From the Guidelines
Asymmetric adenoids can indeed cause Velopharyngeal Insufficiency (VPI) due to the uneven surfaces they create, interfering with the closure mechanism between the soft palate and the pharyngeal walls during speech. VPI occurs when there is incomplete closure between the soft palate and the pharyngeal walls during speech, resulting in hypernasality and nasal air emission. Asymmetric adenoid tissue can interfere with this closure mechanism by creating uneven surfaces against which the soft palate must seal. When adenoid tissue is irregularly distributed, the velum (soft palate) may not be able to make complete contact with the posterior pharyngeal wall, creating gaps that allow air to escape through the nose during speech production.
According to a recent study 1, adenoidectomy, which may be considered as a treatment option for asymmetric adenoids, carries a risk of transient velopharyngeal insufficiency, highlighting the importance of careful patient selection and surgical technique. Key considerations in managing asymmetric adenoids and potential VPI include:
- Speech therapy to strengthen velopharyngeal muscles and develop compensatory articulation patterns
- Surgical intervention, such as adenoidectomy, with careful consideration of how tissue removal might affect closure
- Prosthetic management with speech bulbs or palatal lifts in some cases Diagnosis typically involves a combination of perceptual speech assessment, nasopharyngoscopy, and videofluoroscopy to visualize the asymmetry and its functional impact on speech production. It is essential to weigh the benefits and risks of adenoidectomy, as outlined in the clinical practice guideline 1, which includes optimizing management of adenoid-related disease, reducing the need for further surgery and anesthesia, and optimizing hearing outcomes, against the potential risks, such as surgical risks, additional anesthetic risk, bleeding, hypernasality, velopharyngeal insufficiency, and nasopharyngeal scarring or stenosis.
From the Research
Asymmetric Adenoids and Velopharyngeal Insufficiency (VPI)
- Asymmetric adenoids are not directly mentioned as a cause of Velopharyngeal Insufficiency (VPI) in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that anatomical abnormalities, such as occult submucous cleft palate, short palate, or deep nasopharynx, can contribute to VPI 4, 5.
- Adenoidectomy can also lead to VPI in some cases, with an incidence of one in 1200 adenoidectomies 2.
- The causes of VPI can be varied, including developmental or neurological causes, iatrogenic palatal injury, and other anatomical abnormalities 2, 3, 4, 5, 6.
Treatment of VPI
- Treatment of VPI depends on the underlying cause and severity of the condition 2, 3, 4, 5, 6.
- Speech therapy can be effective in mild cases of VPI, especially when there are no anatomical abnormalities 4.
- Surgical intervention, such as sphincter pharyngoplasty or pharyngeal flap, may be necessary in more severe cases or when anatomical abnormalities are present 2, 3, 4, 5.