What is Velopharyngeal Insufficiency?

J.M. Willhite

Velopharyngeal insufficiency (VPI) is a congenital disorder characterized by impaired soft palate function that adversely affects one’s speech. Generally resulting from impaired soft palate function, velopharyngeal insufficiency can cause one’s speech to possess a nasally resonance. Treatment for velopharyngeal insufficiency generally involves the use of prosthetic devices and surgery to correct structural issues. Speech therapy is the key element of long-term therapy to ensure a good prognosis and reduction in hypernasality.

Velopharyngeal insufficiency is frequently diagnosed in young children.
Velopharyngeal insufficiency is frequently diagnosed in young children.

A diagnosis of VPI is generally made with the administration of an oral mechanism examination by a speech-language therapist. Essential to confirming velopharyngeal insufficiency, the examination is comprised of two segments. An evaluation of the inside of the mouth is conducted to detect undiagnosed conditions, such as structural abnormalities, that may contribute to one's symptoms. A subsequent assessment of the oral cavity is then performed as the individual articulates sounds that may help facilitate the detection of functional issues, such as muscle weakness or paralysis.

Speech therapy is often used to treat VPI that is affecting a child's speech.
Speech therapy is often used to treat VPI that is affecting a child's speech.

The velopharyngeal sphincter, located at the back of the throat, plays an essential role in speech. Comprised of the throat and soft palate, the velopharyngeal sphincter is intended to close to prevent airflow between the mouth and nose when one speaks. In order for a person to make certain consonant sounds, the velopharyngeal sphincter must close completely.

Velopharyngeal insufficiency, also known as velopharyngeal incompetence, results when the velopharyngeal sphincter does not close properly due to palatal impairment. Individuals born with palatal deformity or dysfunction, such as cleft palate or palatal paralysis, will generally demonstrate velopharyngeal incompetence. In some cases, velopharyngeal incompetence may also present following an adenoidectomy, or the removal of one’s tonsils.

Frequently diagnosed in young children, velopharyngeal insufficiency generally presents with patterned signs and symptoms. The most common indication is a nasal intonation to one’s speech, a characteristic known as hypernasality. Involuntary sounds, such as snorting, and the adoption of compensatory breathing and speech patterns are not uncommon. Physical signs of VPI often include nasal regurgitation when eating or drinking and involuntary, facial grimacing when speaking.

Treatment for velopharyngeal insufficiency is generally dependent on the cause and severity of one’s condition. Speech therapy is often utilized to help individuals learn proper breathing and articulation techniques. In addition to speech therapy, prosthetic devices, such as an obturator or palatal lift, may be used to artificially close the velopharyngeal sphincter in the presence of neuromuscular issues.

When palatal abnormalities are responsible for velopharyngeal insufficiency, surgery may be performed to correct the deficiency. Pharyngeal flap surgery, or pharyngoplasty, is most common and involves the repositioning of soft tissues to improve velopharyngeal sphincter function. It is not uncommon for some individuals' conditions to necessitate multiple surgeries to correct the deficiency.

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