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Paralysis of the velum which is another organic cause of hypernasality can be either complete or partial. Papillomas are found more frequently in children than in adults. One kind of growth on the laryngeal structures, including the vocal folds, is called papilloma. With most surgical procedures, the patient must use one hand to close the stoma while speaking. Patients who are proficient at it can talk clearly for extended durations. These surgical procedures modify the existing structures in the throat to create mechanism that help produce sound. Surgical modification and implanted devices also can be sources of sound. When the air is expelled, it produces vibrations of the soft tissues of the esophagus. In the injection method, the air is impounded in the mouth, as in saying /t/ or /p/. Some post-laryngectomy patients find it hard to learn esophageal speech. Adenoidectomy or tonsillectomy also can cause hypernasality, especially when the child's velopharyngeal mechanism initially did not have sufficient muscle mass. The speech produced with the help of an electronic larynx may be monotonous. This muscular tube may be made to produce sound by first inhaling air into it and then releasing it in the form of a belch. A speaker who is well trained by a speech-language pathologist can produce intelligible speech with the help of an electronic larynx. Children born to mothers who have genital warts may have a papilloma of the larynx at the time of birth. However, those who can learn are able to speak surprisingly well and listeners can easily understand their speech. Some papillomas are hard and look like warts and the vocal folds can be covered with such wart like growth. Some patients may find this a difficult chore. On some devices, the speaker can change the pitch, and this can help in achieving a more normal-sounding voice. However, most alaryngeal speakers must use relatively short phrases and sentences. Many laryngectomy patients learn esophageal speech with or without the help of surgical procedures. The esophagus, which is the flexible tube through which food reaches the stomach, also is a source of sound. All implanted devices require some form of surgery, but some surgical procedures do not include implanted devices. In the inhalation method, the patient is taught to inhale rapidly while keeping the esophagus open or relaxed. The belching sound is then articulated into speech sounds, and the speech produced by this means is known as esophageal speech. The voice also may lack pitch variations, and the vocal intensity also may be limited. Nonetheless, with proper training and family support, most alaryngeal speakers manage their day-to-day communicative needs. The inhaled air passes through the esophagus and sets its tissues into vibratory motion. Other papillomas are soft and do not resemble warts. Patients must first learn to get air into the pharyngeal area.
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