Velopharyngeal insufficiency due to hypertrophic tonsils. A report of two cases

Adult Tonsillectomy: Anatomical Differences Affect Postoperative Transient Hypernasality

“…The low value of the mean DV recorded before surgery showed that the size of the velopharyngeal passageway was considerably reduced in patients with big palatine tonsils and/or a palate position that allowed visualization of the hard palate only [16]. Earlier studies utilizing nasopharyngoscopy, multiview videofluoroscopy and behavioral speech assessment gave results contrary to ours, proving that hypertrophic tonsils can alter resonance in the throat, particularly if they are interposed between the velum and the posterior pharyngeal wall [2,23,24]. This can lead to incomplete velopharyngeal closure and hypernasality, obstructing sound transmission into both the oral and the nasal cavity and causing a mixture of hyponasality and cul-de-sac resonance [2,23,24].…”

“…Earlier studies utilizing nasopharyngoscopy, multiview videofluoroscopy and behavioral speech assessment gave results contrary to ours, proving that hypertrophic tonsils can alter resonance in the throat, particularly if they are interposed between the velum and the posterior pharyngeal wall [2,23,24]. This can lead to incomplete velopharyngeal closure and hypernasality, obstructing sound transmission into both the oral and the nasal cavity and causing a mixture of hyponasality and cul-de-sac resonance [2,23,24]. Tonsillectomy eliminates all of these characteristics [2,24], and therefore it was established that this procedure was not contraindicated even in individuals with or at risk of velopharyngeal insufficiency [25].…”

“…This can lead to incomplete velopharyngeal closure and hypernasality, obstructing sound transmission into both the oral and the nasal cavity and causing a mixture of hyponasality and cul-de-sac resonance [2,23,24]. Tonsillectomy eliminates all of these characteristics [2,24], and therefore it was established that this procedure was not contraindicated even in individuals with or at risk of velopharyngeal insufficiency [25]. The discrepancy between results of the previous and our studies may be caused by various shapes of the hypertrophic tonsils and different diagnostic methods used to assess the patency of the velopharyngeal passageway.…”

The impact of tonsillectomy with or without adenoidectomy on speech and voice

“…Although, several authors have noted that enlarged tonsils and hypertrophic adenoids may alter the size of the pharyngeal orifice and interfere with sound transmission, most surgeons are not well aware of the effects of tonsil and adenoid removal on the soft palate [15]. Enlarged tonsils may grow anteriorly in the oral cavity or upward behind the faucial pillars and soft palate, when they grow in the nasopharynx, they may impede full palatal movement [16]. Velopharyngeal insufficiency (VPI) is a well-recognized complication of adenoidectomy and adenotonsillectomy and it is often caused by unmasking of a pre-existing palatal problem [17].…”

Non-cleft causes of velopharyngeal dysfunction: Implications for treatment

“…However, hypertrophic tonsils can become so big that they intrude into the pharynx. This can cause mechanical interference with the function of the velopharyngeal valve by restricting the medial movement of the lateral pharyngeal walls and preventing the velum from achieving an adequate velopharyngeal seal during speech [25,[29][30][31][32].…”