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What exactly is cul-de-sac resonance and what causes it?

Ann W. Kummer, PhD, CCC-SLP, ASHA Fellow

May 1, 2024

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Question

What exactly is cul-de-sac resonance and what causes it?

Answer

Cul-de-sac resonance occurs when the sound energy enters a cavity of the vocal tract, but is blocked at the exit of cavity’s normal outlet. The sound is therefore trapped in a blind pouch. Because some of the sound is absorbed by the soft tissues, the speech/voice is perceived as muffled and low in volume. Like hyponasality, cul-de-sac resonance is due to obstruction, but in this case, the place of obstruction is at the cavity’s exit point rather than at the entrance or within the nasal cavity.

There are three types of cul-de-sac resonance, depending on the location of the blockage (Kummer, 2020a). All are defined by blockage at the cavity’s exit point. As such, oral cul-de-sac resonance occurs when the sound is partially blocked from exiting the oral cavity during speech. This can occur due to microstomia (a small mouth opening). It is also what is heard with “mumbling” or speaking without opening the mouth normally. To imitate oral cul-de-sac resonance, say oral sentences with a very small mouth opening. Nasal cul-de-sac resonance occurs when the sound is partially blocked from exiting the nasal cavity during speech. This is most noticeable when there is a combination of VPI (which would otherwise cause hypernasality), but also a blockage in the anterior part of the nose or nares. Nasal cul-de-sac resonance is commonly found in individuals with a history of cleft lip and palate, which can cause both VPI and either a deviated septum (due to a unilateral cleft lip) or a stenotic naris (due to scarring after a cleft lip repair). Nasal cul-de-sac resonance can be simulated by imitating hypernasality while closing one or both nostrils. Pharyngeal cul-de-sac resonance occurs when the sound is blocked from exiting the oropharynx during speech. This is typically caused by enlarged tonsils that block the oropharyngeal opening (exit of the pharynx). As with other types of cul-de-sac resonance, this blockage causes speech to be low in volume and muffled in quality. Although enlarged tonsils are the most common cause of pharyngeal cul-de-sac resonance, it can also occur due to scar tissue or other forms of obstruction on the pharyngeal wall of the hypopharynx or oropharynx. To imitate pharyngeal cul-de-sac resonance, produce oral sentences with your closed fist over your mouth.

This Ask the Expert is an excerpt from the course 20Q: Evaluation and Treatment of Speech/Resonance Disorders and Velopharyngeal Dysfunction presented by Ann W. Kummer, PhD CCC-SLP.


ann w kummer

Ann W. Kummer, PhD, CCC-SLP, ASHA Fellow

Ann W. Kummer, PhD retired as the Senior Director of Speech-Language Pathology at Cincinnati Children's. She is a Professor Emeritus at the University of Cincinnati College of Medicine. She’s done hundreds of national and international lectures. She’s authored numerous articles, 22 book chapters, and the text entitled: Cleft Palate and Craniofacial Anomalies: A Comprehensive Guide to Clinical Management, 4th Edition, Jones & Bartlett Learning. Dr. Kummer has received many honors, including Fellow of ASHA and Honors of ASHA.


Related Courses

20Q: Evaluation and Treatment of Speech/Resonance Disorders and Velopharyngeal Dysfunction
Presented by Ann W. Kummer, PhD, CCC-SLP
Text

Presenter

Ann W. Kummer, PhD, CCC-SLP
Course: #8729Level: Intermediate1 Hour
  'I actually think that this would have been a more effective course with more tables and visual examples, pictures of the oral/pharyngeal/nasal structures'   Read Reviews
Children with speech and resonance disorders (hypernasality, hyponasality, and cul-de-sac resonance) and/or nasal emission present challenges for speech-language pathologists (SLPs) in all settings. This article will help participants to recognize resonance disorders and the characteristics of velopharyngeal dysfunction, and provide appropriate management.

Causes and Characteristics of Resonance Disorders and Velopharyngeal Dysfunction, presented in partnership with Cincinnati Children's
Presented by Ann W. Kummer, PhD, CCC-SLP
Video

Presenter

Ann W. Kummer, PhD, CCC-SLP
Course: #7915Level: Intermediate1.5 Hours
  'I like the videos that were shown'   Read Reviews
This is Part 1 of a two-part series. Children with resonance disorders (hypernasality, hyponasality and cul-de-sac resonance) or suspected velopharyngeal dysfunction present challenges for SLPs in all settings. This course is designed to provide information about the causes and characteristics of resonance disorders and velopharyngeal dysfunction so that these disorders can be recognized and appropriate treatment can be recommended.

Evaluation of Speech/Resonance Disorders Secondary to Velopharyngeal Dysfunction, presented in partnership with Cincinnati Children's
Presented by Ann W. Kummer, PhD, CCC-SLP
Video

Presenter

Ann W. Kummer, PhD, CCC-SLP
Course: #7916Level: Intermediate1.5 Hours
  'I love how very specific techniques were given as to how we can assess for hypernasality, nasal emission, and hyponasality'   Read Reviews
This is Part 2 of a two-part series. Children with resonance disorders (hypernasality, hyponasality and cul-de-sac resonance) present challenges for speech-language pathologists (SLPs) in all settings. This course is designed to provide simple, yet very reliable low-tech evaluation techniques for practicing SLPs who frequently or occasionally see clients with cleft palate, hypernasality, or suspected velopharyngeal dysfunction. (Part 1: Course 7915)

Sound Judgment: Speech Prerequisites, Therapy Techniques, and Use of Motor Learning Principles
Presented by Ann W. Kummer, PhD, CCC-SLP, ASHA Fellow
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Ann W. Kummer, PhD, CCC-SLP, ASHA Fellow
Course: #10447Level: Intermediate1.5 Hours
  'I learned so much in this course and I'm an experienced SLP! Thank you'   Read Reviews
Differentiating obligatory distortions from compensatory productions, sensory feedback techniques, and effective placement strategies for correction of speech sound errors (e.g., lateral lisp and distortion of /ɚ/ and /r/) are described in this course. Motor learning and motor memory principles are discussed as a framework for achieving carryover after sound acquisition has occurred.

20Q: Velo-Cardio-Facial Syndrome (VCFS)
Presented by Karen J. Golding-Kushner, PhD, CCC-SLP, ASHA Fellow
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Karen J. Golding-Kushner, PhD, CCC-SLP, ASHA Fellow
Course: #8700Level: Intermediate1 Hour
  'comprehensive explanation of genetic and developmental factors and treatment approaches'   Read Reviews
This course describes the characteristics of Velo-cardio-facial syndrome that are of the greatest relevance to SLPs: those that affect feeding, speech and language. Best practice for intervention is also explained.

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