Disorders of Speech and Language

drtbalu's otolaryngology online

Disorders of speech & Language

Dr T Balasubramanian


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


Normal speech development essentials

● Sensory stimulation – normal● Imitation● Experimentation● Feedback


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


Imitation

● Speech is learnt by imitation● Child loves to imitate its mother● More the mother talks to the child – faster the

speech develops


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


Feed back

● Encouragement● Emotions – mother● Response to sounds generated by the child


Stages of speech development


Stages of phonation

● Phonation stage● Primitive articulation stage● Expansion phase● Canonical babbling phase


Phonation stage

● Occurs during the first 2-3 months● Infant raises vowel like sounds● Sounds produced are known as cooing


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


Expansion phase

● In this phase the infant combines vowels with consonents

● Infant needs to be encouraged during this stage


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.


Classification of speech disorders

● Receptive disorders● Expressive disorders● Mixed disorders


Receptive disorders

● Neurological – secondary to cognitive impairment

● Sensory – Secondary to hearing / visual impairment

● Environmental – Poor sensory stimulation


Expressive disorders

● Voice disorders● Oropharyngeal structural disorders – cleft

palate, rhinolalia● Motor nerve and cortical disorders (dysarthria)● Fluency disorders (stuttering)


Combined disorders

● Psycological morbidity (Autism)● Developmental disorders (cerebral palsy)


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


Problems of delayed speech

● Literacy problems● Socializing problems● Behavioral problems● Learning difficulties● Antisocial activities


Importance of history in diagnosis of delayed speech

● Details of pregnancy● Details of delivery● Developmental milestones● Feeding history of the child


Normal speech development depends on

● Respiration● Phonation● Articulation● Resonance● Velopharyngeal sphincter


Nasal speech

● Rhinolalia clausa● Rhinolalia aperta


Thank you

Documents

Disorders of Speech and Language