Velopharyngeal Dysfunction
Explanation
Velopharyngeal Dysfunction (VPD) includes velopharyngeal insufficiency and velopharyngeal incompetence - VPI.
In order to produce speech sounds, the nose must be closed off from the mouth during speech. Several structures come together to achieve this velopharyngeal closure. These include the soft palate (velum) and the walls of the throat (pharyngeal walls). With this closure, the speaker is able to build up air pressure and sound in the mouth to produce the various speech sounds. In some children, this closure is not possible, so speech is impaired. When closure is not possible due to a structural abnormality, the condition is called velopharyngeal insufficiency (VPI). If there is a neurological problem that affects the movement of these structures, it is called velopharyngeal incompetence (VPI).
What are the Causes?
The most common cause of velopharyngeal dysfunction is cleft palate or submucous cleft.
Other causes include a short soft palate, cranial base anomalies, adenoidectomy, enlarged tonsils, irregular adenoids, apraxia of speech, or any neuromotor disorder that causes poor velopharyngeal movement.
What are the Symptoms?
- Hypernasality or too much sound in the nose during speech
- Nasal air emission during consonant production (air escapes out of nose)
- Weak or omitted consonants due to inadequate pressure in the mouth
- Short utterance length due to loss of air pressure through the nose
- Compensatory speech sound productions (example: using a glottal stop like "uh" instead of the consonant sound /g/)
What Happens During an Evaluation?
The evaluation includes an assessment of articulation (speech-sound production) and resonance ("nasality"). An oral examination is done to rule out a structural problem. Finally, a computer-based assessment (nasometry) is done to obtain objective information regarding the function of the velopharyngeal valve.
What is the Treatment?
Surgical intervention can be done to correct the structural abnormalities that cause velopharyngeal dysfunction. Prosthetic devices can be used on a temporary or permanent basis. Speech therapy is usually required to help the patient make the best use of the velopharyngeal structures, particularly after surgical intervention. Therapy is important for correcting the speech-sound errors that result from the velopharyngeal dysfunction.
When to Call the Doctor
If your child's voice or speech are a concern to you or if you have further questions, you may contact the Speech Pathology Department at Cincinnati Children's Hospital Medical Center, 513-636-4341. You can ask to speak to a Speech Pathologist on the Voice / Resonance Team.
Why Cincinnati Children's?
As a national leader in pediatric speech pathology, Cincinnati Children's has a program for the treatment of velopharyngeal dysfunction. This program is staffed by speech-language pathologists who have undergone specific specialty training. We welcome referrals from primary care providers and specialty physicians.
Recommended Print Resources
The Speech Pathology Department at Cincinnati Children's recommends the following book for further information about clefts, velopharyngeal dysfunction and team care:
- Kummer AW. (2008). Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance, 2nd Edition. Clifton Park, NY: Thomson Delmar Learning.
Rev. 11/07
