Speech prostheses in the management of nasal speech
This page explains about speech prostheses in the management of nasal speech and what to expect when your child comes to Great Ormond Street Hospital (GOSH) to have this treatment.
This information describes the use of dental plates or prostheses to help correct nasal-sounding speech. Specialists from different professions are involved in this treatment. They include a speech and language therapist, a dental technician, a specialist dentist and a plastic surgeon.
You have probably already seen a speech and language therapist
and other members of a cleft lip and palate team. If so, the therapist has assessed your speech as sounding nasal and carried out some tests. These are likely to have included a nasendoscopy and a videofluoroscopy to look at the soft palate and the walls of your throat during speech. A prosthesis has now been suggested to you as a treatment option.
What causes nasal-sounding speech?
Nasal-sounding speech is associated with an inability of the soft palate to shut off the nose from the mouth during speech.
What is a speech prosthesis?A speech prosthesis is a removable plastic plate that fits against the hard and soft palate and is anchored to some of the upper teeth by metal clips. At the back of the plate there is an extension of plastic, which is the part of the prosthesis that acts to improve speech. The way it does this is explained later in this leaflet. Speech prostheses are similar to the removable braces used by orthodontists to straighten teeth.
Why do I need a speech prosthesis?We recommend a speech prosthesis when other options, such as surgery, have failed or are not advisable for medical or other reasons. Sometimes, when surgery is being considered as an option to improve nasal speech, a prosthesis may be used on a trial basis to gauge how successful an operation might be. Usually speech therapy will not help to reduce the nasal sound in your speech.
What are the different types of prostheses?There are two types of speech prostheses. Each has a different purpose and works in a different way.
i) Palatal lift applianceThis acts by lifting the soft palate upwards and backwards, which may help to encourage movement of the soft palate and the back of the throat. We may recommend this type of device if the soft palate does not move very much during speech, but appears long enough to reach the back of the throat.
ii) Speech bulbs
If there is a significant gap between your soft palate and your throat when you speak, we may suggest attaching a speech bulb or speech obturator to the basic plate appliance. The aim of this is to "block up" the space. We may recommend a speech bulb when surgery is not possible because of medical or anaesthetic risks, or sometimes when the gap is so large that surgery is unlikely to work.
How is a speech prosthesis made?
A dental impression of the top teeth and palate is taken and a dental cast is made. A plastic plate is then made to fit exactly over the cast of the palate, and metal clips are attached. These are for clipping on to some of the back teeth to keep the appliance in place.
The important part of a speech bulb is made by placing a layer of impression material onto the back of the plate and actively moulding it to extend into the full area of the gap behind the soft palate. The active part of a lift appliance differs in that the ‘lift’ procedure involves the gradual building up of layers of plastic in order to lift up the soft palate towards the back of the throat.
Fitting these appliances usually takes several visits to the Maxillofacial and Dental Department over a period of some weeks for the gradual addition of plastic onto the dental plate. Nasendoscopy, involving a small tube attached to a video camera being passed through the nose to look at the soft palate and walls of the throat while speaking, is used to get a very good fit of the prosthesis and to finalise the plate’s fitting.
Frequently asked questions
How long will it take for me to get used to it?
The prosthesis may be a little uncomfortable for a few days, but with persistent and continuous daytime wear, it should feel comfortable within a week. If it is still causing discomfort after this period, you should come back to the Maxillofacial and Dental Department for reassessment, but try in the meantime to keep wearing the appliance.
Should I wear it when I sleep?
No. It is very important that you do not do this.
How is it maintained?
The prosthesis should be cleaned using a toothbrush and warm water. Avoid scrubbing the metal clips as this may cause them to distort, which can affect the fit of the prosthesis. If you have any problems, please contact the Maxillofacial and Dental Department.
What happens when I eat?
You should keep it in when eating. This is very important. You should rinse it under warm water after eating to remove any food debris and try to avoid sticky foods.
Is it visible to other people?
No. The clips are on the back teeth so no-one will be able to see the prosthesis.
Will I need speech therapy?
The speech and language therapist assesses and measures your speech before treatment and as part of the final fitting of the prosthesis. Therapy is sometimes recommended, particularly when there are problems of pronounciation of consonent sounds.
Tips for wearing the appliance
- Regular check ups in the Dental department are required after fitting the appliance
- The plate must be removed at night
- The plate should ideally be left in during the day for meals
- It is particularly important that regular teeth brushing is continued.
Last reviewed by Great Ormond Street Hospital: March 2010
Ref: 2009F0683 © GOSH Trust March 2010
Compiled by the Speech and Langauge Therapy Department in collaboration with the Child and Family Information Group.
This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.