What Is Velopharyngeal Insufficiency (VPI)?
Velopharyngeal insufficiency affects speech after palate repair. Here is what families need to know.
Velopharyngeal insufficiency (VPI) occurs when the soft palate does not close properly against the back of the throat during speech. This allows air to escape through the nose when it should come out of the mouth.
- What happens normally:
- During speech, the soft palate lifts and presses against the back of the throat
- This creates a seal (velopharyngeal closure) that directs air through the mouth
- This is necessary for making speech sounds like P, B, T, D, S, and Z
- What happens with VPI:
- The soft palate does not reach the back of the throat
- Air leaks through the nose during speech
- Speech sounds "hypernasal" (too much air through the nose)
- The child may have difficulty being understood
- Causes:
- Short soft palate after cleft repair
- Poor movement of the palate
- Large space between the palate and throat
- Submucous cleft palate
How VPI Is Diagnosed
- Speech evaluation by a speech-language pathologist
- Nasopharyngoscopy (a small camera through the nose)
- Videofluoroscopy (X-ray video of speech)
- Nasometry (measures nasal air flow)
Treatment Options
- Speech therapy β for mild VPI
- Secondary palate surgery β Furlow palatoplasty to lengthen the palate
- Pharyngeal flap β a flap of tissue from the throat wall
- Sphincter pharyngoplasty β narrows the throat opening
- Prosthetic β a speech bulb or palatal lift appliance (rarely used)
Clinical Guidance
VPI occurs when the soft palate cannot close the airway during speech, causing hypernasal speech. It is diagnosed by a speech pathologist and treated with therapy, surgery, or both. Most children achieve normal speech with appropriate treatment.