Velopharyngeal Dysfunction (VPD)
What is VPD?
Velopharyngeal dysfunction (VPD) is the inadequate separation of the oral and nasal cavities during speech and/or swallowing. VPD is caused by structural and/or functional abnormalities of the soft palate and pharyngeal muscles. Patients with VPD often exhibit hypernasal speech, abnormal articulation, and decreased intelligibility. Successful surgical management of VPD requires precision in diagnosis and individualization of treatment.
What Causes VPD?
Most children with VPD also have articulation difficulties and may be difficult to understand. The cause of VPD varies, but is most commonly due to:
Some of the common causes of VPD are:
- A short soft palate that cannot reach the back of the throat
- A mismatch between the length of the palate and the depth of the throat, so the palate cannot reach the back of the throat
- Limited muscle function, weakness or an uncoordinated soft palate. This means the palate may be long enough but is unable to move high or far enough.
Some of the risk factors for VPD are:
- Cleft palate or submucous cleft palate
- Certain syndromes, such as 22q11.2 deletion syndrome
- Some diseases of the central nervous system or Muscle weakness caused by certain conditions
- Some children have more risk of VPD after having an adenoidectomy, if they have any of the above risk factors.
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What are the Signs and Symptoms of VPD?
Signs and symptoms of VPD may include:
- Excessively nasal speech quality (also known as hypernasality)
- Leakage of air through the nose while speaking
- Speech which sounds weak or muffled
- Abnormal articulation
- Leakage of food or liquid through the nose while eating
How is VPD Diagnosed?
If VPD is suspected, your child will see a speech-language specialist and a surgeon to be evaluated and confirm the diagnosis. Children typically have a speech evaluation, which means special tests to measure nasality and imaging, if it is needed. (For more information, see Helping Hand HH-I-444, Nasopharyngoscopic Evaluation of Velopharyngeal Closure During Speech or HH-III-148, Multiview Speech Fluoroscopy) The surgeon and speech pathologist will also examine your child’s mouth.
Speech sound (articulation) testing may also be done. During the speech evaluation and any imaging procedures, the child needs to attempt to say enough sounds or words to let us decide if speech symptoms of VPD are present.
In some cases more testing, such as an MRI, sleep study, or genetic testing, may be needed before the cause of VPD or the treatment plan can be finalized.
The diagnosis and treatment of VPD requires a team approach. The team includes a specially-trained speech-language pathologist and a surgeon, and sometimes additional healthcare providers, if needed.
If VPD is suspected at any age, a referral should be made to a specialized VPD Team or to a cleft lip and palate team for proper diagnosis and management.
Children with VPD who also have other medical conditions (e.g., heart abnormalities) or learning difficulties often require evaluation by a geneticist to determine if there is an identifiable genetic cause of their VPD.
The most common genetic cause of VPD is a condition known as 22q11.2 deletion syndrome. Children with 22q11.2 deletion syndrome benefit from a comprehensive evaluation by a team of expert professionals to ensure development of the safest and most effective treatment plan for their VPD.
How is VPD Treated?
VPD is a treatable condition. Treatment options may include the following:
- Surgery is typically the first-line approach to treatment of VPD. There are several surgical treatments commonly used. Your child’s surgeon will choose which one is right for your child. Surgical management of VPD is very effective. It aims to improve speech by reducing the leakage of sound and airflow through the nose while the child is talking. The expected result of speech surgery is speech that is both easier to understand and more socially acceptable.
- Many children with VPD will also need speech therapy. The treatment team will decide if your child needs speech therapy, surgery, or both.
- Rarely, a speech prosthesis may be an option to treat VPD. This is more common in people with a history of head or neck cancer, severe motor disorders or other complex medical situations.
