Tonsillectomy-Adenoidectomy and Hypernasality

Tonsillectomy-Adenoidectomy and Hypernasality

My sister-in-law called me today with questions about her son that recently had his tonsils and adenoids out. She was saying that since the surgery he received one week ago he suddenly has a very nasal quality about his speech.

Temporary change in voice following surgery is common.

In response to her concern I explained that it is common for children following a tonsil adenoidectomy to experience a temporary change in voice after the surgery for the first few months until the soft palate has lengthened enough to close the gap left by the absence of the tonsils and adenoids. In most cases additional exercises for the palate are not needed in order to achieve the closure. However, blowing exercises can speed up the process and ensure a quicker recovery. Please remember, it is important to wait until the healing process is complete to start blowing exercises! This usually takes about 2-3 weeks.

Try a kazoo!

Tonsillectomy-Adenoidectomy and Hypernasality - Mommy Speech Therapy

Blowing a kazoo is the exercise I have found to be the most beneficial for strengthening the soft palate for the purpose of eliminating hypernasal speech. It is effective because it requires the blower to use voice in addition to blowing. When the blower uses this combination of both voice and air it stimulates the soft palate to close off the nasal passage. Subsequent blowing on the kazoo strengthens and lengthens the soft palate eventually leading to the elimination of the hypernasal vocal quality. For this exercise to be the most effective the child should be supervised by an adult to make sure he/she does not bite the kazoo or wrap their tongue around the kazoo (lips only). In addition the kazoo should be blown at least 25 times daily for a period of at least 1-2 seconds per blow with a one second break in between.

You may also try having the child puff up the cheeks, or practice multiple repetitions of the /p/ and /b/ sounds.

Contact an ENT or SLP if :

If you don’t see results within a 2-3 months from starting these exercises you should follow up with your ENT. He/she may recommend you see a Speech-Language Pathologist for more help.

11 Comments

  1. Can you tell me how many times exactly we have to do it? You mentioned 25 times a day. But approximately how many days?

  2. Hi Pragnesh,

    Thanks for your comment. If you are experiencing hyper nasality following a surgery be sure to wait until you are completely healed before beginning any exercises. If you are experiencing continued hyper nasality after you have healed completely try the kazoo for a few weeks. If you do not see any progress after a few weeks contact your ENT for a follow up evaluation. He may have some other exercises or recommendations that will help correct the hyper nasality. I would love to hear how it goes if you would be willing to come back and share your experience with us.

    Wishing you the best,
    Heidi

  3. Thank You so much for replying back Heidi. I haven’t gotten any surgeries done. I just noticed it recently that sometimes when I say words it comes out under my nose and after I came across this page, I thought that maybe since maybe my soft palate is weak that’s why.

    As far as therapy goes, I have seen a therapist where I live and I have gotten an evaluation done. Before I go to her, I want to know all of the things I do wrong when I speak so that makes our sessions much more valuable. Speech therapy is very expensive and I dont want to spend most of the time in finding out what’s wrong when I can just research on this site. 🙂

  4. Hi Heidi.I am writing you from Macedonia considering a problem that I have with my son…You see he had a adenoidectomy and tonsillectomy a year ago and still have the nasal speech…Please give me some advice what to do because frenkly I am loosing hope that he will get better.:(((.Thanks

  5. I would recommend you take him in for a follow up examination with the doctor that performed the procedure to make sure that structurally he has the ability to close off the nasal passage. If he structurally has the ability to close off the nasal passage and it is just an issue of strengthening the soft palate to close off the nasal passage then I would recommend you see a speech language pathologist to guide you through some exercises to help strengthen the soft palate to eliminate the hyper nasal speech. In the mean time any exercises that you can do to encourage oral air flow will help strengthen the soft palate. For example blowing cotton balls across a table, blowing a pin wheel, blowing bubbles, horns and kazoos. I hope this helps.

    Best of luck!
    Heidi

  6. I am so happy to come across this, My four year old had his tonsils and adenoids out 5 weeks ago, he had trouble with speech and always sounded as though he had a cold, His speech has improved alot since but I have been so worried as he still sounds bunged up, so I am delighted to hear this is normal, Nobody ever explained about the soft palate, I will be trying the blowing from tomorrow.

    Thank you so much.x

  7. Glad you found this helpful Charlotte. Hopefully your son is doing well!

  8. My daughter had a T&A a week shy of 2 months ago. She is still sounding pretty nasally (especially when she is excited and talking loud). The nurse at the ent office said to have her blow a balloon about three times a day for a week. Well, my daughter is 3 yes old and it is a Great if I get her to “blow” it up 3x a piece 3x a day. She can’t really even blow it up very well! I tried it about a week with no results. Any advice? Thanks!!

  9. Hi! My son (2.75 yrs old) just had his adenoids removed two days ago. He sounds so nasal now and his speech is much harder to understand now. Is this likely temporary? How long does this last? It is very worrisome to hear his speech regress like this…
    Thank you

  10. Hi Amanda,
    Like Heidi wrote in the blog above, it is fairly common to hear changes occur in the voice of your child following therapy. Usually it’s no cause for concern and the change in speech is usually temporary. It may take up to 2-3 months for your child’s soft palate to heal. Thanks for your question and good luck with the healing process. If you still have concerns in a few months you’ll want to follow up with your ENT or consult a speech pathologist.

  11. Hi Alycia,
    Any other type of play-geared blowing exercises could help. In the article, Heidi recommends blowing a kazoo, puffing out her cheeks multiple times, or repetitions of the /p/ and /b/ sound. Other activities such as blowing a cotton ball across the table with a straw, blowing a paper boat down a stream of water, or even blowing bubbles may be more appropriate for your 3 year old, and may be just as beneficial. If you still feel she’s pretty nasally even after trying these exercises for a few weeks, it would be recommended you consult with an SLP who has experience with nasality. Good luck!