Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
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What is Velopharyngeal Insufficiency


Velopharyngeal insufficiency or VPI is the inability of the velum (the soft palate) and related anatomy to close the nasopharynx. The nasopharynx separates the oral and nasal cavities and is used to make the sounds of consonants during speech. An insufficiency can have a variety of causes. Most VPI is caused by a physical defect, although sometimes there may be a "functional" origin that includes misuse of the velum. VPI may also be a result of an obstruction of the nasopharynx, including enlarged adenoids or a narrow or damaged nasopharynx. The most common cause of VPI is cleft palate with or without cleft lip.

The symptoms of VPI can include

  • Hypernasality - Speech that sounds overly nasal, as if the person is "talking through his/her nose."
  • Hyponasality - A lack of normal nasal sounds during speech
  • Nasal air escape - Air escaping from the nose during speech
  • Reduced oral pressure for pronouncing consonants
  • Compensatory Articulation including
    • Glottal stop - The glottis is the gap between the vocal folds that is closed up in the production of certain sounds.
    • Pharyngeal fricatives - A type of consonant sound produced during speech
    • Nasal rustle and posterior nasal fricatives (also called nasal "snorts")
      Air escaping from the nose when certain sounds are pronounced

Structural defects that can cause VPI include

Cleft palate (with or without cleft lip)
These are usually identified at birth and typically includes high risk for hypernasal speech. Research supports early identification of VPI and initiation of treatment as beneficial to the outcome of overall typical speech.

Submucous cleft palate
These are typically more difficult to identify. The most obvious forms include a bifid uvula, intact mucous membranes but noticeable separation of muscle in the middle of the soft palate, and absent posterior nasal spine of the hard palate with obvious forward attachment of the soft palate muscles. Less obvious forms can be detected only by measuring the thickness of the soft palate on radiographic studies, or studying the muscle on the nasal surface of the soft palate by endoscopic examination.

Deep pharynx
This is the most difficult defect to recognize and identify. This is because the defect is in the size of the nasopharynx and not in the soft palate. Sometimes the soft palate appears normal by oral exam, so accurate diagnosis requires lateral radiography or lateral fluoroscopy. Primary speech features include hypernasal resonance, nasal air escape, and sometimes misarticulations like those seen in cleft palate defects. Nasal regurgitation as a newborn, difficulty nursing, and delayed and hypernasal speech in the setting of normal language development may also be early signs.

Last Edited: June 13, 2016
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