Velopharyngeal Insufficiency

What are the symptoms of velopharyngeal insufficiency?

• Hypernasal speech (speech that has a high nasal quality)
• Increased nasal resonance (sound energy traveling through the nose and mouth)
• Nasal regurgitation (food comes out of the nose)
• Nasal emission during speech (air escapes through the nose during speech)

What tests are used to diagnose velopharyngeal insufficiency?

VPI is diagnosed during a thorough evaluation at our VPI Clinic. A typical visit at our VPI clinic includes the following:

• Caregiver interview: The team nurse and speech-language pathologist will ask questions about your child's medical history and speech-language development.
• Speech and resonance evaluation: The speech-language pathologist will do an evaluation of your child's speech sounds, oral and nasal resonance and nasal emission (air escape through the nose) during speech.
• Nasometer: The speech-language pathologist will do an evaluation with a nasometer. A nasometer is a computer-based tool that measures sound energy coming from the nose and mouth. Your child will wear a special headset during this portion of the evaluation.
• Physical exam: The doctor will look in your child's ears, nose and mouth.
• Endoscopy: The doctor may do a brief endoscopy procedure. An endoscopy is done to evaluate how the palate and the structures around it move during speech. An endoscope is a flexible, narrow tube attached to a bright light and a camera. The endoscope allows us to view the speech structures inside the nose and throat.
  • The tube goes a short distance into the nose. While the tube is in place, the speech-language pathologist will ask the child to say some words and sentences. The child and caregiver can observe the procedure as it is happening on a screen. The procedure lasts from less than a minute to approximately two to three minutes.

VPI evaluation results are shared with the parent/caregiver and child (if developmentally appropriate) at the end of the visit. A longer report is sent in the mail within one to two weeks of the visit. If needed, the team speech-language pathologist is available to discuss the results of the evaluation with your child's home speech-language pathologist.

What can we expect from velopharyngeal insufficiency testing?

Testing will take about one hour. Many caregivers have questions about whether their child will tolerate the endoscopy portion of the VPI evaluation. Our team makes a significant effort to ensure that this part of the evaluation is as comfortable as possible for your child. Numbing medicine is sprayed inside the nose before the evaluation to help decrease any discomfort.

The endoscope is a small scope designed for use with children. This portion of the visit may be uncomfortable, but will not be painful. It often lasts just a few minutes. Most children do cry some. This is normal and expected.

If you feel that your child will not tolerate this procedure well, please contact our scheduler in advance. We can connect you and your child to a child life specialist who can provide suggestions to make this procedure easier.

Why choose Children's Hospital Colorado for velopharyngeal insufficiency testing?

We have extensive experience performing tests used to diagnose VPI and have excellent reliability. We use a multidisciplinary approach to evaluate, diagnose and treat your child. We use equipment that is designed for children, which helps to minimize discomfort. Our care team members only work with children and understand how to meet the unique needs of children.

How is velopharyngeal insufficiency treated?

Treatment depends on your child's condition. Your child's treatment may include any of the following:

• Speech therapy: Treatment of VPI often initially involves a course of speech therapy for three to six months before we consider surgery.
• Surgery: There are three main surgeries that are done to manage VPI. The best surgery for your child depends on your child's condition. Each of these surgeries is done to lower the amount of air escaping from the mouth into the nose.
  • Furlow palatoplasty: This surgery is done to repair the soft palate. The muscles of the palate are realigned and the palate is lengthened.
  • Pharyngeal flap: Tissue from the back of the throat is attached to the soft palate, making a physical barrier in the back of the throat. This surgery is done when there is good movement in the sidewalls of the throat. The size of the flap is determined by the size of the opening as well as the sidewall movement.
  • Sphincter pharyngoplasty: Muscles are attached from the side of the throat to the back of the throat. This surgery is usually done when there is good movement of the palate. The size of the muscle flaps used is determined by the size of the opening.

Why choose Children's Colorado for your child's velopharyngeal insufficiency treatment?

Our multidisciplinary team works together to understand the cause of your child's speech difficulties and provide recommendations to improve your child's ability to communicate and be understood. Both the speech-language therapist and the surgeon who perform evaluations and treatment are trained in and focused on pediatric care. We have state-of-the-art equipment, which enables us to provide high-quality, comprehensive care to your child.