Velopharyngeal Dysfunction

Symptoms of VPI may include:

• A nasal sounding voice (called hypernasality)
• Blowing air out the nose while speaking or making sounds
• The inability to make sounds that require air pressure in the mouth (like b, d, and g)
• Food and fluid coming back out through the nose when the child tries to swallow

If you notice anything unusual in your child’s ability to eat or breathe, or if your child consistently makes sounds in a highly nasal tone, see your child’s healthcare provider.

When VPI is diagnosed at birth as part of a cleft palate, your child may already have a diagnosis. Your child should have regular evaluations by a medical team that includes a speech specialist. They will assess your child’s speech production and language development.

Your child’s healthcare provider may recommend that you also visit an ear, nose, and throat specialist or a surgeon to correct the tissues that won’t seal off the back of the mouth.

Your child’s medical team should also closely watch for ear problems. Children with VPI often have ear infections that could lead to hearing loss if untreated.

A cleft palate is the most common cause of VPI. A cleft palate is when the roof of the mouth has not formed properly. The cause of a cleft palate is not always clear, but if the mother smokes, has diabetes, or takes certain medicines, risk can increase.

Other less common causes of VPI can include:

• Tissue deficiencies
• Mouth abnormalities
• An immobile soft palate
• Tumors
• Stroke
• Traumatic injury
• Nerve damage
• Enlarged tonsils

A baby can be born with VPI, or it can develop later in life.

When VPI happens with cleft palate, it is usually diagnosed at birth. If your child’s healthcare provider suspects VPI, they will usually do a nasal scope to see what is happening in the nasal cavity, throat, and mouth. They may also use a magnetic resonance imaging (MRI) test to better see the tissues of the mouth and throat.

Your child’s medical team may include any of the following people:

• A plastic surgeon who specializes in facial repair
• An ear, nose, and throat specialist, called an otolaryngologist [oh-toe-lar-in-GOLL-oh-jist]
• An a specialist in hearing, called an audiologist [aw-dee-OLL-o-jist],
• A speech-language pathologist
• A social worker

Treatments can include:

• Speech therapy. Children with VPI need speech therapy to help them learn how to form sounds and speak properly. If your child has mild hypernasality, this may be all the treatment they need.
• Speech aid device. Another nonsurgical treatment is a speech aid that fits in the mouth like an orthodontic retainer. The two most common types of speech aids are a speech bulb and palatal lift. The speech bulb helps to close off the space between the soft palate and throat. The palatal lift raises the soft palate to a position that allows your child to close the space between the soft palate and throat on their own. These aids are often best used in children over age 5.
• Surgery. However, these treatments may not be enough if your child has severe VPI. Your child may need palate surgery. The most common surgery to correct VPI is pharyngeal [far-in-JEE-uhl] flap surgery. This is where tissue is taken from the back of the mouth and used to close part of the gap. After surgery, most children continue to receive speech therapy.

Your child’s medical team will work together to plan the therapies and surgeries that will promote a happy, healthy life for your baby.

VPI can’t be prevented. However, pregnant women should do all they can to ensure a healthy pregnancy. Eat a healthy diet, and take prenatal vitamins before and during pregnancy. You may need to take folic acid or other supplements as instructed by your healthcare provider.

Pregnant women should work to reduce risk of infections during pregnancy, since some infections may increase the risk that the unborn baby will develop cleft lip/cleft palate, which often occurs with VPI.

• March of Dimes

Most hospitals in large cities have cleft palate/craniofacial teams. Check with your local health care facility for information. Visit the American Cleft Palate-Craniofacial Association or call 919-933-9044.

Velopharyngeal [VEE-loh-feh-rin-JEE-ul] insufficiency (VPI), also called velopharyngeal dysfunction (VPD), is a disorder of speech production. It happens when your baby’s throat and soft palate can’t seal off the nasal cavity when your child speaks, eats, or breathes. VPI is often caused by a cleft palate, but it can happen for other reasons. A cleft palate is when the sides of a baby’s palate do not form properly.

Speech Issues

VPI is a speech disorder. When a person speaks, the roof of the mouth directs sound from the vocal cords out through the mouth. For a child with VPI, sound is directed into the nose because the soft palate can’t close off the nose from the mouth. Your child may sound like they are talking “through their nose” (hypernasality [hy-PUR-ney-zahl-ih-tee]) and can be hard to understand.

Speech therapy can help your child form sounds that can be understood by others. About 1 in 4 children whose cleft palate is repaired still have VPI and will need to continue speech therapy.

Eating Issues

Babies born with VPI can have a hard time swallowing. If your baby is unable to breastfeed, you can use a breast pump and a special bottle designed to make feeding easier. You may have to try different products to find what works best for you and your child. If milk comes out of their nose while feeding, just wipe it away with a soft cloth. This is not a health risk.

Ear Issues

Babies with VPI often have problems in the ear. There is a small tube in the ear called a eustachian [you-STAY-shun] tube. This connects the middle ear (inside the ear) to inside the nose and throat. Normally, it drains fluid from the ear. Often, the eustachian tubes in babies with VPI do not drain properly, creating frequent ear infections. Your medical team should carefully monitor your baby’s ears to avoid hearing loss later from unmanaged ear infections.

VPI is usually treated with speech therapy. Some children with severe VPI may also need surgery.