| Abstract | Objective: There is currently no effective behavioral therapy for hypernasality in patients with cleft palate. In previous research with typical and hypernasal speakers, it was found on a group level that extreme forward focus resulted in higher nasalance scores while backward focus resulted in lower nasalance scores. However, some individual speakers were found to show lower nasalance scores in forward focus. If focus could be used to help speakers voluntarily narrow the pharynx and lower nasalance scores, this might result in new avenues for treatment. The present study investigated how many individuals in a small convenience sample of hypernasal individuals could be made to lower their nasalance scores using extreme backward or forward focus.
Methods: Six young speakers (4 F, ages 5-18) with cleft palate and hypernasal speech learned to produce extreme backward and forward focus. Repeated nasalance scores for a non-nasal sentence, a nasal sentence, a sentence with rapid nasal-oral transitions and a phonetically balanced sentence were recorded with a Nasometer at baseline, in backward focus, in forward focus and at a final baseline. Nasalance scores were averaged per participant, sentence and speaking condition. The descriptive statistics were tabulated and analyzed for reductions in nasalance of 10% and greater from baseline.
Results: For the group, the mean nasalance scores for all 4 stimuli combined changed from 57.5% nasalance (SD 11.3) to 46.0% (SD 17.2) in backward focus, 64.6% (SD 18.7) in forward focus, and 53.5% (SD 11.7) at the final baseline. Differences between timepoints were significant, F(3) = 19.27, p < 0.01. Nasalance scores in the backward focus were significantly lower, and in the forward focus significantly higher than all other speaking conditions (Tukey-Kramer post-hoc tests, all differences p < 0.05). Inspection of the individual scores showed that 3 of the 6 participants reduced their nasalance scores by more than -10% with the voice focus adjustments. Reductions of nasalance of up to -44% in backward focus and -23% in forward focus were noted.
Conclusions: The results demonstrated that even in a small clinical convenience sample, 3 of 6 participants had considerably lower nasalance scores when using extreme backward or forward voice focus adjustments. Further research will explore the effectiveness of this approach as a speech therapy intervention in hypernasal speakers with cleft palate.
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