From Big Medical Encyclopedia

TWANG (rhinolalia) — pathological change of a timbre of a voice and the distorted pronunciation of sounds of the speech, sound pronunciations caused by disturbance of normal participation of a nasal cavity in processes and phonations. Distinguish two main types of G. — open (rhinolalia aperta) and closed (rhinolalia clausa). At open G. during pronouncing all sounds of the speech air passes not only through a mouth, but also through a nose; at the closed G. air passes only through a mouth that takes place and during the pronouncing nasal sounds («m» and «N»). The closed G. meets much less often than open.

Open twang

At normal pronouncing all sounds of the speech, except nasal, a soft palate usually adjoins a back wall of a throat and by that separates an oral part of a throat from a nasopharynx. Thereof the current of air which is formed at sound pronouncing goes through a mouth, and sounds of the speech get the normal timbre. The timbre is not distorted in noticeable degree and when the soft palate at reduction recedes from a back wall of a throat a little, leaving here small (3 — 5 mm) a crack; the voice current of air also in this case goes not to a nose through a narrow crack, and to a mouth through a wide gleam of a pharynx. The nasal shade acquires the speech only when a considerable part of air gets into a nose. At the same time vowels get a nasal timbre, and in the most expressed cases the pronunciation and most of concordants is distorted, and the speech becomes muffled. It is observed:

1) at inborn not fusions of a hard and soft palate (see); 2) at defects of a hard and soft palate as a result of wound or after disintegration of a syphiloma; 3) during the shortening of a soft palate; 4) at paralyzes and paresis of a soft palate (e.g., after diphtheria). Quite often open G. can be also in the absence of the expressed anatomic defects; in these cases speak about functional opened G. Takaya G. results sometimes from disturbance of acoustical self-checking over a pronunciation at deafs, after elimination of the mechanical reasons interfering normal functioning of a soft palate (e.g., after removal of hypertrophied almonds), after removal of adenoid growths or tumors of a nasopharynx when during nek-ry time function of a palatine velum remains insufficient owing to the partial atrophy of muscles of a soft palate which arose from long inaction.

The closed twang

leads Disturbance of normal passability of a nasal cavity to full or partial switching off of a nasal resonance. The voice in these cases loses a number of overtones, sounds deafly. If the obstacle causing closing of a nasal cavity (adenoid growths, tumors of a nasopharynx, choanal polyps, cicatricial unions of a soft palate with a back wall of a throat and so forth), is in a nasopharynx or in back departments of a nose, then there is a back closed G. — rhinolalia clausa posterior. In the presence of an obstacle in front departments of a nasal cavity (dogleg of a nasal partition, nasal polyps, a hypertrophy of nasal sinks, swelling of a mucous membrane at cold and so forth) there is a front closed G. (rhinolalia clausa anterior). At the front closed G. the nasal resonance sometimes to some extent remains.

At the closed G. pronouncing nasal sounds is especially broken. In cases of a full rhinocleisis instead of sounds of «m» and «N» «would» be said respectively and «д» (instead of «mother» — «woman», instead of «nurse» — «uncle», instead of «at me is cold» — «at bedya dasbork»); at partial obstruction of «m» sounds as «MB» (mbamb), «N» as «нд» (ndyandya).

The closed G. in some cases can also be functional; in particular, it, as well as open G., is observed sometimes at deafs as a result of lack of acoustical control over a pronunciation.

The diagnosis

G.'s Recognition does not represent work. Characteristic change of a timbre of a voice during the pronouncing sounds of the speech usually easily is defined on hearing. Localization of the anatomic defects which are a cause of infringement of a normal nasal resonance is defined by means of faringoskopiya (see), front and back rinoskopiya (see). Are applied as well functional trials: 1) touch with fingers a ridge of the nose and suggest investigated to pronounce words and sounds; if during the pronouncing not nasal sounds vibration is felt — open G. is defined and if during the pronouncing nasal sounds («m» and «N») do not have vibration — the closed G.; 2) investigated says a sound combination «аи»; if at a latching of outside openings of a nose of G. does not change, it closed if amplifies, G. open. Sometimes in the presence of an explicit obstacle for passing of air to G.'s nose it is not closed, and open since at the same time there is a lag of a palatine velum from a back wall of a throat. Removal of adenoides in such cases is undesirable, and sometimes and contraindicated since it can lead to open G.'s strengthening


At the open G. caused by slot-hole defects of a hard and soft palate the corresponding plastic surgeries — urano-and the staphyloplasty are made (see. Sky ). If for some reason or other an operative measure is contraindicated, then palate defects close special prostheses — obturators (see). At paresis of a soft palate its massage and an electrotherapy is shown. At the closed G. treatment consists in removal of obstacles in a nose and a nasopharynx. In all cases of G. it is necessary to carry out logopedic exercises. At the closed G. these exercises are carried out after an operative measure. At open G. are reasonable as well presurgical logopedic occupations. At children such occupations shall begin as soon as possible (at 3-year age).

The forecast

In most cases surgical treatment in combination with logopedic exercises yields positive takes.

Bibliography: Szeemann M. Alalias at children's age, the lane from Czeches., M., 1962; Neumann L. W. Anatomy, physiology and pathology of acoustic organs and speech, M., 1970; Pravdina O. V. Logopedics, page 85, M., 1969; In gays of n in-ge of N. of Rhinolalia aperta bei progressiver Sklerodermie, Z. Laryng. Rhinol., Bd 51, S. 458, 1972; M a r a n A. G. a. o. Hypernasality, bony and soft tissue relationships, J. Laryng., y. 85, p. 105, 1971; Mor-1 e y M. E. Cleft palate and speech, L., 1962; Opperbeck J. Submukose Gau-menspalte ais Ursache einer Rhinolalia aperta nach Tonsillektomie, Z. Laryng. Rhinol., Bd 49, S. 805, 1970.

L. B. Neumann.