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drtbalu's otolaryngology online
Disorders of speech & Language
Dr T Balasubramanian
drtbalu's otolaryngology online
Introduction
● Communication is a fundamental part in the developmental process
● ENT surgeons are commonly involved in diagnosing and treating patients with communication disorders
● Speech language therapists play a vital role in managing children with communication problems
drtbalu's otolaryngology online
Normal speech development essentials
● Sensory stimulation – normal● Imitation● Experimentation● Feedback
drtbalu's otolaryngology online
Sensory stimulation
● Normal hearing is a must for normal speech● Hearing diability is the commonest cause of
speech disturbance● Earlier hearing disability is identified and
corrected chances of normal speech development is bright
● Augmentation devices should be prescribed at a very early age – under the age of 1 in patients with deafness
drtbalu's otolaryngology online
Imitation
● Speech is learnt by imitation● Child loves to imitate its mother● More the mother talks to the child – faster the
speech develops
drtbalu's otolaryngology online
Experimentation
● Child loves to experiment● Control and generation of speech is largely
gained through experimentation● Drooling is one feature of experimentation● Drooling stops as soon as the child comes out
of this phase
drtbalu's otolaryngology online
Feed back
● Encouragement● Emotions – mother● Response to sounds generated by the child
drtbalu's otolaryngology online
Stages of speech development
drtbalu's otolaryngology online
Stages of phonation
● Phonation stage● Primitive articulation stage● Expansion phase● Canonical babbling phase
drtbalu's otolaryngology online
Phonation stage
● Occurs during the first 2-3 months● Infant raises vowel like sounds● Sounds produced are known as cooing
drtbalu's otolaryngology online
Primitive articulation stage
● This is also referred as gooing● Wide variety of sounds are produced by the
infant in this stage● This phase is a must before the child can
migrate to the expansion phase
drtbalu's otolaryngology online
Expansion phase
● In this phase the infant combines vowels with consonents
● Infant needs to be encouraged during this stage
drtbalu's otolaryngology online
Canonical babbling phase
● In this stage the infant learns to string syllables to form complex sounds
● In this phase child learns to speak works like mamma, dadda etc.
drtbalu's otolaryngology online
Classification of speech disorders
● Receptive disorders● Expressive disorders● Mixed disorders
drtbalu's otolaryngology online
Receptive disorders
● Neurological – secondary to cognitive impairment
● Sensory – Secondary to hearing / visual impairment
● Environmental – Poor sensory stimulation
drtbalu's otolaryngology online
Expressive disorders
● Voice disorders● Oropharyngeal structural disorders – cleft
palate, rhinolalia● Motor nerve and cortical disorders (dysarthria)● Fluency disorders (stuttering)
drtbalu's otolaryngology online
Combined disorders
● Psycological morbidity (Autism)● Developmental disorders (cerebral palsy)
drtbalu's otolaryngology online
Speech / language delay
● Commonest problem● Parental anxiety● Rescorla criteria – Children at 24 months who
speak less than 50 single words and use no two words combination belong to this group
● Incidence is about 15% of normal population
drtbalu's otolaryngology online
Problems of delayed speech
● Literacy problems● Socializing problems● Behavioral problems● Learning difficulties● Antisocial activities
drtbalu's otolaryngology online
Importance of history in diagnosis of delayed speech
● Details of pregnancy● Details of delivery● Developmental milestones● Feeding history of the child
drtbalu's otolaryngology online
Normal speech development depends on
● Respiration● Phonation● Articulation● Resonance● Velopharyngeal sphincter
drtbalu's otolaryngology online
Nasal speech
● Rhinolalia clausa● Rhinolalia aperta
drtbalu's otolaryngology online
Thank you