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Clinical Presentation of Management of Idiopathic Velopharyngeal Incompetency Using Speech Aids

The nasal and oral cavity must be completely closed off while swallowing, vomiting, blowing, sucking, whistling and speaking oral sounds. This velopharyngeal closure is especially important when producing pressure-sensitive sounds. During normal velopharyngeal (VP) function, posterior third of soft palate moves posterior-superiorly, pharyngeal wall moves anteriorly and medially to form a shape of a sphincter resulting the closure of oral and nasal cavities. Velopharyngeal dysfunction (VPD) is a term describing an inappropriate function of VP port which consists of lateral and posterior pharyngeal walls and soft palate. This muscular valve can control the air passage between oro- and nasopharynx. The impairment of velopharyngeal function can be attributed to structural causes, neurologic causes and speech mislearning. Diagnosis of VPD, identifying a critical cause of the dysfunction, can be carried out through physical and oral examination, perceptual speech assessment, radiographic mulitplanar videofluoroscopy and nasendoscopy. Treatment options of VPD include surgical and prosthetic interventions in combination with speech therapy. Speech therapy is the mainstay in treatment of patients with VPD. Prosthetic devices for VPD can be alternative treatment method when surgical approach is not considered. Widely used types of these devices, called speech aids, are palatal lift appliance and speech bulb.