Rinolalia (benchmark) is a change in voice timbre, distorting the pronunciation of sounds as a result of violation of the normal participation of the nasal cavity in the process of rebuilding. During the lantern, a pathological change in the resonation of the nasal cavity occurs. In case of pathological exhalation, the air jet is either headed into the nose with all the sounds of speech (open rinolalia), or the passage to the nasal cavity is always closed, even when pronouncing the nasal sounds (closed rinolalia).

Causes: 1. Organic and functional central or peripheral nature; 2. Regenerate and acquired

Organic Central Character:brain hemorrhages, CHMT, umbrellas of um, central or peripheral paralysis, extrapyramidal disorders, leading to a violation of the innervation of mild sky muscles and causing it paresis and paralysis.

Organic peripherals(Congenital and acquired): shortened soft sky; lack of small tongue; shortened or split soft tongue; Polyps, adenoids, tumors, curvature of the nasal partition, hypertrophy of the nasal mucosa, heaven injury, consequences of operations and diseases (perforation, scar changes); Cleaners sky and lips of various sizes and shapes

Functional central.Cause improper functioning (after transferred mental shocks, with neurotic disorders, as consequences of operations)

Functional peripherals.Disorders of the respiratory processes, habitually lowered soft sky (for example, after the post-infiltury pares, adenotomy, operational injuries), imitation of the voices of the surrounding, Eustachius pipe diseases, nervously associated with a mild sky, discounts of auditory control.

The causes of the debris of the sky: biological (flu, rubella, steaming, toxoplasmosis); chemical (medicine, poisons); endocrine diseases; Mental diseases; Professional harm; bad habits; Genetic manifestations.

Congenital debris sky M.B. Multiple species: Sleeps of soft sky (hidden - submucosic, incomplete, full); Sleep and solid sky clefts (hidden, incomplete, full); Full cleft of the alveolar process, solid and soft sky (one-sided, bilateral); Full cleft of the alveolar process and the front of the soft sky (one-sided, bilateral). Sky and lips color clefts can be combined.

15. Classification of Rinolalia. Characteristics of various shapes.

With a normal lantern, the nasal and mouth cavities are separated ( gabno-sip ) occurs by reducing the muscles of the soft sky and the side and rear walls of the throat ( passavana roller ). Soft heaven is continuously lowered and rises at different heights. The strongest closure is the sound of the weakness - the sound of V. at Rinolalia is broken by the celestial silence

1. Open P: Functional open r.; Organic Open R.

2. Closed p: - organic closed P (front closed p; rear closed P); Functional closed R.

Open R. - The oral sounds acquire the nasility (bent nasal tint): when pronouncing hissing and fricative - hoarse sound in the nasal cavity; when uttered explosive p, b, d, t, k, r - sounds are pronounced lubricated, it is unclear (air pressure deficiency); Sounds l, r - sound with a nose tint, p - without vibration

Functional open R. - insufficient rise of a soft sky with sluggish articulation: after removing adenoids ("familiar"); After transferred diphtheria (post-informy cut)

Organic Open R.- M.B. acquired (sky perforations, cuts, paralysis, scar changes, tumors ) and congenital(Sleep and solid sky crevices, shorten sky shorten)

Closed R.it is raised with low-physiological nose resonance. Causes: Organic changes in the nasal space, illness, resulting in novel breathing. Manifestations: the lack of nasal resonance at the sounds of m, d, n, ny (sound like sounds of B. B, D, DB)

1. Front closed p- Under the obstruction of the nasal cavities: hypertrophy of the nasal mucosa; polyps; curvature of the nasal cavity and the nasal partition; Tumors of the nasal cavity.

2. Rear closed p - Reduce. nasal cavity: adenoids; tumors

3. Functional closed p- Soft heaven rises very high and closes access to sound waves to the nasophal (with neurotic disorders in children)

With organic closed p: 1.secressive causes of non-arrival of the nasal cavity; 2. Exercise exercises as with functional disorders

Mixed R. Reason: Dispose of the nasal cavity + lack of gentle-pharyngeal contact of functional or organic origin.

Closed

Difficultization of food

Voting change

Breath Violation

Violation of sound suspension

Violations of the letter

Selfless weight in newborns

Unnatural speech

Need to breathe through the mouth

Involuntary eye fluctuations

Out of the upper ages

Cleaners face

Inclination to colds

Scarce of vocabulary

Silently speech

Tusk voice

Rinolalia is a pathology in which the pronunciation of sounds in particular and the speech as a whole is disturbed. This is a rather rare disorder, which is diagnosed in 1-2 children per 1000. This kind of speech defect can be worn both congenital and acquired nature, which is also the predisposing development factors will also differ.

The disease has specific symptoms, to ignore parents cannot. The main symptoms are considered to be a vague or inexpressive speech, later pronunciation of the first words to the baby, as well as a large number of psychological signs.

In the overwhelming majority of cases, the establishment of the correct diagnosis is not a problem, however, difficulties may occur with the determination of the species of the disease. It is in this background that the diagnosis is comprehensive and includes consulting specialists from various fields of medicine.

Treatment in children is often based on conservative methods, but in some forms of the disease, it is mandatory to turn to surgical interference.

