EpistemisOpen or closed rhinolalia
Specialty: Otolaryngology.
Why it occurs
- Obstructive adenoid hypertrophy of the cavum in pediatric age (cause of closed rhinolalia)
- Velopharyngeal insufficiency or incompetence due to congenital cleft palate, submucous cleft palate, or sequelae of adenoidectomy (cause of open rhinolalia)
- Massive bilateral nasal polyposis that completely blocks the resonance of the nasal passages
- Unilateral or bilateral paralysis of the soft palate (involvement of cranial nerves IX and X)
Initial workup
Dynamic nasofibrolaryngoscopy assessing velopharyngeal closure during phonation of oral and nasal phonemes, acoustic analysis of the voice with computerized nasometry, velopharyngeal videofluoroscopy in lateral projection, and MRI of the posterior fossa and skull base if there is suspicion of neurological involvement.
red flags
Nasal regurgitation of liquid or solid foods of recent onset, generalized weakness of other lower cranial nerves (severe dysphagia, dysarthria, shoulder weakness), persistent blowing voice, or obstructive dyspnea at rest with intercostal indrawing.
Standard management
- Pharmacological management is secondary and adjuvant
- Nasal corticosteroids such as fluticasone if the origin is nasal obstructive inflammatory — polyposis or mucosal hypertrophy
- Intensive speech therapy or speech therapy — essential in the reeducation of velopharyngeal closure
- In severe anatomical cases, treatment requires reconstructive surgery (palatoplasty or pharyngoplasty) or palate elevation prosthesis.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 4