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Pediatric Velopharyngeal Incompetence (VPI)



If your child’s speech sounds as if air is escaping from the nose, he/she may have a condition called velopharyngeal incompetence (VPI). Following an evaluation with a trained speech-language pathologist and Ear, Nose, and Throat (ENT) physician at our Non-Cleft Velopharyngeal Incompetency Clinic, treatment recommendations may include surgery, orthodontic appliances, and/or speech therapy.

Expanded Overview

When we talk, air moves from our lungs, up through the vocal cords, and into the velopharynx (back of the throat). To form clear speech sounds, the air must go to the right place – we make some speech sounds in our nose and others in our mouth. The soft palate (velum) directs the flow of air to the correct place. The lips, teeth, and tongue then shape the air to make specific speech sounds. If the soft palate doesn’t work well, then your child’s speech may sound unusual with a nasal quality.

Most families have never heard of VPI until their child is diagnosed with it. Children’s Health has a great deal of experience treating VPI with our expert speech-language pathologists and ENTs. To limit the impact on your child's speech and social development, early detection and treatment are critical. 


If your child has VPI, you may notice the following:

  • Hypernasality
  • Nasal air escape or turbulence during speech
  • Weak air pressure
  • Soft vocal quality

Tests and Diagnosis

Patients who visit the Non-Cleft Velopharyngeal Incompetency Clinic will be evaluated by an ENT physician and our trained speech-language pathologists. A comprehensive speech and resonance assessment will be performed.  To evaluate for VPI, your child will need to imitate words and phrases during the evaluation.

When velopharyngeal incompetency is suspected, speech is investigated using two techniques:

  • Nasoendoscopy -  A small camera is passed through the nose to view the soft palate. During speech, the movement and closure pattern of the soft palate can be viewed.  
  • Video fluoroscopy – Your child will stand in an X-ray machine and imitate words and phrases. When speaking, the movement of the soft palate can be viewed.

The results will be explained so you can make the most informed decision about your child’s care.


Whether surgery is recommended or not, the team will discuss the benefits and potential problems associated with all options.  The goal of surgery will be to fix your child’s soft palate so that less air escapes from the nose during speech. Speech therapy may also be needed to teach the correct lip and tongue movements for speech

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