Velopharyngeal Dysfunction

Speech therapy improves velopharyngeal function when velopharyngeal dysfunction (VPD) is minimal or due to articulation errors and in postoperative patients. Compensatory articulation techniques secondary to VPD also can be corrected with speech therapy. However, in patients with a specific anatomic deficiency that precludes adequate closure of the velopharynx, speech therapy cannot replace surgery.

Upon completion of speech and language testing, the SLP determines if VPD and hypernasality are related to articulation errors or if the condition is phoneme specific. If either is the case, the VPD usually is not related to structural abnormalities, and correction with speech therapy most likely is possible.

VPD also can be a result of decreased muscle tone in the oral musculature and soft palate. Decreased muscle tone can be observed on fiberoptic nasoendoscopy when the soft palate closes inconsistently or when closure appears slow in connected speech. [2A period of speech/language therapy focusing on improving overall oral motor skills and improving strength and elevation of the velum may be able to correct VPD in this case.

Visual feedback

In some children, especially those with hearing impairments, visual feedback can assist in therapy to improve VPD. Several devices are available to assist with this method. Simple tools (e.g., cold mirror, paper paddle) can serve to show the patient when nasal escape occurs. Other devices are commercially available, such as the See-Scape, which is placed at the nose and causes a ball to rise when airflow is nasal rather than oral.

A more sophisticated method is the use of a Nasometer, which graphically displays a ratio of oral sound energy to nasal sound energy. The visual readout can help the therapist and patient develop compensatory techniques to reduce nasalance. In older children, videotaped nasopharyngoscopy has been used to achieve the same goals.

Nasal continuous positive airway pressure therapy

Continuous positive airway pressure (CPAP) therapy is beneficial for patients whose VPD seems related to oral motor issues or velar weakness rather than structural problems of the velum. CPAP therapy is a palate-strengthening program using CPAP equipment, including a nasal mask, which is completed 6 days per week for 8 weeks in the patient’s home. With the mask in place, the patient repeats a series of consonant-vowel combinations and sentences designed to cause the velum to open and close against air pressure from the nasal mask. CPAP pressures are increased on a regimented schedule, producing exercises similar to a weightlifting program for the soft palate.