Evaluation of velopharyngeal insufficiency.

To summarize briefly, in our opinion, the combined use of end-viewing flexible fiber optic nasopharyngoscopy and multiview videofluoroscopy (which must include lateral and frontal views) and a behavioral assessment of the patient's speech provides the examiner with all of the information necessary to select the appropriate treatment for VPI. Indirect assessment procedures, such as airflow studies, do not enhance the decision making process even though they may provide what would appear to be objective data. Treatment decisions depend on the ability to confirm the type of speech abnormality present (by behavioral assessment) followed by a direct view of the defect (by endoscopy and fluoroscopy).