Nasal speech and velopharyngeal dysfunction

The aim of the service is to provide a comprehensive speech and language therapy service for individuals presenting with velopharyngeal dysfunction within the context of the North Thames Regional Cleft Lip and Palate service.

Patients present with an overall nasal tone to their voice (hypernasality) and/or air coming down their nose (nasal emission, nasal turbulence), sometimes together with consonant articulation problems.

Approximately 50 per cent of patients seen within this service have had a cleft palate repair.

Other patients are seen with submucous cleft palate, congenital enlarged nasopharynx, post-adenoidectomy, post-tumour excision, dysarthria/dyspraxia. Some patients have associated syndromes such as 22q11 Deletion Syndrome.

Patients are seen for special tests which include a moving X-ray (lateral videofluoroscopy), sometimes the use of a tiny telescope to look at the back of the throat during speaking (nasendoscopy), as well as detailed speech assessment and measurements of the voice using a computer.

Management usually includes surgery, but prosthetics, including the use of a speech bulb obturator and palatal lift, are used in a small group of patients. Speech therapy is also a treatment option.

Linked clinics:

• Velopharyngeal dysfunction clinic

• Prosthetics clinic

• 22q11 deletion syndrome clinic