Etiology

The pathogenesis of the disease lies in the wrong interaction between the nasal cavity and the rotoglot. This becomes the reason that during the formation of sounds the air flow goes wrong, against the background of which the pronunciation is distorted.

The reasons for the innate form of illness are presented:

• violation of the integrity of the soft or solid sky, which in the medical sphere is called the syndrome "";
• cleavage of the upper jaw or upper lip - such a disorder is widely known as "";
• defects of a soft sky, namely by its shortening;
• pathologies of a small tongue - here should include its complete absence or, on the contrary, split;
• cleaners of a solid sky that are hidden.

In addition, severe diseases transferred to the woman during the tooling of the fetus in the first trimester can cause primary rinolalia. To such diseases should include:

• and other infectious processes.

Not the last role in the occurrence of such a breakfast disorder also play:

• the effects of toxic substances on the body of a pregnant woman;
• the addiction of the future mother to narcotic substances, alcohol or nicotine is not all female representatives, learning that the child awaits, consider it necessary to get rid of the harmful addictions;
• frequent stressful situations undergoing women in position;
• the flow of endocrine disorders before or in the pregnancy.

It is worth noting that the above defects provoking the emergence of Rinolalia are formed by the fetus in the early stages of intrauterine development, namely, the seventh or eighth week.

It is also believed that no longest place is a burdened heredity. A high probability of developing a child of such a violation of speech, if one of the parents are present:

• cleft lip or sky;
• asymmetry of the tip of the nose;
• the asymmetry of the wings of the nose.

The mechanisms of development of the acquired Rinolalia will be dictated by a variety of illness. For example, to promote the development of secondary open organic rinologias will be:

• sky deformations of a scars;
• states such as paralysis or paressers of soft nose;
• squeezing with a tumor of such nerves as the wandering and language forces.

Open functional acquired rinolalia develops on the background:

• previously transferred intervention in the excision of adenoid;
• parish of a soft nose resulting from diphtheria.

The closed rinolalia of organic nature often occurs due to a wide range of anatomical changes in the nose or nasophal. It follows from this that sources can act

• located in the nasal cavity;
• the emergence of benign neoplasms or polyps;
• hypertrophy of the nasal mucosa;
• malignant tumors in the nose;
• the formation of unpaired almonds.

The functional form of closed rinolalia is represented by such a etiological factor as the high tone of the soft sky. Such a state is expressed in that it is impossible to a complete yield of air jet through the nose. This violation may arise due to:

• adenoidectomy, i.e. operations on excision of adenoids;
• various deviations of neurological origin;
• banal copying of the gnusiness of the speech of surrounding people.

Classification

Rinolalia, the definition of which is in the improper functional relationship of the nasal cavity and the rotogling, has several varieties.

The main classification divides such a disease into two forms:

• open rinolalia - air simultaneously passes through the mouth and nose;
• closed Rinolalia - It is characterized in that the air does not pass through the nose, which is caused by the presence of obstacles in the nasal cavity or in the zone of the nasopharynx. This becomes the reason that the sounds "M" and "N" are largely distorted. In addition, vowels are subject to change, namely lose their tonality and bellivity;
• mixed Rinolalia - There are signs of the two above forms, and the voice of the child acquires a nasal sound.

It is noteworthy that open rinolalia is diagnosed several times more often a closed or mixed type of illness.

For reasons for occurrence, both open and closed rinulalia happens:

• organic. For an open form, the emergence is caused by congenital, less often acquired by the defects of the rotogling or nasal cavity. A closed type of illness cause nasal deformations;
• functional - Functional open rinolalia due to previously transferred to any nasopharynk disease. With a closed variety of illness, the air flow is directed through the mouth, and the predisposing factors are often represented by neurological disorders.

In addition, there are such types of Rinolalia:

• front - in the overwhelming majority of cases, it is expressed on the background of the expression, which they lead to the overlap of the Hohan;
• rear - develops due to, polyps or curvature of the nasal partition.

Symptomatics

The structure of the speech defect at rinolalia, i.e. the symptoms of the disease, will be somewhat different depending on its type.

For example, such symptoms will be characteristic for the open form of pathology:

• violation of the respiratory function;
• difficulties during the feeding of a breast child or self-nutrition of children from two years;
• lack of body weight of the newborn;
• the presence of congenital cleft face;
• ottop of the Upper Century;
• quiet speech;
• involuntary eye vibrational movements;
• hyperreflexia;
• - The first words children are often pronounced at the age of two;
• the appearance of the grimace during communication;
• surrious vocabulary, which makes it even more difficult for a speech description of the child occurring in the life;
• irritability and closure;
• increased predisposition to such a little bit, like, pneumonia or.

The characteristic of the closed form of Rinolalia is the following clinical manifestations:

• changing voice timbre;
• violation in pronunciation of nasal sounds;
• difficulties when communicating with outsiders;
• unnaturalness and dullness of the voice;
• the need for constant breathing through the mouth;
• a tendency to colds;
• development of asthenic syndrome;
• violation of the letter, which is expressed in or;
• insufficient supply of words, compared to peers similar to age category.

Diagnostics

The child with Rinolalia and the expression of the above symptoms must be left to consult a speech therapist. However, due to the fact that such a violation can develop against the backdrop of a large number of diverse factors, such specialists also participate in the patient survey:

• maxillofacial surgeon;
• neurologist;
• otolaryngologist;
• orthodontist;
• foniator;
• defectologist;
• psychologist.

