Velopharyngeal Dysfunction (VPD)

Velopharyngeal dysfunction, or VPD, is a condition resulting from inadequate closure of the velopharyngeal port, or the opening between the nose and the mouth, during speech. Children with VPD have speech that is difficult to understand by others, as too much or too little sound comes from the nose. This is a common condition among children diagnosed with 22q11.2 Deletion Syndrome, patients with cleft palate, neuromuscular weakness, a deep pharynx (throat) and, rarely, after surgical procedures such as removal of the adenoids. It can also be associated with other medical problems, syndromes or an isolated finding in otherwise healthy patients.

Velopharyngeal insufficiency (VPI) is a subtype of VPD where there is an anatomic deficiency rather than a functional cause of the speech issues. In cases of VPI, surgical treatment may be needed to correct the problem and allow for closure between the nose and the mouth during speech production.

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What Causes VPD?

For VPD patients, their palate – or the roof of their mouth – is short and may not move correctly. This causes too much air to go through the nose when speaking, so that many sounds of consonants (non-vowel letters) may be difficult to understand. To correctly diagnose and treat the condition, patients will undergo an evaluation of their speech by a multidisciplinary team including a trained Lurie Children’s speech language pathologist and a Lurie Children’s Otolaryngology (ENT) specialist. First, a perceptual speech assessment is performed where the speech language pathologist carefully prompts and listens for speech production sounds with syllables, individual words and in sentences. Then, a nasal endoscopy is performed. A nasal endoscopy is performed by a Lurie Children’s Otolaryngologist (ENT) specialist with a speech language pathologist and involves use of a flexible scope (a tiny camera) inserted into the nose to visualize the entire velopharyngeal port at the back of the nose. With the scope in place, the patient will be asked to again repeat various sounds, words and/or sentences so the provider can visualize movement of the patient’s muscles while they speak. Usually, this procedure takes only a few minutes and provides the necessary information to guide the next steps of care. This may include further speech therapy or surgery in select cases.

Lurie Children’s pediatric specialists help make the nasal endoscopy as comfortable as possible for the patient. To help you prepare, please refer to the documents below: 

How is VPD or VPI Treated?

Problems with speech associated with VPD or VPI will often need a combined approach of speech therapy with a speech language pathologist and surgical correction by Lurie Children’s Otolaryngology-ENT specialist, or a Plastic & Reconstructive Surgery specialist.

The surgical procedure that is selected is based on the nasal endoscopy evaluation and the child’s individual findings. For this procedure, Lurie Children’s surgeons improve the closure between the nose and the mouth by filling in, or lengthening, a child’s palate, and/or rearranging muscles of the palate and the back of the throat. A child often stays in the hospital 1-2 nights following this surgery to ensure the airway stays clear, help control discomfort and maintain their hydration. In most cases, the surgery successfully repairs the issue with the palate, allowing patients to successfully complete their speech therapy and overcome their speech issues.

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