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Pediatric velopharyngeal incompetence (VPI)

If your child’s speech sounds as if air is escaping from the nose, they may have a condition called velopharyngeal incompetence (ve·​lo·​pha·​ryn·​geal - in·​com·​pe·​tence) or VPI.

Children’s Health℠ has a great deal of experience treating VPI with our expert speech-language pathologists, plastic surgeons and ear, nose and throat (ENT) physicians.

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What is pediatric velopharyngeal incompetence (VPI)?

When we talk, air moves from our lungs, up through the vocal cords and into the velopharynx (back of the throat). For clear speech, the air must go to the right place, which is sometimes our nose and other times 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 with a cleft or submucous cleft palate will see a plastic surgeon. All other VPI conditions are treated by an ENT physician. 

To limit the impact on your child's speech and social development, early detection and treatment are critical. 

What are the signs and symptoms of pediatric velopharyngeal incompetence (VPI)?

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

How is pediatric velopharyngeal incompetence (VPI) diagnosed?

A trained speech-language pathologist and a plastic surgeon or ENT carry out tests to decide whether your child has VPI and whether it is a cleft or non-cleft type of VPI. These tests include a comprehensive speech and resonance assessment. Your child will need to imitate words and phrases during the evaluation.

If the doctor thinks your child has VPI, their speech is tested further with 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.

How is pediatric velopharyngeal incompetence (VPI)] treated?

Following the diagnosis, treatment recommendations may include speech therapy combined with surgery or orthodontic appliances. In some cases, speech therapy is the only treatment needed.

  • Speech therapy - Speech therapy may also be needed to teach the correct lip and tongue movements for speech.
  • Surgery - The goal of surgery will be to fix your child’s soft palate so that less air escapes from the nose during speech.

Pediatric velopharyngeal incompetence (VPI) doctors and providers