Primary diagnosis includes:

• studying the history of the disease and life history of the patient - it also takes into account information regarding pregnancy. This will enable the clinician not only to establish the cause of the development of the disease, but also to determine its type;
• conducting a thorough physical inspection - to identify external disorders, for example, hare lips or wolf grazing;
• detailed poll of parents or adult patient.

The speech therapy examination is based on the assessment:

• the articulation apparatus, in particular its structure and mobility;
• breathing - physiological and lamination;
• voices and pronunciation of all sounds;
• the status of reading and writing is determined in school age children.

Sometimes to establish the etiological factor may require instrumental examinations, among which they allocate:

Laboratory tests of blood and other human biological fluids have no diagnostic value.

Treatment

Rinolalia correction will be fully dictated by a type of flow of such a speech defect.

In cases of diagnosing organic variety of pathology, the elimination of anatomical defects is shown, which is performed using:

• applications of the pharyngeal obtutor;
• surgical adjustment of deformities of the face - here should include Uranoplasty, cyfaringoplasty and hailoplastic;
• removal of adenoids and polyps in the nose;
• excision of pharynx neoplasms;
• septoplasty.

Functional Rinioralia therapy is based on:

• physiotherapeutic procedures;
• psychotherapy;
• long working speech therapist with the patient.

In addition, the treatment also takes part:

• speech therapy massage - the features of the speech therapy work are in the implementation of the finger massage of some parts of the solid sky and the vibration massage of the soft sky;
• breathing exercises;
• articulation exercises.

The most efficient exercises of the articulation gymnastics are:

• "Break" - at the same time, the language is folded into the tube and slowly supered from the mouth. The number of repetitions seven times
• "Needle" - mouth closed, and the tongue needs to be alternately to touch the inner surface of each cheek;
• "Clock" - wide open mouth, the tongue is folded into the tube and make them circular movements;
• "Liana" - the language is cut into the chin and hold in this position for about five seconds;
• "Metronomy" - the mouth is widely open, and the language moves from one corner of the mouth to another;
• "Takes up-landing" - differs from the previous exercise by the fact that the language, as far as possible, pull out to the nose, after which they lower as much as possible to the chin.

If the correction of such a violation required the implementation of the operation, then after the intervention, the work of the speech therapist is carried out regarding the features of sounding sounds under Rinolalia in new anatomical conditions for the patient.

Correctional work with the doctor is best to start as soon as possible in order to achieve positive results of therapy by the time as a child.

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Ministry of Education and Science of the Russian Federation

Federal State Budgetary Educational Institution

higher professional education

"Vladimir State University

named after Alexander Grigorievich and Nikolai Grigorievich Councilovoy "

by discipline:

"Spent"

on the topic: "Etiology of the emergence of Rinolalia"

Performed:

art. c. ZKP - 113.

Botulin E.A.

Accept: Makarov Antonina Ivanovna

Vladimir 2015.

Content

• Introduction
• Symptoms of rinolalia
• Conclusion
• Bibliography

Introduction

Rinolalia is a violation of the pronunciation side of speech or voice collected due to anatomy-physiological damage to the speech apparatus. At Rinolalia, a specific change in voice occurs. This is due to the fact that when they uttered all the sounds, the air jet is not in the mouth, but in the nasal cavity in which resonance occurs. The speech becomes bent, all the sounds without exception are disturbed (only some sounds may violate during dislons). The child becomes monotonous and vague.

Rinolalia, due to congenital debris, lips and nose, is a serious problem for various industries of medicine and speech therapy. It is the subject of attention of dental surgeons, orthodontists, children's otorinolaryngologists, psychoneurologists and speech therapists. Cleaners belong to the most frequent and heavy defects. The frequency of birth of children with clefts is different among different peoples, in different countries and even in different areas of each country. A. Limberg (1964), summarizing information from the literature, notes that one child with a cleft lip and a neba is born at 600-1000 newborns. Currently, the birth rate in different countries of children with congenital pathology of the face and jaws fluctuates from 1 to 500 newborns to 1 to 2500 with a tendency to increase over the past 15 years (Burian, S.I. Blokhin et al. (1995).

Rinolalia: Characteristics of Disorders

Rinolalia is a nasal shade of voice, accompanied by impaired sound-proof and due to defects in the structure and functioning of the speech apparatus. Previously, the term "bend", having a folk origin and a reflecting feature of the external manifestation of disorder, was used to designate this violation of the speech.

Rinolalia is a violation of the sound impact and the proper side of speech, first of all, the voices caused by a violation of the structure of the articulation apparatus in the form of a cleft of the sky, the battle of the lip, the alveolar process, gums, solid and soft nose.

The speech therapy science refers to Rinolalia such a defect of the speech apparatus as congenital debris.

Currently adopted the following classification.

Congenital clefts of the upper lip: hidden cleft, incomplete cleft:

a) without deformation of the skin-cartilaginous nose;

b) with deformation of the skin-cartilaginous department of the nose.

