Key Points about Velopharyngeal Insufficiency

  • Nasal speech from velopharyngeal insufficiency is a result of the soft palate not blocking off the nasal cavity
  • This condition can be improved by speech therapy and in severe cases, surgery.
Common related conditions
Cleft Lip and Palate Apert Syndrome Craniosynostosis Pierre Robin sequence (PRS) Treacher Collins syndrome (TCS)


Velopharyngeal insufficiency (VPI) occurs when air and sound escape from the child’s nose during speech. This produces speech that sounds nasal in quality. VPI may lead to hoarseness or fatigue of your child’s voice.

Velopharyngeal insufficiency causes

  • Abnormality in the soft palate — The velum is too short to close the velopharyngeal valve.
  • Adenoidectomy - Removal of the adenoids may cause velopharyngeal insufficiency because the adenoids aid in closing the velopharyngeal valve.
  • Tonsillectomy — removal of the tonsils
  • Palatal tumors

Velopharyngeal insufficiency risk factors

  • Cleft palate — velopharyngeal insufficiency may occur when a child has a cleft palate or submucous cleft.

Velopharyngeal insufficiency symptoms

  • Hypernasal sounding speech
  • Not able to generate certain speech sounds because of a lack of pressure
  • Not able to form speech sounds correctly

Velopharyngeal insufficiency diagnosis

A clinical examination can be done to understand the state of the condition. A test can be done to evaluate the velopharynx during speech using video nasoendoscopy or video fluoroscopy.

  • Video nasoendoscopy — A small camera is placed through the nose to observe the velopharyngeal mechanism during speech.
  • Video fluoroscopy — An imaging technique done by a radiologist and speech pathologist in which a barium solution goes inside the child’s nose to make structures more prominent and then a video is recorded during speech.

Velopharyngeal insufficiency treatment

Pharyngeal surgery as well as post-operative speech pathology treatment can be used to treat velopharyngeal insufficiency

  • Furlow palatoplasty — Used in cleft palate repair, this procedure lengthens the palate and improves its function.
  • Palatal revision — If there is a hole in the palate because a previous repair surgery did not heal correctly, a revision procedure can be done to close the opening to improve the quality of speech.
  • Posterior pharyngeal flap — Tissue is taken from the back of the throat and attached to the soft palate.
  • Sphincter pharyngoplasty — Tissue is taken from the sides of the throat and is attached at the back of the throat.
  • Speech therapy — Specialized speech therapy techniques can improve overall speech quality with regular therapy.

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