Does your child speak through his nose? Learn about Velopharyngeal Insufficiency (VPI)

When your little one speaks, do you ever hear a "nasal" sound, like their voice is coming from their nose? Sometimes when they say letters like "प", "ब", "त" they make a slurred, nasal sound? Many parents think this is normal, but sometimes there can be a medical reason behind it. Don't worry, today we are going to talk about such a situation.

Simply put, what is Velopharyngeal Insufficiency ( VPI )?

While this name may sound a bit complicated, the point is very simple. Let's understand this.

Imagine that there is a door between our mouth (oral cavity) and the cavity inside our nose (nasal cavity). We call this door the `velopharyngeal sphincter`. This is actually a ring of muscles . When we speak or swallow, this door closes tightly, preventing air from entering our nose. For example, when we say "bread", the air pressure that comes to the letter "p" is created inside our mouth. At that time, the door is closed, so air does not escape into our nose.

Velopharyngeal Insufficiency ( VPI ) is a condition where that door, or `sphincter`, doesn't close properly. That means there's a small gap left. What happens then? When we speak, some of the air that should come out of our mouth escapes into our nose. That's why our voice sounds nasal. In some severe cases, it can even come up through our nose when we drink something liquid like water.

Who is more likely to develop this condition?

Although VPI can occur in anyone, it is especially common in children. There are several factors that contribute to this.

• Congenital problems: Some children are born with certain problems with their palate. For example, children with a cleft palate may have this condition. Also, some children's soft palate may be slightly shortened at birth.
• Enlarged tonsils and adenoids : In some children, when the tonsils in the throat or the adenoids behind the nose become enlarged, this can interfere with the 'sphincter' we mentioned.
• Genetic conditions: VPI can also occur with certain genetic conditions, such as Down syndrome or neurofibromatosis.
• Muscle weakness: Neurological disorders such as cerebral palsy can cause the muscles of the head to become weak and not function properly.
• Some surgeries:
• Adenoidectomy.
• Tonsillectomy.
• Surgery to remove tissue from the back of the throat (UPPP surgery) for conditions like snoring .
• Other causes: Having a tumor on the skull or receiving radiation therapy for throat/nose cancer can also cause VPI.

Rarely, musicians who play brass or woodwind instruments can also develop a temporary condition called "stress VPI" due to stress.

What are the symptoms of someone with VPI?

If you suspect your child has VPI, keep an eye out for these symptoms.

How does the voice sound in the VPI situation?

To be precise, when someone with this condition speaks, you might hear things like:

• The story just seems to get stuck in the middle, and the story stops strangely.
• The voice is not clear, it seems to be muffled (muffled speech).
• When speaking, you may hear a 'puff' sound, a 'squeak' sound, or a 'snort' sound, as if your nose is blocked .
• It clearly feels like you're speaking through your nose instead of your mouth.

How to recognize this condition?

If you notice these symptoms in your child, the best thing to do is to see a doctor. An ear, nose, and throat specialist (ENT surgeon) is the best person for this. He or she will run several tests to confirm the condition.

1. Physical examination: First, the doctor will feel the child's palate to see if there are any abnormalities.

2. Speech analysis: Let the child speak and listen carefully for sounds typical of VPI.

3. Nasoendoscopy: In this, a thin, flexible tube with a camera and light is inserted into the nose and the doctor looks directly at the screen to see if the sphincter closes when you speak or if there are any gaps. Although this may seem a little uncomfortable, it is very important for an accurate diagnosis.

4. Videofluoroscopy: This is a special X-ray test. The child is given a liquid called barium to drink, and the X-ray shows the movement of the parts of the palate and throat as they swallow and speak.

What are the treatments for VPI?

Once the VPI status is confirmed, there is nothing to fear. There are effective treatments for this. Treatment methods can be divided into two main categories.

1. Speech Therapy

This is a very important part. A speech therapist teaches the child how to speak with VPI in a way that reduces the nasal sound in the voice. Sometimes, speech therapy is needed before and after surgery. After surgery, the child needs to learn to pronounce sounds in a new way.

2. Surgery

In most cases, the permanent solution to VPI is surgery. The main goal of surgery is to close the gap between the nose and mouth. However, care must be taken not to obstruct nasal breathing. Depending on the child's condition, the doctor may use different surgical techniques.

• Changing the shape of the soft palate.
• Making the throat wall slightly thicker and reducing the distance to the palate.
• Stretching or retraining the muscles of the palm.
• A muscular flap (`pharyngeal flap`) is taken from the back wall of the throat and attached to the roof of the mouth. This closes the gap to a large extent.

Sometimes, for those who cannot or do not want surgery, a special device (`oral prosthetic`) is placed in the mouth, similar to a retainer that is placed on the teeth. This is done to push the roof of the mouth up and close the gap. However, it can be a bit difficult to use these continuously.

Are there any risks to surgery?

Like any surgery, VPI surgery can carry some minor risks, but these do not occur in most cases.

• Hyponasal speech: This means that after surgery, the sound coming from the nose becomes less than normal, and the voice sounds like it comes from a cold.
• Difficulty breathing through the nose.
• Snoring and obstructive sleep apnea.
• Sometimes, even after surgery, the nasal voice (hypernasal speech) may not disappear completely, but may even increase.

Your doctor will discuss this with you in detail before the surgery.

What should I do if my child has this condition?

The most important thing to do is to see a doctor as soon as possible and seek advice. If you notice unusual patterns, habits, or sounds in your child's speech, especially if the voice sounds nasal, don't ignore it.

Because the sooner this condition is treated, the better the results. If not, the child may develop a habit of speaking incorrectly and it may be difficult to change that habit later.

There is no specific way to prevent this condition, as it is often congenital or caused by other medical conditions.