Symptoms of Velopharyngeal Insufficiency
Speech with VPI.
The two main speech symptoms of velopharyngeal insufficiency (VPI) are hypernasality and nasal air emission.
Hypernasality is sometimes called nasal speech. In English the sounds "m," "n" and "ng" are the only sounds that should resonate nasally. Hypernasality occurs when sounds other than these resonate through the nose, and it varies from mild to severe.
Some other consonants can be produced without velopharyngeal closure, including "h," "w," "y," "l" and "r."
The rest of the consonants are referred to as pressure consonants because they require buildup of air pressure in the mouth to produce normal sounds.
Nasal air emission occurs when air escapes through the nose on pressure consonants, and it can sound like puffs, squeaks or snorts, or it might make speech sound muffled.
Children sometimes develop unusual speech sounds to compensate for their VPI. A common one is a glottal stop, produced by stopping air with the vocal cords (as one would do when saying "uh oh").
Some other sounds are made by awkward stopping or restricting air with the tongue in the throat or mouth in unusual ways.
Velopharyngeal Insufficiency Diagnosis
To diagnose VPI, a speech language pathologist will assess your child’s speech.
Your child will also see an otolaryngologist (ear, nose and throat specialist) for an exam. This doctor will insert a flexible fiber optic tube into your child’s nose to see the back of their throat where their velopharyngeal muscles are attempting to close. This is called nasopharyngoscopy.
The doctor may also perform a special X-ray of your child's palate and throat during speech. This test requires flavored drops to be inserted into the nose so the palate and throat muscles can be seen clearly.
Children with VPI may have other issues that affect their speech.
When figuring out whether your child has VPI, it is just as important to find out if your child has difficulties with articulation (the way they make sounds), speech coordination (putting the sounds together) and voice (producing a sound from the voice box or larynx).