Sunbelt Staffing #2 - July 2018

Velopharyngeal Insufficiency After Tonsillectomy

Ann Kummer, Ph.D,CCC-SLP

August 30, 2010



I am currently studying Music at Rhodes University, Grahamstown South Africa. I am in my third year with Alto Saxophone as my major instrument. In December 2009 I was tested and confirmed to have glandular fever, and from there is when things started goin


The velopharyngeal valve consists of the velum (soft palate) and pharyngeal walls (walls of the throat). During speech, the velum raises and closes against the posterior pharyngeal wall. The lateral pharyngeal walls move medially, to close either against or behind the velum. These structures therefore serve as a valve to close off the nose from the mouth during speech, sucking and blowing.

Velopharyngeal insufficiency (VPI) is a structural problem that affects the function of the velopharyngeal valve. The term "velopharyngeal incompetence" is sometimes used interchangeably, but we use it to mean a neurophysiological basis for poor velopharyngeal function. Regardless, both are abbreviated as VPI so we will use that for the rest of this discussion. For more information about VPI, go to

VPI is a risk with adenoidectomy because with children, the adenoids often provide extra bulk for firm velopharyngeal closure. VPI is very rare after tonsillectomy alone. When it does occur, it may be due to unconscious "protecting" of the velopharyngeal mechanism from the postoperative pain. This abnormal pattern may disappear after 4-6 weeks, but it can persist as a habit, requiring speech therapy. In each case of this that has been reported, this also results in severe hypernasality during speech.

The other known cause of VPI after tonsillectomy is scarring, particularly of one or both of the posterior faucial pillars (the back of the two drapes that are on each side of the back of the mouth). This pillar includes a muscle that is important for velopharyngeal closure.

The best thing to be done right now is to see a speech pathologist and ENT that are associated with a craniofacial team. They need to do a nasopharyngoscopy (also called nasendoscopy or videonasendoscopy). That way, they can see the opening while you are playing the saxophone and determine the cause. A surgical procedure may be necessary to fix it, but since the opening is probably small, it should be a relatively minor surgery.

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Dr. Kummer is Senior Director of the Speech Pathology Department at Cincinnati Children's and Professor of Clinical Pediatrics and Professor of Otolaryngology at the University of Cincinnati Medical Center. She does many lectures and seminars on a national and international level. She is the author of many professional articles, 16 book chapters, an inventor of the Oral and Nasal Listener, and author of the SNAP nasometry test. She is also the author of the text entitled Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, 2nd Edition, Clifton Park, NY: Delmar Cengage Learning, 2008. She is an ASHA Fellow.

Ann Kummer, Ph.D,CCC-SLP

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