At Pediatric ENT of Oklahoma, we’ve taken a special interest in advanced airway disorders. One of our focal points is c (VPI), a dysfunction of the palate and throat that causes speech and swallowing difficulties. We understand how frustrating it can be to get a firm VPI diagnosis, and we’re happy to be an ENT in OKC that specializes in VPI.
What Is Velopharyngeal Insufficiency?
Speech is a complicated process. We rely on many structures in our mouth and throat working together to produce the sound we want. If any one structure isn’t working properly, there can be a noticeable speech abnormality.
VPI gets its name from the structures it impacts:
- “Velo”: refers to the soft palate, which is also called the velum. It’s the part of the mouth’s roof that lifts when the doctor says, “Say ‘Ah.'”
- “Pharyngeal”: refers to the pharynx, or the part of the throat that connects the mouth and nasal cavity.
VPI causes hypernasality, an airy, nasal buzz to the voice that makes vocalizations like hard “p”s sound weak. It occurs when parts of the throat and roof of the mouth aren’t formed correctly.
In a normal speech pattern, the roof of the mouth rises to block airflow into the nasal passages. This forces all of the air out of our mouth for fullness and clarity when we speak. In children with VPI, structural abnormalities prevent the the roof of the mouth from forming a complete seal. Air escapes into the nasal cavity and causes the telltale sounds.
What Are the Symptoms?
VPI can cause a number of abnormalities. The most common symptoms include:
- Hypernasal voice
- Weak voice
- Poor articulation, especially on sounds like “p” or “d” (plosives)
- Airy sounds from the nose during speech
- Tightening of muscles around the nose during speech
- Liquid coming up through the nose while drinking
Keep in mind that precise diagnosis of a speech abnormality can be complex. It requires the trained ear and testing protocols of a speech assessment specialist. VPI, for instance, is easily mistaken for other abnormalities in its disorder group or a neurological condition called apraxia. Always schedule an appointment with an ENT in OKC for precise diagnosis and treatment.
Causes of VPI
While movement and speech formation abnormalities can cause similar symptoms, velopharyngeal insufficiency refers specifically to a failure of the structures in the mouth and throat.
Some examples include:
- Cleft Palate: An estimated 20% of children with VPI were born a cleft palate. A cleft palate is a gap in the soft and hard palate. It occurs when the two growth plates that form a baby’s jaw don’t fuse completely in the womb. Even if the cleft palate has been surgically repaired by an ENT in OKC, there is a chance the child can develop VPI.
- Short Palate: A child can be born with a short palate that isn’t long or large enough to block the pharynx.
- Abnormal Pharynx: Congenital abnormalities in the pharynx can give it the wrong shape to be fully blocked.
- Enlarged Tonsils: Swollen tonsils or adenoids can impede closure of the pharynx.
- Adenoid Removal: In some cases, the adenoids were acting as a “plug” blocking a gap between the palate and the pharynx. Once removed, the gap is exposed and air starts to flow inappropriately during speech.
Diagnosing and Correcting VPI
Correctly diagnosing VPI and its causes can require multidisciplinary evaluation and several tests. Speech evaluations are often the first assessment. Then, your ENT will want to visualize potential defects. Nasoendoscopy, in which a tiny camera is threaded through the nostril and into the throat, gives a first-person view of the area. If the defect still isn’t obvious, videofluoroscopy could be attempted. In this procedure, your child swallows a contrast solution while an x-ray is taken. The contrast solution shows up brightly on the x-ray and makes it easier to spot potential abnormalities.
In most cases, treatment for VPI is a combination of speech therapy and corrective surgery to address the underlying defect. Pharyngeal flap, pharyngolplasty, implants and prosthetics are just a few of the numerous procedures that could be recommended. Your child may have a whole team of health care professionals, a plastic surgeon, dentist, ENT, audiologist and more, for support.
Corrective surgery is only one step in the process. Speech therapy will be necessary to retrain your child’s throat and palate. Your child will likely have a dedicated speech therapist and exercises to do at home.
If you suspect your child has VPI, you don’t have to travel far evaluation. You have an ENT here in OKC you can count on. Call us today to schedule your child’s evaluation.