Congenital debris:

1) Sleeping cleft: hidden (submucose); incomplete; full;

2) Sleep and solid debris: hidden; incomplete; full;

3) Full cleft of the alveolar process, solid and soft nose: one-sided; bilateral;

4) Full splitting of the alveolar process and the front department of the solid nose: one-sided; bilateral.

Cleaners are: through, complete and incomplete, bilateral and one-sided (both right-hand and left-sided).

Through clefts are considered to be such that, starting from the upper lip, pass through the upper jaw, the solid and soft palate right up to the small tongue, which also turns out to be twisted or may be completely absent. Incomplete crevices can be limited only to shortening soft paws, lack of small tongue or split it. There are also minor defects of the bone island of solid chicken, and with the so-called submucose (sublimated) slots under the mucous membrane, Such a gap is tested with a slight nagged to the rear edge of the solid coat and is detected with a loud-eating sound of the sound and in the form of a triangle in the same place in the same place, and its value will correspond to bone cleft.

The causes of the occurrence of Rinolalia

Congenital debris are one of the most common defects of the development of the face and the jaws. The reasons for it can be a variety of exogenous and endogenous factors affecting the fruit at an early stage of its development - up to 7-9 weeks.

According to information available in the literature, only 5,000 children with chickens are born annually in our country, and this figure tends to increase. The appearance of similar clefts may be due to hereditary factors, with unfavorable conditions for the flow of the first two months of pregnancy (Mother's influenza disease, vapor, rubella; toxoplasmosis; the presence of endocrine disorders; professional harm; mental injuries, etc.). There is also a negative effect of adverse environmental factors, alcoholism, smoking, etc. In many cases, all these harm may interact anyway.

1) The presence of congenital (less frequently acquired) cleft and solid nose, leading to the complete impossibility of disagreement of the nasal and oral cavities.

2) Short soft packed.

4) the presence of paralysis and paresses of a soft nose, fully eliminating or sharply limiting the possibility of its lifting and closure with the rear wall of the pharynx, which again does not allow isolate the nasal cavity from the mouth.

5) Some overall lethargy of articulatory muscles (including soft nose), which is most often observed in physically weakened children and also preventing the formation of a full-fledged chill-pharyngeal shutter. The "habitual" decrease in the activity of a soft nose also leads to the same results after the removal of adenoid growths that prevent its normal work, or after the post of diphtheria paralysis has already passed.

6) the presence of adenoid growths, nasal polyps, tumors in the area of \u200b\u200bnasopharynx, the curvatures of the nasal partition, creating conditions for constant isolation of the nasal cavity from the mouth. At the same time, the air or not at all falls into the nasal cavity or falls into it in a very limited amount. The voice also acquires a nasal shade.

7) Increased function (hyperfunction) of soft nose muscles, leading to the fact that it is constantly in the raised position and thereby pronouncing all speech sounds, including nasal, isolating the nasal cavity from the mouth.

The first five of the listed causes lead to the constant absence of the isolation of the nasal cavity from the mouth, and the last two to the presence of their constant isolation during the speech process. However, in all these cases, normal resonation of the nasal cavity is disturbed during rumor, which causes the emergence of different types of rinolalia (when the nasal resonator is turned off, as already noted, the voice also acquires a nasal shade).

All the listed causes of Rinolalia are customary to divide on organic and functional, depending on whether they violate the anatomical structure of the speech apparatus in its central or peripheral sections or lead only to a violation of its normal functioning. In accordance with this, organic reasons include the presence of small cleft and all the above-mentioned anatomical changes in the nasopharynx cavity (the peripheral diversity of the speech apparatus), as well as paralybly and paresis of soft nose (organically suffer from the central speech of the speech analyzer). Functional reasons include hypo - or hyperfunction (that is, low or increased activity) of a soft nose without explicit signs of organic damage. In very rare cases, the functional cause of Rinolalia can be imitued.

Symptoms of rinolalia

Distinguish closed and open Rinolalia. Organic closed rinolalia is due to the fact that for some reason the passage to the nasal cavity is constantly closed. The timbre is significantly violated when pronouncing consonants. When pronouncing hissing and fricative, a hoarse sound occurring in the nasal cavity is added. Explosive: (p, b, d, t, k, d) sounds unclear, since the necessary air pressure is not formed in the oral cavity due to the incomplete overlap of the nasal cavity. The air jet in the mouth is so weak that is insufficient to fluctuate the tip of the tongue necessary for the formation of sound r. The violation of nasal breathing characteristic of the organic closed rinolalia leads in many cases to the appearance and a number of non-ferry symptoms: the insufficient development of the child's chest and weak gas exchange in the lungs, sleep impaired, dysfunction of the battery (during chewing and swallowing, the child is forced to breathe only mouth that Tightens the food process and causes a number of unpleasant sensations), fast fatigue, irritability, predisposition to chronic respiratory diseases.

Depending on the preferential localization of organic changes (the cavity of the nose or nasopharynx), the organic closed rhinolalium is customary to divide into two types: the front and rear.

The causes of the front closed rinolalia can be polyps or tumors of the nasal cavity, curvature of the nasal partition, hypertrophy of the nasal mucosa due to chronic rhinics. The rear closed rinolalia is a consequence of polyps and tumors in the field of nasopharynx, as well as the result of adenoid growths or a soft chopping unit with the rear wall of the pharynx. In all these cases, nasal obstruction occurs.

