Velopharyngeal Insufficiency

Velopharyngeal Insufficiency

Technically defined, Velopharygneal Insufficiency (VPI) is a disorder where the soft palate does not form complete closure during speech which allows air to flow through the nose instead of only the mouth.  

Essentially, when you speak (especially saying consonants like b, p, d, t, k, and g), air comes from your lungs and out of your mouth, stopped briefly by your tongue or your lips to form the consonant sound.  The reason the air comes out of your mouth is that your soft palate (the top of your mouth toward the back of your throat) moves to block air from coming up your nose.  Ever take a drink and have milk come out your nose? Your soft palate wasn't closing off your nose.  That is a case of VPI, basically, your soft palate didn't close off your nose from your mouth.

Here are some pictures from the Seattle Children's Hospital which hopefully illustrate what I just explained above:

Soft Palate during typical speech. 

Soft Palate at rest.  See how air comes up from your lungs through your mouth and nose? That is how the soft palate rests in those with VPI during speech as well.

 The main symptoms of VPI are:

• Nasal sounding speech
• Nasal emissions (essentially snorting air out of the nose especially when producing "stop" consonants like p, b, t, d, k, and g)
• Substituting glottal stops (like the sound in between "uh-oh") for consonants
• Unusual productions of sounds like using your tongue to produce "b" instead of just your lips.

Many of the people who have VPI are those with a history of cleft palate.   Additionally, those with recent adenoidectomies, recent traumatic brain injuries are susceptible.  Occasionally, there are people who have VPI with no definable cause. 

When a child (or adult) is suspected of having VPI, the speech therapist will refer them to an ENT to get a full evaluation.  In some bigger locations, there are teams who are specialists in this area (may be cleft palate teams) who are also able to evalute.  When you go to the ENT appointment, the ENT will look through your nose and down your throat, possibly with a cool fiber optic tube to see how the soft palate is working.  Additionally, you may be asked to take part in a special x-ray to monitor soft palate use during speech. Occasionally, during diagnosis, you may be asked to see a team of specialists including an ENT, surgeon, and speech language patholgoist.

Speech Therapy cannot cure VPI alone.  While speech therapy can assist in learning techniques to help speak after the main treatment which is either a speech appliance or surgical intervention.  

A speech appliance, called an obturator, is somewhat similar to a retainer, and is worn in the mouth and used to help keep the soft palate up where it needs to be. The obturator can be used before surgery, after surgery, or instead of surgery. Additionally, some patients opt to not use it at all and wait for surgery.

Surgical Interventions are either a Furlow palatoplasty, which moves muscles in the throat to be better positioned for moving the soft palate into the position it should be for speech, or a sphincter pharyngoplasty which places tissue in the back of the throat to close the gap between the back of the throat and the soft palate. Speech therapy can be provided before and after surgery to help the child learn proper positioning of consonants and to help the child correct incorrect speech patterns.


 
References:

• Pictures and Information from Seattle Children's Hospital Velopharyngeal Insufficiency 
• Cincinnati Children's Hospital has some great pictures and explanations
• Velopharyngeal Disfunction just in case you want to get your research on!