Velopharyngeal Insufficiency, also referred to as VPI, is a condition that affects the speaker's speech resonance. When we speak, air normally passes through the mouth and nose. The back part of the roof of the mouth (hard palate) is made of soft tissue (soft palate), also called the velum. The soft palate acts like a door, opening and closing depending upon the sounds we produce. All sounds except for m, n and -ing require the soft palate to elevate and stretch back to close with the back of throat. If the soft palate is unable to close adequately, too much air is allowed through the nose, causing one's speech to sound excessively nasal (hypernasal).
- Cleft palate - when a child is born with an opening in the hard or soft palates
- Congenital short soft palate and/or excessively deep pharynx - this is identified by a lateral radiograph and proves nasal air escape without obvious physical defects
- Skeletal abnormalities of the head and neck, such as conditions where the jaw and/or neck are in irregular positions
- Submucous Cleft palate- split uvula, absence of posterior nasal spine of the hard palate with obvious forward attachment of the soft palate muscles, intact but noticeable separation of muscle in the midline of the soft palate
- Neurological impairment causing weakness or poor coordination of movement in the palate and throat muscles
- Velopharyngeal mislearning- using the hard and soft palates inappropriately
- Hypernasality or too much sound in the nose during speech
- Air escaping out of the nose during speech
- Weak or omitted consonants due to inadequate pressure in the mouth
- Nasal grimace- a tightening of the facial muscles during speech
- Audible nasal snorting during specific sounds
- Loss of liquid through the nose when drinking
The Speech evaluation includes obtaining a thorough history, an oral mechanism examination to rule out structural problems, and an assessment of articulation. Speech resonance (nasality) is observed and then compared to computer based assessment (acoustical nasometry). Depending upon the results of these assessments, radiographic analysis (cephalometry) may be scheduled to further obtain information regarding the function of the velopharyngeal valve.
Velopharyngeal insufficiency (VPI) may be treated with a combination of speech therapy and/or surgical procedures. Surgical intervention is done to correct any structural abnormality and speech therapy is done to help the patient make the best use of the velopharyngeal structures. If hypernasality is a learned behavior, speech therapy alone may be sufficient to resolve the problem.