Encyclopedia of Health and Medicine

V
velopharyngeal insufficiency Inadequate closure
the velopharyngeal sphincter, a MUSCLE at the
back of the soft palate, that directs air flow to the
NOSE or to the MOUTH. Velopharyngeal insufficiency
often accompanies CLEFT PALATE/CLEFT PALATE AND
LIP anomalies and interferes with both speech and
swallowing. It also can occur as a complication of
tonsillectomy and adenoidectomy, operations to
remove the tonsils and ADENOIDS, respectively, and
of neurologic damage, such as from STROKE, that
restricts neuromuscular function of the pharynx.
The hallmark symptoms of velopharyngeal insufficiency
are nasal speech and regurgitation food
into the back of the nose with swallowing. Sometimes
the person has chronic or recurrent SINUSITIS
resulting from food particles becoming trapped in
the sinuses. The doctor may be able to feel a previously
undiagnosed cleft in the hard palate beneath
an intact soft palate. ULTRASOUND or COMPUTED
TOMOGRAPHY (CT) SCAN can confirm the diagnosis.
Treatment for velopharyngeal insufficiency
when the cause is a structural anomaly begins
with surgery to restore sphincter function to the
extent possible. Operations may include repair of
a cleft palate or reconstructive surgery to extend
the soft palate (pharyngoplasty) to make the
velopharyngeal opening smaller. Most people subsequently
need speech therapy to retrain oralfacial
structures to form the sounds the
velopharyngeal insufficiency kept them from
properly making. These therapeutic interventions
typically restore complete function, though may
not be appropriate or successful when the cause of
the velopharyngeal insufficiency is neurologic
damage or a neuromuscular disorder.
See also OPERATION; SPEECH DISORDERS; SURGERY
BENEFIT AND RISK ASSESSMENT; SWALLOWING DISORDERS.
vertigo The perception of movement, usually
spinning, when none is taking place. Vertigo represents
the body’s inability to accurately interpret
its position and movement within its environment.
People with vertigo feel either that they are
moving or the setting around them is moving.
Vertigo occurs when the balance mechanisms of
the vestibular system, including the NERVE pathways
to the BRAIN, malfunction. The disturbance
can range from mild and brief to extended and
debilitating. Vertigo is a symptom of numerous
health conditions that can be vestibular (affecting
the structures of the inner EAR) or neurologic
(affecting the brain or nerves). Situations that
overstimulate the vestibular system, such as spinning
rapidly in circles (as in carnival rides) or
experiencing gravitational force (as in taking off in
a jet or a space shuttle), also often generate temporary
vertigo.
Causes of Vertigo
Vertigo develops when the brain receives conflicting
or incomplete information from the vestibular
system about the body’s orientation in its environment.
This can occur because injury or disease
damages the structures of the vestibular system or
the parts of the NERVOUS SYSTEM that convey balance
and movement information to the brain.
Brain injury, such as from trauma or STROKE, that
affects parts of the brainstem involved in movement
also can result in vertigo.
Most commonly vertigo reflects dysfunction of
the vestibular system and the structures of the
inner ear. The semicircular canals, three fluidfilled
loops, detect rotational movements. The saccule
and the utricle, also fluid-filled chambers,
detect linear (horizontal and vertical) movements.
60