What is Velopharyngeal Insufficiency & How is it Treated?

velopharyngeal Dysfunction is a pathological condition in which the speech of an individual is affected as a result of dysfunction of the throat and the roof of the mouth. The condition gets it name from the term “velo” which means the soft palate and pharynx which means the throat. When an individual speaks, normally the palate rises up and touches the back of the throat and sends the air present there out through the mouth.

In Velopharyngeal Dysfunction, this does not occur due to a dysfunctional soft palate and pharynx and the soft palate does not always touch the back of the throat which causes a part of the air to escape from the nose or the nasal cavity. This results in the individual having a nasal quality to his or her voice.

Velopharyngeal Insufficiency is a type of Velopharyngeal Dysfunction when there is insufficient tissue in the palate or the throat resulting in the palate not coming in contact with the throat during speaking causing a nasal quality to the voice. This is what is termed as Velopharyngeal Insufficiency.

Velopharyngeal Insufficiency is commonly present in children who have a cleft palate, certain chromosomal disorders, children who have had adenoidectomy, have weak muscles of the throat, have a motor speech disorder, or have abundant space between the palate and the throat.

There are basically two main symptoms of a Velopharyngeal Insufficiency. These symptoms are:

• Nasal tone to the speech
• Air escaping through the nasal cavity

Nasal Tone; The nasal tone to the speech can be clearly seen when the child is speaking words that have the letters “m” or “n” in them. Nasal tone may also be seen with words “w”, “y”, “l”, and “r” in children with Velopharyngeal Insufficiency.

Nasal Air Escape: This can be seen when the child is pronouncing words like “p”, “b”, “t”, “d”, “k”, “ch”, and “th.” These letters are called pressure consonants as when these letters are pronounced, pressure build up in the mouth.

Under normal circumstances, this air escapes through the mouth but it escapes through the nose in children with Velopharyngeal Insufficiency. The speech of the child will also be very soft if he or she has Velopharyngeal Insufficiency.

An accurate diagnosis of Velopharyngeal Insufficiency is a must for the child to have the best treatment for this condition. An incorrect diagnosis may lead to a different treatment given which may not resolve the condition. Some of the ways to diagnose Velopharyngeal Insufficiency are:

Speech Analysis: This is the first test that is conducted for a diagnosis of Velopharyngeal Insufficiency. In this the quality of the speech of the patient is tested. The audiologist will carefully listen to the speech of the patient analyzing closely the articulation of the words looking for any abnormality which may point towards a Velopharyngeal Insufficiency. The main thing to look for will be nasal tone in voice with certain letters of the alphabet which have been mentioned above.

Nasometry: This is a test which calculates the ratio between the sounds which have a nasal quality and the sounds which do not have a nasal quality to it.
This will be compared to that of a normal standard result. A mean deviation will be calculated which will give a clear indication as to whether the child has Velopharyngeal Insufficiency.

Additionally, the physician may inspect the soft palate and the pharynx closely along with doing a speech analysis and an audiometry testing which will confirm the diagnosis of Velopharyngeal Insufficiency.

Nasoendoscopy: This is yet another procedure which is done to diagnose Velopharyngeal Insufficiency. In this study, a scope is inserted inside the mouth to inspect the palate and the pharynx and any abnormality in these structures will be clearly seen and confirm the diagnosis of Velopharyngeal Insufficiency.

The aim of treatment for Velopharyngeal Insufficiency is to eliminate the dysfunction at the earliest possible time and restore normal speech for the child.

The best way to treat Velopharyngeal Insufficiency is through surgery or through a speech appliance. The treatment begins with speech therapy which is also an important tool to treat Velopharyngeal Insufficiency.

Speech Therapy: During speech therapy the child will be taught how to control the flow of air through the tongue, lips, and jaw so as to correctly phonate letters of the alphabet.

Speech Appliance: For some cases of Velopharyngeal Insufficiency, a speech appliance may be used so as to correct the quality of the child’s speech.

The most preferred speech appliance is called the obturator. This appliance works by decreasing the nasal quality of the child’s voice and prevent the air from escaping through the nose while speaking.

A visit to the dentist will be required in order to make an obturator of the appropriate fit. A speech pathologist will then fix the obturator into the mouth and check for its effectiveness.

The child will have to wear it during the day while at school or at home and take it out at night before going to bed. Since it does not affect the way a child eats so it can be worn during eating as well. This speech appliance may be used short term or even in some cases after surgery for Velopharyngeal Insufficiency.

Surgery: This is the permanent fix for Velopharyngeal Insufficiency. This is because there is not enough tissue within the muscles of the throat or the soft palate. The most preferred surgery done for Velopharyngeal Insufficiency is called the Furlow Palatoplasty.

Furlow Palatoplasty: This procedure is designed to bring the muscles of the palate into a more normal position thus restoring the normal quality of speech in the child.

Sphincter Pharyngoplasty: This is yet another procedure done for Velopharyngeal Insufficiency. In this procedure, tissue is moved from the side of the throat to the back of the throat in such a way that the soft palate is able to touch the throat and thus normal speech pattern is restored and the child is said to be treated from Velopharyngeal Insufficiency.