After removal of a benign tumor at the base of the brain, a 76-year-old has severe nasalization and a weak, breathy voice; four-month post-surgery assessment shows no improvement. Remediation should focus on?

• A. Evaluation for prosthetic or surgical intervention
• B. Strengthening exercises for the oral articulators
• C. A trial period using the yawn-sign technique
• D. Complete vocal rest

Answer: (A)

Air leaks through the nasal cavity during speech because the velopharyngeal mechanism isn’t closing properly after the base-of-brain surgery, leading to hypernasality and a weak, breathy voice. When several months of remediation don’t yield improvement, the focus shifts from just changing how sounds are formed to restoring the actual closure of the velopharyngeal port. That means evaluating for prosthetic or surgical correction, such as a palatal lift or speech bulb prosthesis, or considering surgical options to improve closure. Strengthening the oral articulators may help with articulation, but it won’t fix a persistent leak at the velopharyngeal mechanism. The yawn-sign technique is a therapeutic cue, but it won’t provide a lasting solution to a structural closure deficit, and vocal rest won’t address the resonance problem.