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A 16-item questionnaire designed to survey opinions on the management of velopharyngeal insufficiency (VPI) was distributed to all members (N = 296) of the American Cleft Palate Association who were speech-language pathologists. Questionnaires were completed by 173 respondents (58.4 percent). There were differences of opinion among speech-language pathologists on various management issues related to VPI, including the value of instrumental assessment of VPI, the importance of oral examination of velopharyngeal function, and the effectiveness of speech therapy in the treatment of VPI. The implications of these findings for clinical training in VPI are discussed.

Warren (1979) described an approach for screening velopharyngeal inadequacy using a device (PERCI) that measures orifice differential pressure (P). The PERCI score is based on the relationship between velopharyngeal orifice (VPO) area and velopharyngeal orifice differential pressure. The purpose of this study was to test the original assumptions, which were based on modeling experiments and a small sample size. The sample in this study included 515 subjects who demonstrated various degrees of velopharyngeal inadequacy. The pressure-flow technique was used to estimate velopharyngeal orifice size and to measure orifice differential pressure. The data demonstrate that differential pressures greater than 3.0 cm H2O generally predict adequacy of closure, whereas differential pressures less than 3.0 cm H2O usually indicate inadequacy. These findings support the use of orifice differential pressure as a simple screening of velopharyngeal function.

A questionnaire designed to survey methods of diagnosis and management of velopharyngeal insufficiency associated with cleft palate was distributed to over 1,000 speech pathologists in the United States and Canada. There was a 60% response, and 65% of those responding were associated with cleft palate teams. Findings included: (1) 90% of responding cleft palate team members primarily rely on listener judgment, oral examination, and articulation testing in the diagnosis of velopharyngeal insufficiency (VPI) and for the recommendation of pharyngoplasty. (2) Only 11% indicated that their team had a radiologist. (3) More than half of those responding said that they would prefer palatal repair to be completed after the age of two. (4) 60% of those responding regarded VPI as a voice disorder, yet 84% treated the symptoms of VPI with articulation therapy rather than voice therapy.

Seven speech pathologists with expertise in the evaluation of the speech of individuals with cleft palate agreed that the following parameters should be assessed: case history, oral-peripheral mechanism, articulation, and voice quality. From such information and observations the clinician should be in a position to make inferences about velopharyngeal function. If velopharyngeal function is not normal, it is mandatory that additional information about the mechanism be obtained.

The purpose of this work was to develop an articulation test which would be discriminating in the determination of velopharyngeal incompetency in young children. From 50 words containing the /p/ and /b/ sounds, normative data for children approximately 3 1/2 years of age were collected. From the responses of these children, 25 words were selected for a base test. Validity of the test is currently being determined.

A questionnaire designed to survey methods of assessing velopharyngeal closure and the extent of training and experience in velopharyngeal assessment was distributed to 256 randomly selected American Cleft Palate Association members. There was a 50% response rate and 94% of those responding were associated with cleft palate teams. Findings included the following: (1) the respondents rely primarily upon the use of listener judgments of spontaneous speech samples, phonological analysis, and lateral view cine/videofluoroscopy; (2) the majority spend thirty minutes or less on an average diagnostic evaluation of velopharyngeal competency; and (3) 45% feel that they are inadequately trained in assessment of velopharyngeal closure.

This study compared longitudinally perceptual ratings of articulation defectiveness, nasality, and velopharyngeal competency in 13 subjects who required secondary palatal management after age 10 with a second group. Perceptual data when examined longitudinally did not adequately discriminate between subjects who at one time achieved velopharyngeal closure but who ultimately required secondary management and those patients who needed no further treatment. A decrease in articulation scores and an increase in severity of nasality and articulation defectiveness over time indicate that patients are at risk for secondary management. Evaluation of lateral x-rays indicated that those in the group that required secondary operations demonstrated more variability in velopharyngeal closure than those in the comparison group, who required no secondary operations and that adenoidal involution did not appear to be a significant factor.

Nasal air flow was measured during the speech of 112 normal subjects (59 females and 53 males) ranging in age from three years to 37 years, six months. Flow was zero during nearly all oral consonant and vowel utterances, suggesting that velopharyngeal closure was air-tight. Flow occurred during all nasal consonants and during vowels adjacent to nasal consonants. These effects were interpreted as showing that progressively older subjects and female subjects demonstrate earlier anticipatory coarticulation in preparation for forthcoming nasal consonants.

Twenty-two patients with the Facio-Auriculo-Vertebral Malformation Complex (hemifacial microsomia) were examined with multi-view videofluoroscopy and nasopharyngoscopy at rest and during speech. Fifty-five per cent of the subjects had velopharyngeal insufficiency (VPI) and hypernasal speech. Only two of these 12 subjects had cleft palate. VPI was related to structural and physiological asymmetry of the pharynx. No relationship was found between the severity of facial malformation and the presence of VPI.

Although sophisticated techniques for estimating velopharyngeal port area during speech are available, clinicians continue to seek approaches for screening patients with suspected velar inadequacy. The aim of the present study is to determine the sensitivity and specificity of predicting velopharyngeal dysfunction based on nasal airflow measurements. The pressure-flow technique was used to measure velopharyngeal orifice area and nasal airflow rate in 211 subjects with cleft palate or velar dysfunction, or both. The data demonstrate that nasal airflow rates above 125 cc/sec are almost always associated with velar dysfunction. Sensitivity and specificity of this index were high (0.85 and 0.96, respectively). A correct diagnosis was made in 93% of the cases. As expected, errors in judgment occurred most frequently in subjects with borderline velopharyngeal inadequacy.