Frequency of Velopharyngeal Insufficiency in Patients After Adenoidectomy, Tonsillectomy, and Adenotonsillectomy

Abstract

Velopharyngeal insufficiency (VPI) is an uncommon but clinically relevant complication following adenoidectomy, tonsillectomy, and adenotonsillectomy. It may result in hypernasality, nasal air escape, and impaired speech, thereby affecting postoperative recovery and quality of life. Despite the high frequency of adenotonsillar surgeries in children, local data regarding postoperative VPI in Pakistan remain limited. Objective: To determine the frequency of velopharyngeal insufficiency in paediatric patients after adenoidectomy, tonsillectomy, and adenotonsillectomy, and to assess its association with selected demographic and clinical factors. Methods: This descriptive case series was conducted in the Department of ENT Teaching Hospital, Gujranwala, from September 2024 to March 2025. A total of 92 children aged 5 to 16 years undergoing adenoidectomy, tonsillectomy, or adenotonsillectomy were enrolled through non-probability consecutive sampling. Patients with previous adenotonsillar surgery, cleft palate, congenital craniofacial anomalies, or pre-existing speech and language problems were excluded. All procedures were performed under general anaesthesia by the same consultant ENT surgeon. Patients were followed three weeks postoperatively, and VPI was assessed using nasometry and nasoendoscopy. Data were analysed using SPSS version 25. Quantitative variables were expressed as mean ± SD, while qualitative variables were reported as frequencies and percentages. Stratified analysis was performed using the chi-square test, with p<0.05 considered statistically significant.  Results: The mean age of the participants was 9.84 ± 3.12 years. There were 54 (58.7%) males and 38 (41.3%) females. The mean body mass index was 18.21 ± 2.64 kg/m², and the mean duration of symptoms was 8.73 ± 3.91 months. Adenotonsillectomy was the most frequently performed procedure in 39 (42.4%) patients, followed by tonsillectomy in 31 (33.7%) and adenoidectomy in 22 (23.9%). At three weeks after surgery, VPI was identified in 8 (8.7%) patients. A comparatively higher frequency of VPI was observed among children aged 5-10 years, those with BMI <18 kg/m², those with symptom duration ≥9 months, and those undergoing adenotonsillectomy. The highest proportion of VPI was seen after adenotonsillectomy, where 6 (15.4%) patients developed postoperative VPI. However, no statistically significant association was found between VPI and age, gender, BMI, duration of symptoms, or type of surgical procedure (p>0.05). Conclusion: Velopharyngeal insufficiency was observed in 8.7% of paediatric patients three weeks after adenotonsillar surgery in this tertiary care setting. Although VPI appeared more frequent after adenotonsillectomy and among younger children, these associations were not statistically significant. Early postoperative surveillance is advisable to identify affected patients promptly, while larger multicentre studies with longer follow-up are needed to distinguish transient from persistent VPI and to clarify associated risk factors.