Treating Velopharyngeal Insufficiency in a Case of Substance Abuse: A New Client Population

Objective: A case study is presented to illustrate the management of a patient who presented with significant tissue damage of the soft palate due to substance abuse, which involved the inhalation of drugs. Method: The patient was seen in a university medical center cleft palate clinic upon referral from a mental health facility with reported speech and swallowing problems. Perceptual and physiologic speech testing, a behavioral swallowing assessment, and other interdisciplinary assessments were conducted to confirm the patient's complaints and develop a treatment plan. Results: A speech appliance was fabricated to correct the defect and follow-up testing showed improvement in both speech and swallowing skills. Perceptual assessment indicated improved resonance balance and reduction in audible nasal emission, while physiologic testing revealed decreased nasal airflow. The team successfully implemented a plan to correct the patient's speech, resonance, and swallowing problems. Conclusions: Substance abuse is now a significant national crisis and patients may need a range of services depending on their complex of problems. Some individuals may need assistance with speech, resonance, and swallowing disorders and require prosthetic intervention provided via interdisciplinary management from a cleft palate team.