Functional closed rinolanalysis is most often due to the hyperfunction of a soft nose, which is constantly in the raised position.

Open rinolalia is observed in defects of soft or solid sweat. In the sound-proof, the air jet passes through the nose, and not through the mouth, it becomes incomprehensible, with a nose tint.

Open rinolalia can be organic and functional. The first is congenital and acquired. Most often, the cause of congenital form is the splitting of soft and solid nose. The acquired form appears as a result of the injuries of the oral and nasal cavity.

rinolalia Summer Sliver Speech

With organic rinolalia, the timbre of sounds, especially vowels, is disturbed by sound testing of many consonants. The clefts of the upper jaw and the solid nose later change the formation of a normal bite. In case of debris, the respiratory and voice departments of the peripheral speech apparatus do not have any anatomical disorders, and the upper part (articulation) is rudely broken in its structure: the possibility of insulation between the oral and nasal cavities is disturbed. The exhalation of rinolalica during speech with a fairly good and complete breath remains short, peculiar, differentiated oral and nasal breathing is not formed. The sound of voice, in addition to the beacon, is distinguished by poverty modulations. The oral cavity is particularly characterized by the high position of the root of the language, which is an adaptive position for closing the debris of the nose. This position of the language limits the mobility of the language. Thanks to the mutual communication of the muscles of the language and lips, the movement of the lips also inhibit.

With functional rhinolalia, the pronunciation of vowel sounds is disturbed and after phoniatric exercises, the nasal timbre disappears, and violations of pronunciation are eliminated by conventional exercises.

Mixed rinolalia takes place in cases where the reasons leading to the appearance of both open and closed rinolalia simultaneously coexist. This may be observed in the presence of nasal polyps or a curved nasal septum (conditions for the appearance of closed rinolalia) in combination with a short soft naite or hidden solid waste (conditions for the existence of open rinolalia).

Conclusion

The study of psychological and pedagogical literature on this problem made it possible to draw the following conclusions

Rinolalia is a nasal shade of voice, accompanied by impaired sound-proof and due to defects in the structure and functioning of the speech apparatus.

The speech therapy science refers to Rinolalia such a defect of the speech apparatus as congenital debris. The clefts are through, full and incomplete, bilateral and one-sided (both right-hand and left-hand).

The main reasons that can lead to a violation of the normal functioning of a non-pharyngeal shutter:

1) The presence of a cleaner of a soft and solid nose.

2) Short soft packed.

3) the absence of a small tongue or its splitness.

4) the presence of paralolies and paresses of soft nose.

5) Some overall lethargy of articulatory muscles.

6) the presence of adenoid growths, nasal polyps, tumors in the area of \u200b\u200bnasopharynx, the curvatures of the nasal partition, creating conditions for constant isolation of the nasal cavity from the mouth.

7) Increased function (hyperfunction) of soft nose muscles.

Distinguish closed and open Rinolalia.

Bibliography

1. Ermakova I.I. Correction of speech at Rinolalia in children and adolescents. M., Enlightenment, 1984.

2. Speech therapy. Ed. Volkova L.S., Shakhovskaya S.N.M., Vlados, 1999.

3. Paramonov L. Speech therapy for all. St. Petersburg, Peter, 2004.

4. Preddina O.V. Speech therapy. M., Enlightenment, 1969.

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Rinolalia (from Greek. rhinos -nose, lALLA -speech) - violation of voice timbre and sound suspension due to anatomy-physiological defects of the speech apparatus. The combination of arctication disorders of sounds with voice disorders makes it possible to distinguish Rinolalia from disliers and rinophone.

For Rinolalia, the mechanism of articulation, lamp and voicing has significant deviations from the norm and is due to a violation of the participation of nasal and rotoglotor resonators. With a normal lantern in humans during the pronouncement of all the sounds of speech, except for the nasal, the separation of the nasopharynk and nasal cavity is separated from the pharyngeal and rota.

These cavities are separated by a non-pharmaceutical closure, carried out by reducing the muscles of the soft nose and the side and rear walls of the pharynx.

Simultaneously with the movement of a soft nose, a thickening of the rear wall of the pharynx occurs, which also contributes to the contact of the back surface of the soft nose with the rear wall of the pharynx.

The level of contact of the soft nose with the wall of the pharynx may vary and depends on the length of the soft nose (Fig. 34).

During speech, the soft sky is continuously lowered and rises to different heights depending on the surrounding sounds and fluency of speech. The strength of the nervous-pharyngeal closure depends on the pronounced sounds. It has been established that for vowels, the shutter is less than for consonants. The vowels with a nasal tint appear in the event that there remains space between the rear edge of the soft nose and the rear wall of the throat.

The weakest hard-sizing closure is observed in the consistent in,the strongest thing - with the consistent from(6-7 times stronger than with a vowel but).When pronouncing nasal sounds m, M ", N, N"the air jet freely penetrates the space of the nasal resonator.

Fig. 30. Movement of a soft nose: and the soft palate is raised and tightly pressed against the rear wall of the throat. Voice timbre when pronuncated by all speech sounds, except for nasal, normal; B - the soft palate is raised and pressed to the thickened rear wall of the throat. Voice timbre normal; B is not enough in a soft palate. There is no contact between the soft nob and the walls of the pharynx. Exhaled air freely penetrates the nasal cavity. Voice timbre Nasal

Forms of Rinolalia

Depending on the nature of the disorder, various forms of rinologaly are distinguished by various forms of rinolalia.

