Velopharyngeal insufficiency (VPI) occurs when the seal between your oral and nasal cavities doesn’t close completely. The condition is often associated with palate defects or genetic disorders. With VPI, air escapes through your nose during speech, causing a nasal sound and other speech issues. Treatment usually involves speech therapy and surgery.
Velopharyngeal insufficiency (VPI) occurs when the sphincter between your oral and nasal cavities doesn’t close completely. It can make your voice sound nasally or cause speech problems. In severe cases, solid foods or fluids may regurgitate (come up) through your nose.
VPI is a type of velopharyngeal dysfunction. It involves the velopharyngeal sphincter, the juncture between your:
A sphincter is a ring of muscle that protects or closes an opening or tube in your body. The velopharyngeal sphincter is active when you swallow or speak.
VPI is more likely to occur in children with:
The condition also may occur after certain types of surgery or cancer treatment:
Rarely, a type of “stress VPI” may occur in musicians who play brass or woodwind instruments.
VPI occurs when there’s a structural problem in the velopharyngeal sphincter. When the sphincter’s seal isn’t complete or tight, air can escape through your nose instead of your mouth. This causes the nasal-sounding voice of VPI.
The signs and symptoms of VPI include:
A person with VPI may sound slightly different when speaking. For example:
To diagnose VPI, a healthcare provider will likely:
Velopharyngeal insufficiency treatment usually involves speech therapy and surgery.
Speech therapy can help your child adjust the way they speak to reduce the sounds of VPI. It’s often done before and after surgery.
Surgery aims to create a better seal between the nasal and oral cavities without blocking the airway. Surgical approaches depend on the structural problems involved. A surgeon may:
Some people may wear an oral prosthetic, a custom-made device that pushes their palate higher (like a dental retainer after braces). But these are often difficult to tolerate and are usually used only in people who aren’t good candidates for surgery.
Like any surgical procedure, surgery to correct VPI can cause possible complications, including:
There aren’t any strategies to prevent VPI. Avoiding surgery near the palate and pharynx may help reduce the risk of VPI, but those procedures are often medically necessary.
Surgery corrects VPI in as many as 85% of cases. But some people may still have symptoms or require repeat surgery.
Often, a child with VPI has learned speech habits and needs speech therapy to adjust after surgery.
Talk to your child’s healthcare provider if you notice unusual speech patterns, habits or sounds. If you notice a strong nasal tone during speech, it could be VPI. Early treatment can help prevent long-term habits that can be harder to break.
A note from Cleveland Clinic
Velopharyngeal insufficiency (VPI) occurs when the seal between your oral and nasal cavities doesn’t close completely. The condition allows air to escape from your nose instead of your mouth during speech. If your child has speech issues and speaks nasally, talk to your pediatrician about VPI.
Last reviewed by a Cleveland Clinic medical professional on 07/25/2022.
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