Nasal emission as a component of the misarticulation of sibilants and affricates.

Nasal emission confined solely to the sibilants or sibilants and affricates may be encountered as an articulatory phenomenon in speakers who do not demonstrate velopharyngeal incompetency. This phenomenon may occur both in patients who previously had an incompetent mechanism and in patients in whom such incompetency has never been documented. In the latter case, the patient may be referred to a cleft palate clinic on suspicion of a submucous cleft or other form of palatopharyngeal incompetency. Typically the nasal emission is combined with incorrect tongue placement. The persistent oral-nasal misarticulation may be viewed simplistically as a residual of earlier velopharyngeal incompetency, documented or undocumented. The speaker's own acoustic target for these consonants is grossly deviant, perhaps owing to such factors as malocclusion and earlier compensatory articulation gestures. Many such cases prove impervious to extensive articulation therapy, yet physical management may constitute "over-correction" with undesirable sequelae. Inventive approaches to articulation therapy may be required in these cases, since correction of the combined oral-nasal distortion requires the speaker to make many simultaneous changes in articulator placement without benefit of visual cues.