VPI Clinic Assessment Protocol

The Velopharyngeal Insufficiency / Incompetence (VPI) Clinic at Cincinnati Children’s is a multidisciplinary clinic so that all necessary assessments can be done in one day. In addition, the clinic allows the specialists to work together to develop an appropriate and comprehensive treatment plan for the child.

The following information explains the common assessments we conduct to diagnose children’s VPI.

The speech-language pathologist evaluates the child’s speech sound production, resonance (nasality), and determines whether there is nasal air emission during speech. The speech-language pathologist may ask the child to repeat sounds and short sentences or answer simple questions as part of the evaluation.
Although the speech assessment can determine the type and severity of the speech and resonance disorder, it does not provide objective information. Therefore, the speech-language pathologist does an assessment using the Nasometer. The Nasometer is a computer-based instrument that measures the amount of sound in the mouth and in the nose during speech. The child wears a special headset that has specially designed microphones for this purpose. Once the headset is in place, the patient is asked to repeat sounds or simples sentences. The Nasometer gives the examiner an objective "nasalance score" that can be compared to normal speakers or to the patient’s previous tests.
All team members will likely do an oral examination, which is quick and easy. The child is asked to open his mouth and say “aaah.” The examiners will want to see the soft palate (velum) and look for the presence of enlarged tonsils.
Although resonance disorders and velopharyngeal dysfunction can be identified from the speech evaluation, it is important to determine the cause, size, and location of the velopharyngeal opening. This information is needed so that the appropriate intervention can be determined.

The speech-language pathologist and otolaryngologist (ENT) work together to obtain information through nasopharyngoscopy (also called nasendoscopy). The nasopharyngoscopy procedure involves passing a very narrow scope (about the width of a piece of cooked spaghetti) through a nostril to the back of the nose. That way, it is possible to view the top of the velum. With the scope in place, the examiners can view the velum and the action of the entire velopharyngeal valve during speech.

Although nasopharyngoscopy is not a painful procedure, it can cause minor discomfort. To reduce the discomfort, a nose spray of a topical anesthetic and a decongestant are administered to the child before the procedure.

Nasopharyngoscopy requires a moderate degree of cooperation from the patient. This is due to the fact that the child must sit still and repeat sentences without crying. Our specialists can help to position the child and calm the child during the procedure. In addition, parents can prepare the child for this test by downloading and reviewing this Coloring Book prior to the appointment.

The purpose of the genetics evaluation is to help determine the cause of the problem. This can assist the doctors in anticipating and treating medical and developmental issues that may be related to the diagnosis. The genetics evaluation can also help to determine the recurrence risk for the disorder so that the geneticist can counsel the family on the chance that the disorder will occur in other offspring.

The genetics evaluation includes an interview with the family to obtain information regarding the following:

  • Maternal illnesses during pregnancy and medications taken
  • The child's birth weight, length and head circumference
  • Specific birth defects, such as heart, eye or genital anomalies
  • Complications after birth, especially respiratory problems, seizures, or heart conditions
  • Developmental history
  • School performance
  • Family history for certain traits or anomalies
  • Treatment history

A standard physical examination of the child is done. In addition, there is an assessment of the following:

  • Growth parameters (weight, height or length, and head circumference)
  • The size and shape of the eyes, ears, mouth, nose, hands, fingers and numerous other structures
  • The unique features that may not be familial, but are specific to the child
  • The child's neurologic status, including muscle tone, level of function, and degree of social interaction.

Photographs are taken of the patient at each visit. It is also helpful if the parents bring in earlier photographs of the child, as well as photographs of other family members, to determine how certain traits are inherited.

After the history is reviewed and the examination is completed, additional tests may be ordered, such as a blood test (for analysis of chromosomes), X-rays, or an MRI scan of the brain. Referral to other physicians may also be necessary as part of a complete genetics assessment.

Our Coloring Book

Download our coloring book to help prepare your child for the VPI Clinic Assessment.

Download our coloring book to help prepare your child for the VPI Clinic Assessment.

Contact Us

For more information about the VPI Clinic or to refer a patient, call Sharon Burger, 513-636-0336.