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Child sticking their tongue out getting their throat looked at by a Cleveland Clinic doctor.

Velopharyn­geal Insufficiency

While it might sound like a creature from Harry Potter, the velopharyngeal sphincter is muscle. And it plays a key role in how your child speaks and swallows.

This muscle is in the back of your throat. It’s part of the soft palate, the muscles and tissues at the back of your mouth. And it helps create a seal between your mouth (oral cavity) and the inside of your nose (nasal cavities). But if it doesn’t fully close during fetal development, air can escape through your child’s nose instead of their mouth. This can cause them to talk with a nasal tone, mispronounce words or even have trouble eating. This is velopharyngeal insufficiency (VPI). But there’s good news — we can treat it with speech therapy and surgery.

Cleveland Clinic Children’s head and neck providers treat challenging conditions like VPI. But we know it can be stressful to hear your child needs treatment. That’s why we’re here to help both of you know what to expect. Your questions and concerns are important to us. We listen to you, share information and get your child started on a personalized care plan.

Why Choose Cleveland Clinic Children’s for Velopharyngeal Insufficiency Care?

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Skilled collaborative providers:

Our focus on team-based care means your child will be in the hands of a care team built specifically for their needs. This includes expert pediatric healthcare providers from specialties like head and neck surgery, plastic surgery, speech-language pathology and more.

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Caring approach:

Cleveland Clinic Children’s believes excellent care goes beyond using the latest treatments and equipment. It also means making sure your child gets the most compassionate, personalized care. And your family gets the support you need to make the best choices for your little one. You can count on us to answer your questions and listen to your concerns.

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Trusted experts:

When your child comes to Cleveland Clinic Children’s for VPI care, you can rest easy knowing they’ll have expert healthcare providers on their side. Ones who have training and experience working closely with infants, children and teens. Meet our team.

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Virtual visits:

Sometimes, it can be tough to get kids out the door for in-person appointments. When all they need is a quick check-in or follow-up, virtual visits are a great alternative. All you need is a smartphone, computer or tablet to get connected.

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National recognition:

U.S. News & World Report consistently ranks Cleveland Clinic Children’s a top hospital in the nation. Newsweek has also named Cleveland Clinic a top hospital in the world.

Diagnosing Velopharyngeal Insufficiency at Cleveland Clinic Children’s

You might have wondered for awhile what was causing your child’s struggles with certain speech areas or with eating. Sometimes it can be hard to put your finger on what’s going on. Your child may have signs like:

  • Sounding like they’re talking through their nose.
  • Having muffled speech or puffs or squeaks of air coming out their nose.
  • Saying certain sounds or words incorrectly.
  • Having liquid or food back up and come out of their nose (regurgitation).

But they don’t have to live with this. VPI is treatable. So, it’s important to make an appointment for them with experienced head and neck providers for evaluation and treatment.

What to expect at your child’s first visit

Understanding what’s been going on with your child is a good first start for their provider. So, when you and your child meet with them, you’ll want to be ready to answer a lot of questions. The information you share can help them confirm a diagnosis. And build your child’s individualized treatment plan.

Their provider will want to know about symptoms you’ve noticed. And they’ll ask questions about your child’s overall health. Then they’ll do an oral exam. They’ll look at the roof of your child’s mouth (palate) to check for anything abnormal.

They’ll also do nasal endoscopy. This involves looking inside your child’s mouth and through it with a tool called an endoscope. It’s a thin, flexible tube that has a light and camera on it. Your child’s provider might have them talk during this test. This lets them see if the seal is doing its job.

They may also listen for sounds associated with VPl while your child talks, like whistling or other signs of air. Or problems forming consonants like P, B, T, G and D.

Sometimes, your child might also have a special X-ray called video fluoroscopy. It lets our team see how your child’s body works when they talk and swallow.

We know that having tests can be scary for kids. That’s why your child will have a child life specialist to help them understand what’s going to happen. This specialist can even be at the testing appointment if needed.

Meet Our Pediatric Velopharyngeal Insufficiency Team

The best care comes from healthcare providers who work together to get the best results. Your child will have a care team of pediatric providers from different specialties. We craft this team keeping your child’s needs and unique diagnosis in mind. So, you can rest easy knowing they’re in good hands. Their VPI care team may include:


Our healthcare providers see patients at convenient locations throughout Northeast Ohio.

Treating Velopharyngeal Insufficiency at Cleveland Clinic Children’s

There are two main ways to treat velopharyngeal insufficiency in children — speech therapy and surgery.

Speech therapy

Our team may have your child do speech therapy before and after surgery. It can help them recognize the sounds related to VPI. And it can show them ways to reduce these sounds when they speak.


We may decide that surgery could help create a better seal between your child’s oral and nasal cavities. Our team might change the shape of their soft palate or adjust the back of their throat to decrease the distance to it. We can lengthen or readjust their palate muscles or do other things to strengthen or close the seal.

Oral prosthetics

If your child isn’t a good candidate for surgery, we may have them wear an oral prosthetic. This custom-made device is like a retainer people wear after having their teeth straightened. But instead of keeping their teeth straight, this device pushes your child’s palate higher. Oral prosthetics can be uncomfortable, so we usually only use them if surgery isn’t possible.

Life After Treatment for Velopharyngeal Insufficiency

We’ll continue to keep an eye on your child after treatment. We want to make sure the seal stays closed, so, your child will have regular follow-up visits to check it. We may also recommend they continue with speech therapy to make sure they’re comfortable speaking and swallowing.

Taking the Next Step

You may not know why your child sounds nasally — or can’t pronounce certain sounds. Velopharyngeal insufficiency in children is a common cause. And it’s treatable. Cleveland Clinic Children’s head and neck team is here to help. We’ll build a personalized care plan by learning about how VPI affects your child’s life. We’ll then seal the opening. And help them feel more confident about talking and laughing with their friends.

Getting an appointment with Cleveland Clinic Children’s velopharyngeal insufficiency experts is easy. We’ll help your child get the care they need.


Getting an appointment with Cleveland Clinic Children’s velopharyngeal insufficiency experts is easy. We’ll help your child get the care they need.

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