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Individuals with unrepaired palatal clefts tend to exhibit severe hypernasality. The results is not only hypernaslity but also hyponasality. If the hypernaslity is not excessive, it simply becomes a hallmark of the individual's voice. Most individuals who are deaf have an adequate velopharyngeal mechanism but they cannot effectively control that mechanism during speech. Before treatment begins, the associated organic condition such as cleft palate must be surgically or medically treated. Another organic cause of hypernasality which is paralysis of the velum can be either complete or partial. Because of many reasons, including cleft of the soft palate, the muscle mass of the soft palate is reduced. The client can be reinforced for greater mouth opening or a more posterior tongue position within the mouth. In some individuals, harshness may be a matter how the person has learned to produce voice with hard glottal attacks and abrupt initiations of voice. Resonance is the modification of sound by structures through which that sound passes. Vagus nerve lesions may produce a hoarse voice with marked breathiness. Voice therapy is effective in eliminating harshness caused by some of the structural problems that are due to vocal abuse. Any growth on one or both the folds makes it difficult to approximate the folds, resulting in breathiness. Breathiness is one of the vocal quality deviations that may be observed to some extent in certain speakers. While pitch and intensity are related to the physical measures of frequency and intensity, the quality of voice is related to the complexity of the sound wave and many other factors, some of which are not easily measured. Because the pitch of an adolescent female does not change as dramatically as the pitch of an adolescent male, a higher than normal pitch in a female person is not as noticeable as it is in a male person. It is a vocal behavior that has been reinforced in the past. The process of achieving a lower pitch is associated with pitch breaks, which may be embarrassing or annoying to some boys. Depressed patients talk too softly to be heard even under quiet conditions. A slightly louder voice or lower pitch also can be targeted. However, such treatment might not eliminate hypernasality, suggesting a need for voice treatment. If it is excessive, the person needs voice therapy. Their nasal sounds may sound non-nasal, and the oral sounds may sound nasal. Because people who are deaf have difficulty hearing their own voice, they are not able to monitor the degree of nasality in their speech. Velar paralysis is associated with cerebral palsy, stroke, and other such conditions of neurology. Therefore, the velopharyngeal mechanism is inadequate to achieve a closure. Consequently, it often is difficult to distinguish the nasal from the non-nasal sounds in their speech. Hypernasality, though often associated with some form of organic defect that exists with no such defect, is called fucntional hypernasality. Deafness also is associated with hypernaslity. Several techniques help reduce hypernasality. Velopharyngeal inadequacy is another cause of hypernasality.
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