Evaluating a child for hypernasal speech

Hypernasality occurs in velopharyngeal insufficiency (eg, due to submucous [covert] or overt cleft of the palate). Hypernasality is demonstrated by air escape when the child says words or phrases that contain plosive consonants, especially "b" and "p" (eg, "puppy" or "Bobby"), or sibilant fricatives such as "s," "z," or "sh." A useful test phrase is "Suzie sells sea shells."