Closed rinolalia. Closed rinolalia is characterized by a reduced physiological nasal resonance during the pronunciation of speech sounds. The strongest resonance is normally observed when pronouncing the nasal m, m "n,"" In the process of articulation of these sounds, the nasopharynk shutter remains open and the air penetrates into the nasal cavity. If the nasal resonance is missing, these phonemes sound like oral b, B ", D, D".

In addition to the pronunciation of nasal sound sounds with closed rinolalia, the pronunciation of vowels is violated. It acquires an unnatural, dead shade.

The causes of closed rinolalia are most often organic changes in the nose-free or functional disorders of a non-pharmaceutical closure. Organic changes are caused by painful phenomena, as a result of which the nasal patency decreases and nasal breathing is hampered. Front closed Rinolaliait occurs in chronic hypertrophy of the mucosa of the nose, mainly the rear departments of the lower shells, during polyps in the nasal cavity, when curvatched the nasal partition and. with nasal tumors. Rear closed rinolaliain children, most often is a consequence of large adenoid growths, occasionally of naso-cell polyps, fibromes or other nasooping tumors.

Functional closed rinolalia occurs in children often, but not always correctly recognized. It is characteristic of what arises with good nasal cavity and nasal breathing. With functional closed rinolalia, the timbre of nasal and vowels can be disturbed stronger than with organic. The reason is that the mild palate during the lantern and pronunciation of nasal sounds rises above the norm and closes the sound waves access to the nasophalc. Such phenomena are more often observed with neurotic disorders in children.

With organic closed rinolalia, first of all eliminate the reasons for the obstruction of the nasal cavity. As soon as the correct nasal breathing appears, the defect disappears. If after eliminating the impassability of the nasal cavity (for example, after adenotomy), the closed rinomalia or rinophony continues in the usual form, resort to the same exercises as with functional disorders. With functional closed rinolalia, children systematically exercise in the pronouncement of nasal sounds. Preparatory work is carried out bydifferentiation of oral and nasal breath and exhalation.

Then the static respiratory gymnastics is complicated by voice exercises. It is also useful to apply dynamic) gymnastics, in which respiratory movements are combined with the movements of the hands and the body. Children are trained to pronounce sounds, so that he felt a strong vibration in the field of wings of the nose and the base of the nose. Further preschoolers are encouraged to pronounce pA, PU, \u200b\u200bPU, \u200b\u200bPIso that the vowels sound a little in the nose. In the same way, the pronunciation of consonants in position in front of the nasal sounds (syllables of the type aM, OM, Mind, An).

After the child learn how to correctly pronounce these syllables, the words in which there are nasal sounds. It is necessary that he pronounced them exaggeratedly loudly and long with a strong nose resonance.

The final is the exercises on the loud short and long-term utterance of vowels. In addition, vocal exercises are used.

The duration of correctional work with functional closed rinophony is small. At Rinolalia, the deadlines are longer and it is difficult to predict in advance. This is due to the fact that with functional closed rinolalia, it is also necessary to eliminate the defects of the articulation of sounds. In addition, in children with this form of Rinolalia, some features of mental development are often observed.

Open rinolalia.For a normal lantern, the presence of a shutter between the oral and nasal cavities is characterized when the voice vibration penetrates only through the oral cavity. If the separation between the nasal cavity and the mouth is incomplete, the vibrating sound penetrates into the nasal cavity. As a result of the violation of the barrier between the mouth and the nasal cavity, the voice resonance increases. This changes the timbre of sounds, especially vowels. The most noticeably changed the timbre of vocal sounds andand y,with the articulation of which the mouth is most narrowed. Less nasal sounds e.and about,and even less violated but,since when it pronunciation, the mouth cavity is widely disclosed.

In addition to the voice of vowel sounds, the timbre of some consonants is violated with open rinolalia. When pronouncing hissing sounds and fricative f, B, xa hoarse sound occurring in the nasal cavity is added. Explosive sounds p, b, d, t, toand gas well as sonorn lirit is obscure, since the oral cavity can be formed by the air. The pressure required for their exact pronunciation. With long-term open rinolalia (especially organic), the air jet in the oral cavity is so weak that is insufficient to fluctuate the tip of the tongue, which is necessary for the formation of sound r.

Open rinolalia can be organic and functional.

Organic open rinolalia is congenital or acquired.

The most common cause congenital formit is the splitting of a soft and solid nose.

Acquired open Rinolaliait is formed during the injury of the oral and nasal cavity or as a result of a gender parallery acquired.

The causes of the functional open rinolalia may be different. For example, it happens when the lantern in children with the sluggish articulation of a soft sky. The functional open form is manifested in hysteria, sometimes as an independent defect, sometimes as imitative.

One of the functional forms - familiar open rinulalia,observed, for example, after the removal of large adenoid growths, arises as a result of a long limitation of mobility of soft nose.

Functional examination at open rinolalia does not detect organic changes in solid or soft nose. The sign of the functional open Rinolalia is also the fact that the pronunciation of only vowels is usually disturbed, while when pronouncing the consonants, the hard-sizzm is good and nasalization does not occur.

