Velopharyngeal Dysfunction

When a person speaks, muscles (the soft palate) in the back of their throat prevent too much air from leaking into their nose.

If your child has velopharyngeal dysfunction, their soft palate does not close all the way or closes inconsistently. This allows air to escape through the nose when your child speaks, which makes their speech sound nasal and possibly hard to understand.

The cause of velopharyngeal dysfunction depends on what type your child has.

• Velopharyngeal insufficiency: A structural issue, such as cleft palate, prevents the soft palate from closing during speech. Children with this diagnosis often have nasal-sounding speech. They may have difficulty producing consonants like p, b, t, d, k, g, f, v, s, z, sh, ch, and j. Air may escape through their nose when they talk.
• Velopharyngeal incompetence:  Muscle weakness related to a condition such as Down syndrome or cerebral palsy interferes with the soft palate’s ability to close fully. Symptoms are similar to those of velopharyngeal insufficiency: nasal-sounding speech; difficulty producing consonants like p, b, t, d, k, g, f, v, s, z, sh, ch, and j; and air escaping through the nose when speaking.
• Velopharyngeal mislearning: Speech sounds are made in the nose or throat rather than in the mouth. A child with this diagnosis usually has a normal-sounding tone of voice but may have trouble producing certain sounds. The sounds s, z, and sh are most often affected.

• Nasal-sounding speech
• Speech that’s hard to understand
• Weak or muffled speech sounds
• Throat sounds (glottal stops) or nasal exhalation used in place of consonants
• The sound of air escaping through the nose during speech (may sound like blowing air or a rustle or rumble)

Often, more than one clinician is involved in diagnosing velopharyngeal dysfunction and determining the most appropriate treatment.

• A speech-language pathologist will evaluate your child’s speech to listen for nasality, voice quality, and speech production. Their goal is to determine whether your child has velopharyngeal insufficiency, mislearning, or both.
• An otolaryngologist will look at your child’s ears, nose, and throat. If they suspect a structural issue, they will perform a nasopharyngoscopy, which is a video of the inside of your child’s nose and throat. This test allows doctors to see the structure of the soft palate and how it moves during speech. They can also see the voice box (larynx).
• A plastic surgeon will look at your child’s soft palate. Based on this exam and the results of the nasopharyngoscopy, they’ll determine whether your child has a structural issue that requires surgery.

Your child’s treatment will depend on what type of velopharyngeal dysfunction they have.

• Children with velopharyngeal insufficiency most often need surgical management to address the structural issue causing their speech issues.
• Children with velopharyngeal mislearning can be treated with speech therapy.
• Sometimes children have both velopharyngeal insufficiency and velopharyngeal mislearning. An experienced speech-language pathologist can evaluate this and provide treatment recommendations.

The Velopharyngeal Dysfunction Clinic evaluates and treats children with disorders of resonance and speech intelligibility caused by problems with palate movement and closure.

Our team of otolaryngologists, speech-language pathologists, and plastic surgeons treat hundreds of patients with voice issues, including velopharyngeal dysfunction, each year. We work together with our patients and their families to provide the best care based on each child’s condition and needs.