3.4 Causes of Velopharyngeal Dysfunction

Question 1

What are the organic causes of hypernasality/NAE?

5

Answer 1

• Congenital Palatal Insufficiency (Deep pharynx)
• Neuromuscular Disorders
• Cleft palate
• Ablative surgery
• Radiation to Nasopharynx

Question 2

What are the non-organic causes of hypernasality/NAE?

Answer 2

• functional/ sound specific

Question 3

What are the causes of hyponasality?

2

Answer 3

• Nasal Obstruction

- Pharyngeal Obstruction

Question 4

What are the signs of a submucous cleft?

5

Answer 4

• Absent or broad posterior nasal spine
• No color change
• Anterior attachment of the levators
• Zona Pellucida
• Bifid Uvula

Question 5

A high arched palate will not typically cause what?

Answer 5

A VPI

Question 6

What are the signs of congenital palatal Insufficiency: deep Nasopharynx?

(4)

Answer 6

• Hypernasality is the primary presenting factor
• Palate appears normal
• Nasal regurgitation as newborn may be first sign
• Occurs rarely following maxillary advancement

Question 7

What occurs after an adenoidectomy when you have a congenital palatal insufficiency?

Answer 7

Deep nasopharynx is unmasked (velopharyngeal mechanism seems able to adjust to slow involution but not the sudden increase with adenoidectomy

Question 8

What are the signs of a lower motor lesion?

4

Answer 8

• Flaccidity
• Atrophy
• Fasciculations
• Usually unilateral, but may be bilateral

Question 9

What are the signs of an upper motor lesion?

Answer 9

Both larynx and velum should be assessed (one may be paralyzed)

Question 10

When can neuromuscular insufficiency occur?

3

Answer 10

• Congenitally (Moebius or velocardiofacial syndrome)
• Tumors (congenital or acquired)
• Surgically or via a trauma

Question 11

How is the velum for functional/sound specific VPI?

Answer 11

Velum is neurologically and anatomically capable of closure at time of evaluation

Question 12

What is the most likely cause of functional/sound specific VPI?

Answer 12

Most likely cause is early Conductive Hearing Loss

Question 13

In regards to functional/sound specific VPI, what happens after post T&A with tubes?

Answer 13

improved hearing increases speech output and unmasks the “posterior nasal fricative”

Question 14

Functional/sound specific will not respond to what?

Answer 14

Surgery or Prosthetic management

Question 15

What does functional/sound specific require?

Answer 15

Speech therapy

Question 16

Functional/sound specific is truly a misarticulation using what?

Answer 16

posterior nasal fricative

Question 17

What is apraxia of speech?

Answer 17

Motor speech disorder causing difficulty combining and sequencing motor movements

Question 18

What subsystems of speech does apraxia of speech affect?

3

Answer 18

• Phonation
• Articulation
• Velopharyngeal function

Question 19

Apraxia of speech has poor ______________, ____________, and _____________ of VP closure.

Answer 19

coordination, timing, and duration

Question 20

Apraxia of speech causes what?

Answer 20

inconsistent hypernasality/ hyponasality

Question 21

What happens during apraxia of speech?

Answer 21

velum elevates inappropriately for nasal sounds and remains open for oral sounds

Question 22

What are the nasal airway obstruction?

10

Answer 22

• Nasal cleft deformities
• Allergic Rhinitis
• Vasomotor rhinitis
• Bacterial URL
• Choanal atresia
• Nasal cavity mass
• Septal deviation
• Turbinate enlargement
• Nasal hygiene
• Maxillary retrusion (seen in down, apert, crouzon syndromes)

Question 23

What are the pharyngeal airway obstruction?

6

Answer 23

• Hypertrophied tonsils
• Hypertrophied adenoids
• Complications of cleft palate/craniofacial and airway surgery
• Pharyngoplasty: pharyngeal flap/sphincter
• Stenosis following T+A
• Mandibular Retrusion (Pierre Robin Sequence)