Forecast with functional open rinolalia is more favorable than with organic. Nasal timbre disappears after phoniatric exercises, and pronunciation disorders are eliminated by conventional methods used in disliers.

Rinolalia, due to congenital missessement of the lip and nose, represents a serious problem for the speech therapy and a number of sciences of the medical cycle (surgical dentistry, orthodontics, otolaryngology, medical genetics, etc.). Clear lips and nebes are the most common and severe congenital malformation.

As a result of this defect in children, in the process of their physical development, serious functional disorders arise.

In children with congenital missesses of the lip and neba, the act of sucking is very difficult. He presents special difficulties in children from a cross-cutting lip and a nose, and when bilateral through clefts, this act is not possible at all.

Macreling leads to a weakening of vitality, and the child becomes susceptible to various diseases. The greatest degrees of cleft children are predisposed to the Qatar of the upper respiratory tract, bronchitis, pneumonia, rickets, anemia.

Often, such children have pathological changes in Lororgans; The curvature of the nasal partition, the deformation of the wings of the nose, adenoids, hypertrophy (increase) of the almonds. Often they have inflammatory processes in the nose area. The inflammatory process can move from the mucous membrane of the nose and pharynx on Eustachiye tubes and cause inflammation of the middle ear.

in frequent otitis, often taking chronic flow, serve as a decrease in hearing. Approximately 60-70% of children with desert clefts have a decrease in hearing of varying degrees (more often on one ear) - from a small decline that does not hinder the perception of speech, to significant hearing loss.

With deviations in the anatomical structure of the lip and the neba, underdevelopment of the upper jaw and the wrong bite with the defective location of the teeth are closely connected.

Numerous functional disorders caused by the defect of the structure of the lip and nose require constant medical observation.

In our country, conditions for integrated treatment in specialized centers of traumatology, with surgical dentistry departments, as well as in other institutions where large medical and preventive work is carried out!

Doctors of various specialties watch children and together take a plan for comprehensive treatment.

During the first years of the child's life, the leading role belongs to a pediatrician, which manages the feeding and the regime of the baby's day, provides prevention and conducts treatment, if necessary, recommends an outpatient or inpatient treatment.

Operation on the restoration of the upper lip (hailoplasty) is recommended in the first year of the child's life; Often it is produced in maternity homes in the first days after birth.

In cases of clerk, the dentist-orthodontist applies various devices, including a commonhouse that facilitate meals and create conditions for the development of speech in the preoperative period. The otolaryngologist reveals and treats all painful changes in the ear, nasal cavities, in the nasopharynk and larynx and prepares children to surgery.

Fig.35. Left-sided cleft of the upper lip and alveolar process

Fig. 36. Left-sided solid debris

In case of deviations in the mental development and the presence of severe neurotic reactions, the child consults a neuropathologist.

Operation of the restoration of the nose (Uranoplasty is carried out in most cases in preschool age).

As of mental development, children with debris are divided into three categories: children with normal mental development; children with mental delay; Children with oligophrenia (varying degrees). With a neurological examination, the signs of pronounced focal lesion of the brain are usually not observed. Some children have separate neurological microprotes. Much more often in children there are functional disorders of the nervous system, sometimes significantly pronounced psychogenic reactions, increased excitability.

In addition to the foregoing, congenital debris of the neba have a negative impact on the development of the child's speech.

The clefts of lips and neba play a different role in the formation of speech underdevelopment. It depends on the size and form of an anatomical defect.

The following types of cleft are found:

1) cleft of the upper lip; Upper lips and alveolar process (Fig. 35).

2) solid and soft sleebo cleaners (Fig. 36).

3) clefts of the upper lip, alveolar process and nose - single and bilateral;

4) Sublifting (submucose) debris.

With crevices, lips and neba all sounds acquire a nasal or nasal shade, which grossly violates the permissions of speech.

It is typical is the imposition on the nasalized sounds of additional noise, such as the silence, snoring, the mining and others.

There is a specific violation of voice timbre and sound impact.

To prevent food passing through the nose, the child from the very early age acquires the habit of raising the back of the tongue to block the passage into the nasal cavity. This language position becomes familiar and also changes the articulation of sounds.

During speech, children usually reveal a little mouth and higher than required, raise the back of the tongue. The tip of the language is not fully moving. A similar habit worsens the quality of speech, since at a high position of the jaw and the language, the mouth cavity acquires a form that contributes to the air in the nose, which enhances the nasility.

When trying to pronounce sounds p, b, f, ina child with Rinolalia uses "their" methods. Sounds are replaced by a pharyngeal click, which very peculiarly characterizes the child's speech with a severe form of Rinolalia. A specific click, which resembles the sound of the valve, is formed when contacting the nastrostic with the back of the language.

Direct correspondence between the size of a non-labeled defect and the degree of speech distortion is not established. This is explained by large individual differences in the configuration of the nasal and oral cavities in children, the ratio of resonating cavities and compensatory techniques that each child uses to increase the indestination of their speech. In addition, speech suffering depends on the age and individual and psychological characteristics of children.

