Velopharyngeal Dysfunction (VPD) is a condition where the velopharyngeal valve, located at the back of the throat, fails to close properly during speech. This results in air leakage through the nose, causing speech to sound nasal or hypernasal. VPD can occur due to structural issues, such as a cleft palate, or functional problems, where the muscles controlling the valve do not function effectively. Treatment often involves speech therapy, and in some cases, surgical intervention may be necessary to improve the function of the velopharyngeal mechanism. Early diagnosis and intervention are important for effective management.
What Is Velopharyngeal Dysfunction (VPD)?
Velopharyngeal dysfunction (VPD) is a condition where sound and air leak into the nose during speech, causing a «nasal» voice. It happens because the velopharyngeal valve (the soft palate and throat) doesn’t close properly.
What Causes VPD?
VPD can be caused by:
- History of cleft palate
- Submucous cleft palate
- 22q11.2 deletion syndrome (DiGeorge syndrome)
- Issues with the palate or throat
- Adenoid removal surgery
- Neurological disorders or traumatic brain injury
Signs & Symptoms of VPD Children with VPD may have:
- Hypernasality (nasal-sounding speech)
- Speech sound errors
- Nasal air emissions (air leaks through the nose during speech)
- Weak pressure on speech sounds
- Speech that is hard to understand
- Leaks of food or liquids through the nose when eating or drinking
How Is VPD Diagnosed?
Children with VPD should be evaluated by a specialized team, often at cleft and craniofacial clinics. Specialists like ENT doctors, plastic surgeons, and speech-language pathologists assess the child’s speech and medical history. Tests like nasopharyngoscopy or videofluoroscopy are used to see how air and sound escape through the nose during speech, helping with diagnosis and treatment planning.
How Is VPD Treated?
Speech therapy can help correct speech sound errors but won’t fix VPD on its own. Surgical treatments are often needed to prevent air and sound from leaking through the nose during speech. Common surgeries include:
- Posterior pharyngeal flap (PPF): Tissue from the back of the throat is used to block air and sound from leaking.
- Sphincter pharyngoplasty: Tissue behind the tonsils is used to make the gap smaller and prevent air from escaping.
- Furlow palatoplasty: Rearranging scar tissue to improve soft palate function.
- Palatal lengthening: Tissue from the cheeks is used to lengthen the soft palate, helping it close properly.
Your surgeon will recommend the best option for your child, and tests like sleep studies may be done to rule out risks such as sleep apnea.
Why Is an Evaluation Important?
VPD can significantly impact a child’s ability to speak clearly, make friends, and socialize. It is important to get an evaluation from a specialized team, even if there is no history of cleft palate, as VPD doesn’t resolve on its own. Early treatment can improve speech and quality of life for affected children.