Management of velopharyngeal insufficiency: The evolution of care and the current state of the art

Velopharyngeal insufficiency (VPI) is a condition in which there is incomplete closure of the velopharyngeal valve during speech production. This results in hypernasality and/or audible nasal emission. Nasal emission can cause additional secondary characteristics, including weak or omitted consonants, compensatory articulation productions, short utterance length, and even dysphonia. Overall, this condition affects the quality and intelligibility of speech production, which can have a significant effect on the individual's communication and social interactions. This article provides a brief overview of how the management of VPI has evolved over the past 40 years (which is the extent of this author's career). In addition, the current state of the art in VPI management is discussed from this author's perspective. Finally, a pathway is suggested for the future evolution of care for patients affected by VPI.