Speech therapy classes with a child must begin in the preoperative period to prevent serious changes in the functioning of speech bodies. At this stage, the activity of a soft nose is prepared, the position of the root of the tongue is normalized, the muscle activity of the lips is enhanced, the directional exhaler is produced. All this, combined, creates favorable conditions for improving the efficiency of the operation and subsequent correction. 15-20 days after surgery, special exercises repeat; But now the main purpose of classes is the development of mobility of a soft nose.

The study of the speech activity of children suffering from Rinolalia shows that defective anatomical physiological conditions of recurrence, the limitations of the motor component of speech lead not only to the abnormal development of its sound side, but in some cases to a deeper systematic violation of all its components.

With the age of a child, speech development indicators deteriorate (compared with the indicators of normally speaking children), the structure of the defect is complicated by violating various forms of written speech (J $ TFTR "3?).

An early correction of speech development deviations in children with Rinolalia has an unusually important social and psychological and pedagogical importance to normalize speech, preventing difficulties in learning and choosing a profession.

The formulation of corrective tasks is determined by the results of the survey of the speech of children.

Fig. 37. An example of a broken letter in a child with Rinolalia (On the table there is a Czech; woodpecker is hammered in the trunk of the hollow)

Ministry of Science and Education of the Russian Federation GOU VPO "Yaroslavsky State Pedagogical University named after K.D. Ushinsky"

Rinolalia

Tutorial

UDC 376.3 BBK 74.37p30 p 51 ISBN 978-5-87555-417-8

The purpose of this manual: familiarization of students with the basic concepts and patterns of the general, speech and mental development of children with maxillofacial pathology, with the anatomy-physiological mechanisms of speech at Rinolalia, with methods of diagnosis and voice correction and speech under this violation.

Introduction

Chapter 1. General information about Rinolalia

Rinolalia definition

2. Rinolalia classification

Closed Rinolalia

Open rinolalia

Mixed Rinolalia

Chapter 2. Squares of the sky and their influence on the general and speech development of the child

Causes of congenital debris lips, solid and soft sky

Types of congenital debris

Classification of cleft

4. Anatomy-physiological features of the celestial apparatus in the norm and when clever solid and soft sky

5. Characteristics of the structure of the defect with an open organic rinolalia

Primary disorders in the structure of the speech defect at Rinolalia

Secondary violations in the structure of the speech defect at Rinolalia

Control questions and tasks for independent work:

Chapter 3. Complex examination of children with Rinolalia

Control questions and tasks for independent work

Chapter 4. Correction system with children with congenital debris

1. The history of the development of methods for overcoming open organic rinolalia

2. The main directions of correctional work at Rinolalia

3. Basic conditions that determine the forecast of correctional work

4. Terms of surgical intervention

5. Two periods of correctional work at Rinolalia

6. Development of a full-fledged celestial closure

7. Stages of working on breathing at Rinolalia

8. Activation of the articulation apparatus

9. Setting the right sound testing at Rinolalia

11. Speech therapy rhythm in the general system of therapeutic and correctional impact at Rinolalia

12. Early preventive work with children with congenital clefts of the upper lip and sky

13. Prevention of hearing disorders in children with congenital solid and soft sky clefts

14. Institutions in which Corrective assistance to children with Rinolalia

15. Evaluation of the speech of children with Rinolalia after speech therapy work

Control questions and tasks for independent work

Approximate subjects of abstracts and coursework

Approximate list of questions for the exam

Introduction

Among the congenital malformations, one of the first places occupy the clefts of the upper lip, solid and soft sky. The frequency of such pathology is 1 case for 600-700 births. The main speech defect in such children is an open organic rinolalia.

This study manual discusses the causes of the pathogenetic mechanisms of Rinolalia, the analysis of the structure of the defect, primary and secondary development deviations in children with this pathology is given, the characteristic of the diagnosis program and the correction of sound-proof disorders and voice timbre is proposed.

Educational materials are intended to students of the defectological faculty of the specialty "Speech Studdle" and are aimed at further improving the training of speech therapists - their professional practical skills and skills on the correction of primary defect and secondary development deviations in children with Rinolalia.

The purpose of this manual:acquaintance of students with basic concepts and patterns of general, speech and mental development of children with maxillofacial pathology, with the anatomy-physiological mechanisms of speech at Rinolalia, with methods of diagnosis and voice correction and speech under this violation.

The main tasks of this discipline:

- familiarization of students with etiology and pathogenesis of Rinolalia;

Familiarization with the techniques and methods of medical and psychological and pedagogical diagnostics of the state of children with congenital clefts of the lips and the sky;

The formation of theoretical and practical ideas about the integrated approach to eliminating this speech pathology;

Acquaintance of students with the methods of corrective impact at Rinolalia.

Students who have learned the discipline "Rinolalia" must know:

Etiopathogenetic mechanisms of rinolalia;

The clinical and psychological and pedagogical characteristics of children with Rinolalia;

The main methods of corrective impact at Rinolalia.

Students must be able to:

- conduct a survey of children with Rinolalia;

Determine primary and secondary disorders in the structure of the speech defect;

Select correction techniques, plan and conduct correctional psychological and pedagogical work in pre-and postoperative periods with children with congenital lips and heaven clefts.

Students must keep the skills

Drawing up a survey protocol, analysis of examination materials, selection of speech and didactic material for speech therapy.