Velopharyngeal insufficiency is incomplete closure of the velopharyngeal sphincter between the oral and nasal cavities, causing a hypernasal voice.
The velopharyngeal sphincter (which includes the soft palate and the side and back walls of the throat) separates the oral and nasal cavities during swallowing and speech. Normally, the sphincter closes completely during speech so that air is directed through the mouth and not the nose. In people with velopharyngeal insufficiency, the sphincter does not close completely. As a result,air leaks through the nose, causing the voice to sound nasal (called hypernasal resonant voice).
Velopharyngeal insufficiency can occur in people born with a split in the roof of the mouth (cleft palate) or a palate that is too short. It can sometimes develop after tonsil or adenoid surgery or result from muscle weakness in people with neurologic disorders such as cerebral palsy, stroke, or brain tumors. Other causes include tumors in the palate.
Symptoms of velopharyngeal insufficiency include a hypernasal voice with an inability to form speech sounds correctly. Severe velopharyngeal insufficiency can cause solid foods and fluids to regurgitate through the nose.
Doctors suspect velopharyngeal insufficiency in people with the typical speech abnormalities. To confirm the diagnosis, doctors inspect the velopharyngeal sphincter with a fiberoptic nasoendoscope (a flexible tube passed through the nose) or take x-rays while the person swallows different foods (videofluoroscopy). For this procedure, the foods are mixed with barium, which looks white on x-rays and outlines the digestive tract.
Treatment is with speech therapy and sometimes with a special device (called a palatal lift prosthesis) worn in the mouth or surgery.
