time with no more than 2 cues on 3 out of 4 data collection days
  7. Oral Resonance in Sentences: The client will use oral resonance in sentences 80% of the time with no more than 2 cues on 3 out of 4 data collection days.
  8. Oral Resonance when Reading: The client will use oral resonance when reading aloud independently 80% of the time with no more than 2 cues on 3 out of 4 data collection days.
  9. Oral Resonance in Conversation: The client will independently use oral resonance during conversation in the therapy setting with no more than 2 cues on 3 out of 4 data collection days.
  10. Generalize Oral Air Flow to Other Environments: Student will use correct oral airflow in a variety of situations and environments.
  11. Discontinue Therapy if Not Making Progress: If no progress is made after 6 weeks, client should be re-evaluated by ENT.

**Tips for Nasal Emission: 
For nasal emission, you will use these same steps above.  Here are some additional tips though that may help you establish that oral airflow for these clients: 

  • If there is nasal emission on sibilants only, have the child produce a /t/ sound with the teeth closed. Next, have the child prolong that sound. If the child has a normal velopharyngeal valve, this should result in a normal /s/ without nasal emission. This skill can then be transferred to the other sibilant sounds.
  • If the child co-articulates /ng/ for /l/ or /r/, or if the child has a high tongue position for vowels, it is often helpful to have the child co-articulate a yawn with the sounds. With a yawn, the back of the tongue goes down and the velum goes up.
  • If the child continues to demonstrate hypernasality or nasal emission after a few month or treatment, that child should be referred to a specialist for further assessment and consideration of physical management (source: Resonance Disorders and Nasal Emissions – Evaluation and Treatment using “Low Tech” and “No Tech” Procedures)

Supplemental Materials

Here are some other resources that may help you when working on this skill:

Nasal vs. Oral Mirror Worksheet

Once the child has received the go-ahead from an ENT or cleft palate team, you are ready to try some techniques to establish oral airflow. 

Developmental Norms:   Issues with resonance and nasality are not generally found in typically-developing children.  Young babies (younger than 9 mos) vocalize primarily using quasi-resonant nuclei, which are vowel-like sounds with normal phonation but with limited resonance.  However, around 9 months of age, those vocalizations become fully resonant and the child begins vocalizing using more vowel sounds.  After nine months of age, that resonance becomes mastered and any further resonance or nasality issues should be further investigated.

Resources Specific to Nasal Emission on Sibilants:

Word List for Lisps

It can be helpful to run your client through a list of /s/ and /z/ words to see if there are any contexts in which the child does not lisp.  Try these word lists (no pictures).

No-Prep Kit Worksheet

Have the child practice saying the /s/ sound in isolation (by itself, not in a word) in the following activities. Place the page in a plastic page protector and use a dry erase marker. Or, just have the child trace each item with his/her finger.

/s/ Articulation Worksheet

Additional worksheets with photos to target this sound in therapy or for homework.

Training Videos:

Need some extra help on treating this skill?  Check out these related training videos:

Webinar Recordings:

If you need some in-depth information related to this skill, check out our related webinar recording(s):

Resources, Tools, and Training for Speech-Language Professionals

*** The SLP Solution is for informational and educational purposes only and does not provide medical or psychological advice.  We provide general resources but cannot tell you exactly what should be done for a specific client.  Every client is different and your clinical judgement should be used when making decisions about specific individuals.


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