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Velopharyngeal Insufficiency

What is velopharyngeal insufficiency? 
Velopharyngeal Insufficiency (VPI) is a condition in which the soft palate, or the back moving part of the roof of the mouth, does not close the nose off well enough during speech.  This allows too much air to go through the nose during talking. This can be a problem because most sounds in English require good pressure to be built up in the mouth, with no air escaping through the nose.  People with VPI are often described as having “nasal” sounding speech. 

Who can have velopharyngeal insufficiency?
A child can have VPI after a cleft of the palate is repaired because the palate may remain too short or not move well. Children who have never had a cleft of the palate may also have VPI due to being born with a short palate or having poor muscle control of the palate. Some children who have Apraxia of speech may have VPI because of difficulties coordinating muscle movements of the mouth, including the palate, for speech.

What are the symptoms of velopharyngeal insufficiency?
VPI may result in speech that sounds too nasal (hypernasality). VPI can also make it hard for children to build up the oral pressure needed for many speech sounds. If you lose too much air out the nose, then some sounds may come out “weak” orally.  Also, VPI can result in what is called audible nasal air emission or a “snorting” noise with selected sounds, especially those sounds that require lots of oral air pressure.

When should a child be referred for a specialized speech evaluation for VPI?
Any time there is too much air coming out of the nose during speech, we recommend that child receive a speech evaluation to determine whether they have VPI. Because this speech problem rare and requires specialized training and often times specialized instrumentation for evaluation, we recommend an ACH Speech Department evaluation.   We can help determine if the child’s symptoms should be addressed in speech therapy or if the ACH ENT physician may need to take the next step with a nasendoscopy. We can collaborate with the local speech pathologist about therapy procedures and discuss what to expect over time.

Who can refer for an initial VPI evaluation and how can it be made?
The primary care physician can make this referral through our ACH Appointment Center by calling 501-364-4000.  Many times, the local speech pathologist has suspected VPI and informed the parent that a medical evaluation is needed. Most of these initial evaluations will require an appointment with the Speech Pathologist as well as with the ENT physician on the same day.  These appointments should be requested as “Speech Clinic appointment for VPI” followed by an “ENT appointment” on the same day. This first appointment is not the same as being scheduled for VPI Clinic which is done after the initial evaluation, if appropriate.

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