Children's Hospital Colorado
Ear, Nose and Throat
Ear, Nose and Throat

Velopharyngeal Insufficiency (VPI) Multispecialty Clinic

The VPI clinic is a collaborative effort between Children’s Hospital Colorado’s otolaryngology, plastic surgery, and speech-language pathology departments.

In the VPI clinic, a multidisciplinary team evaluates a child’s speech sound production, oral and nasal resonance (sound energy traveling through the nose and mouth), and velopharyngeal function (movement of the soft palate and structures around it during speech). Children who are referred to the clinic typically have a diagnosis of or suspicion of velopharyngeal dysfunction, or difficulty with moving or closing the soft palate and surrounding structures during speech. These children may have difficulty with having their speech understood by others, or may complain about the quality of their resonance and voice (for example, there is too much or too little sound coming through the nose or complain of quiet or hoarse voice).

Why choose the VPI Clinic at Children’s Hospital Colorado?

The VPI Clinic at Children’s Hospital Colorado is staffed with a multidisciplinary team of pediatric specialists from ENT, plastic surgery and speech-language pathology. Our team works together to understand the reasons behind your child’s speech difficulties and provide recommendations to improve your child’s ability to communicate and be understood. The equipment used during the evaluation is child-sized and team members understand how to use play, humor and child-friendly language to help your child participate as easily and comfortably as possible in the evaluation.

What to expect in the VPI clinic

The purpose of the VPI clinic visit is to evaluate the child’s speech, resonance and voice. This is accomplished through caregiver interview, speech and resonance evaluation, and direct visualization of the speech structures in the nose and throat using a pediatric endoscope. The endoscope is a thin, flexible tube that is attached to a bright light and a camera. The thin tube is passed through the passages in the nose, which allows the team to view the structures inside of the nose and throat and how they function during speech and at rest. Our evaluation is intended to help identify the underlying issues causing the child’s speech, resonance and voice difficulties. The goal of the evaluation is to provide recommendations that will help your child’s speech be more understandable. These recommendations may involve surgery, speech-language therapy, or both.

Typically, children do not come to the VPI clinic before age 2 to 2 1/2. Once a child is referred to the VPI clinic, records will be reviewed by team members to determine if this is the most appropriate evaluation for the child and the VPI clinic scheduler will assist the family in scheduling and preparing for the visit.

A visit to the outpatient VPI clinic is typically about 1 hour long. A typical visit includes the following:

  • The team nurse and speech-language pathologist will ask questions about your child’s medical history and speech-language development.
  • The speech-language pathologist will do an evaluation of your child’s speech sounds, oral and nasal resonance (speech sound energy traveling through the nose and mouth) and nasal emission (air escape through the nose) during speech.
  • The speech-language pathologist will do an evaluation with a nasometer, which 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.
  • The ENT or plastic surgeon will look in your child’s ears, nose and mouth. If it is recommended after the speech and resonance evaluation, the ENT or plastic surgeon will do a brief endoscopy procedure with your child to evaluate how the palate and the structures around it move during speech. Before the endoscopy, the child’s nose will be numbed with an anesthetic spray (pain medication). The endoscope is a flexible, narrow tube attached to a bright light and a camera that allows us to view the speech structures in the inside of 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 (if able) and caregiver can observe the procedure as it is happening on a screen. The procedure lasts anywhere from a less than a minute to approximately 2 to 3 minutes.
  • Results of the VPI evaluation are shared with the parent/caregiver and child (if developmentally appropriate) at the conclusion of the visit. A longer report is sent in the mail within 1 to 2 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.

Many caregivers have questions about whether their child will tolerate the endoscopy portion of the VPI evaluation. The team makes a significant effort to ensure that this part of the evaluation is as comfortable as possible for the child. Numbing medicine is sprayed inside of the nose before the evaluation. The endoscope is a pediatric sized scope designed for use in children. This portion of the visit is uncomfortable, without being painful, and often lasts just a few minutes. It is brief and feels strange, but does not hurt. Nevertheless, most children do cry some, and this is normal and expected. If you feel that your child will not tolerate this procedure well, please contact our scheduler in advance and we will make an effort to connect you and your child to a therapeutic recreation/child life specialist who can provide suggestions for making this easier.

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