A cleft palate is an opening in the roof of the mouth that occurs when the two halves of the roof do not fuse together during embryonic development. Clefting of the upper lip can also occur. As a result, children born with clefts typically experience feeding difficulties in infancy as well as speech and articulation disorders in their early years. Occasionally, these clefts are part of a larger medical diagnosis. Caring for children with cleft palates requires early intervention and the multidisciplinary approach of a Craniofacial Program cleft palate team.
In order to create voice, air from the lungs must pass through the voice box and vibrate the vocal folds. This sound source then travels up through the throat and into the mouth to be transformed into intelligible speech. Many speech sounds require a high degree of air pressure within the mouth in order to create crisp and clear speech. To do this, individuals must be able to close off the area that connects the mouth with the nose at the back of the throat. This area is known as the velopharyngeal port or valve. Individuals who are unable to close this port during speech have a VeloPharyngeal Insufficiency (VPI).
VPI may be caused by several factors, including structural abnormalities, neuromuscular weakness and articulation disorders. Symptoms include abnormal resonance (frequently hypernasality), nasal air escaping audibly, nasal turbulence and reduced speech intelligibility.
VPI treatment is based on the root cause of the issue and may involve surgery, therapy or a combination of the two. Weill Cornell Medicine speech pathologists work closely pediatric otolaryngologists (ENT specialists) in our VPI & Voice Center, utilizing advanced clinical evaluation and nasopharyngoscopy techniques to determine causal agents of VPI.
During evaluation, speech pathologists:
- Review developmental, audiological, medical and surgical history.
- Discuss current concerns and needs.
- Perform intraoral examination to evaluate structure and function.
- Assess articulation skills and perceptual resonance.
- Assess nasal air escape via a mirror fogging test.
- Perform nasometry, a noninvasive means of evaluating nasal and oral acoustic energy, which can be compared to normative data.
- Discuss results and recommendations.
The velopharyngeal port cannot be viewed by looking into the mouth. Nasopharyngoscopy involves examination of the velopharyngeal port by passing a thin, flexible, fiber-optic scope into one nostril, positioning it above the velopharyngeal valve and observing its movement during simple speech tasks. Nostril anesthetization before the procedure requires no more than two minutes, nasopharyngoscopy produces no lasting negative effects and the procedure requires no radiation. The examination allows our team to view the valve in action during speech, confirm or rule out structural abnormalities and determine the best possible management options.
If a patient’s velopharyngeal dysfunction is deemed to be either fully or partially resulting from faulty articulation patterns, therapy is recommended. Often additional recommendations, including auditory, somnial and/or genetic testing, may be necessary.
Once therapy has been recommended, a highly personalized treatment plan is developed.
A functional, play-based approach is utilized to engage children in stimulating and enjoyable activities that target specific erroneous or compensatory articulation errors and provide ample opportunity for practicing target sounds. Therapy sessions are primarily one-on-one, with parental involvement to impart strategies to facilitate practice at home. We are always available to consult with a child’s home or school speech pathologist in order to provide resources and refine therapy goals and techniques.
Therapy consists of one-on-one sessions with a speech pathologist to target erroneous articulation errors, supplemented with home practice sheets in order to facilitate generalization of the newly acquired speech production skills to typical daily interactions. For many of our patients traveling a significant distance for their evaluation, every effort is made to find a suitable speech pathologist in their area.