ABSTRACT
The evaluation of velopharyngeal insufficiency and its associated effects on speech represent a complex interaction of both listener judgments of nasality and visual observation of the velopharyngeal mechanism. Although trained judgments of hypernasal speech are the most frequent index leading to the clinical decision to treat or not to treat, the clinician must also determine what kind of treatment would provide the best results, especially if surgical repair is being considered. This requires an accurate assessment of velopharyngeal insufficiency. Assessment of velopharyngeal insufficiency requires visualization of the velopharyngeal mechanism using endoscopy or radiographic analysis in order to evaluate the ability to achieve closure of the velopharyngeal port. The purpose of this article is to provide a comprehensive diagnostic procedure that integrates perceptual judgments of nasality with visual judgments of velopharyngeal insufficiency using endoscopy. Moreover, this paper provides rationales for the selection and implementation of both non speech and speech protocols to enable the clinician to accurately assess the parameters of nasality and velopharyngeal insufficiency.