What is VPD?
VPD or velopharyngeal dysfunction occurs when a child is unable to separate the mouth from the nose during speech. It is caused by structural issues with the soft palate and throat, and can cause significant psychosocial stress related to difficulty understanding speech. Because the speech problems are structural, surgery may be required to correct this.
VPD often occurs in children born with cleft palate or other craniofacial and genetic conditions, but may also be present in otherwise healthy children, or those who have undergone surgery in the throat such as adenoid removal.
Concerns over speech may be brought up by parents, teachers, speech pathologists, or your pediatrician or ENT doctor.
Common Symptoms of VPD
- Hypernasality, or too much air escaping in to the nose during speech
- Speech articulation “backing” errors such as making sounds in the throat or voicebox
- Reflux of liquids or food into the nose while eating
Treatment for VPD
The management of VPD requires a team approach to build a customized plan for your child. At Golisano Children’s Hospital we provide the most comprehensive evaluation in the region, with the belief that the combined expertise of our providers enables us to deliver both safe and effective care.
Because VPD is often related to a structural problem, speech therapy alone often will not solve the problem, although it may play an important role in the preoperative or postoperative care plan for your child. There are various surgical options for the management of VPD, including surgeries of the soft palate, pharyngeal flaps, and sphincter pharyngoplasties. The decision regarding what surgery is best for your child is a joint decision between members of our team based on your child’s specific needs, as well as parental and child involvement.
If there are concerns over VPD, we would be happy to meet with your child at any age. Some diagnostic tests (see below) may require your child to be mature enough for a thorough evaluation, often around 4-5 years of age. If your child requires these tests to safely and effectively treat VPD, we may recommend following your child for a few years until old enough to proceed with further treatments.
Postoperative care instructions after speech surgery
Pamphlet on VPD from the Cleft Palate Foundation
If there are concerns regarding possible VPD in your child, the evaluation process often begins with a visit with our speech pathologist, who has dedicated her career to caring for such children. While your child may receive speech therapy services already, our speech pathologist has special expertise in the identification and treatment of these specific disorders.
Based on the evaluation of our speech pathologist, if there is a confirmed diagnosis of VPD, your child will likely undergo additional diagnostic tests or procedures to determine the safest and best surgery for them.
Tests and Procedures
In this test, our speech pathologist and pediatric ENT physician will numb your child’s nose with a spray. They will then pass a very small camera in to look at how the soft palate and throat function during speech. This will also allow us to look at the airway overall, including the tonsils and adenoids. This exam is recorded so that our entire team can review the study. This test is performed at our pediatric ENT office.
This test is a radiographic study where our speech pathologist looks at how the soft palate and throat functions in order to customize a surgical approach just for your child. This exam is recorded so that our entire team can review the study. This test is performed in the radiology department at Golisano Children’s Hospital.
Overnight Sleep Study
Most of the surgical treatments for VPD work by narrowing the space for air to pass into the nose during speech. These surgeries carry with them a risk for developing obstructive sleep apnea, so our team often recommends sleep study evaluation both before and after surgery to optimize the safest outcome for you child. This test is performed at our outpatient pediatric sleep lab.
Magnetic Resonance Angiography (MRA) of the Neck
Patients with 22q11 deletion syndrome may require MRA before some operations to ensure that no spine or vascular abnormalities preclude safe surgery. Depending on your child’s age, this may require anesthesia.
Tonsillectomy and Adenoidectomy
Depending on the surgery we recommend for the treatment of VPD, we may request that your child has their tonsils and adenoids removed before speech surgery to optimize the outcome.