Investigation

An assessment by an experience speech and language therapist provides a good subjective measure of velopharyngeal insufficiency. However, a number of different procedures can be used as adjuncts:

• nasopharygoscopy
• multiview videofluroscopy
• oral and nasal pressure and airflow; gives information about the effect of treatment but little help with regard to treatment planning
• acoustic analysis
• MRI studies:
  • still experimental
  • advantageous as non-invasive
  • too slow at present to offer dynamic, functional imaging

Nasopharyngoscopy and multiview videofluoroscopy are the most widely used. They are complementary techniques and are sometimes used simultaneously. They provide information about the shape, size and range of movement of the velum and the pharnyx. Typically, both are carried out while the subject repeats a number of standard speech sounds. A systematic approach allows comparison or pre- and post-operative results.