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Pediatric Velopharyngeal Incompetence (VPI)



If your child’s speech as it develops sounds very soft or nasal and difficult to understand, she may have a condition called velopharyngeal incompetence or inadequacy. Depending on the extent of the condition, speech therapy can help or, in some cases, surgery may be necessary.

Expanded Overview

VPI affects your child's ability to speak because the velopharynx doesn't close properly, and air escapes through the nose instead of the mouth. Children with VPI may have difficulty with having their speech understood by others, or have a nasal quality when speaking.

To limit the impact on your child's speech development and minimize further developmental problems, early detection and treatment are critical. 


When we talk, air comes out of our lungs, travels up through the vocal cords and arrives at the back of the throat. In order to form speech sounds with that air, it then has to 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 into the right place for the right sound.

Most of the sounds in speech are made in our mouths, so if the soft palate has a cleft, or if it doesn’t work well, then most of the sounds that we use in speech can’t be made.

Tests and Diagnosis

Patients who visit the multidisciplinary Velopharyngeal Incompetence Clinic will be evaluated by an Ear, Nose and Throat (ENT) physician and a speech and language specialist. The speech and language specialists will perform a comprehensive speech evaluation to assess your child's ability to communicate.

When velopharyngeal dysfunction is suspected, speech is investigated by two main techniques.

  • Video fluoroscopy - This is an X-ray test showing the palate moving during speech. It is useful to assess the shape and movement of the palate and to give an idea of any gap in the “valve” mechanism that might require surgery to correct.
  • Nasoendoscopy -  A small camera is passed through a nostril until it is looking at the top of the soft palate during speech. During this test, the movements of the palate and back of the throat can be seen directly, and any gap in the “valve” mechanism can be seen.

Based on the results of both evaluations, your surgeon will determine whether surgery is likely to help and which operation is likely to give the best result with the lowest risk of complications. He also will discuss and explain the benefits and potential problems associated with each option, so you can make the most informed decision about your child's care. 


It may be necessary to treat the VPI with surgery, followed by speech therapy. Using the results from a video fluoroscopy and nasoendoscopy, your surgeon will discuss and explain the benefits and potential problems associated with each option, so you can make the most informed decision about your child's care.

Surgical Options

  • Relocate the muscles of the soft palate to allow it to move more effectively
  • Lengthen the soft palate either by rearranging the shape of the palate or by using tissue from elsewhere in the mouth
  • Narrow the space behind the soft palate so that the soft palate has a smaller gap to close
  • Fix the soft palate to the back of the throat and to create a new valve system that can be controlled by the muscles of the throat


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