Successful and rapid response of speech bulb reduction program combined with speech therapy in velopharyngeal dysfunction: a case report

Maxillofacial Plastic and Reconstructive Surgery

Table 2 Degree of nasalance and suggested treatment options for VPD (Shin’s criteria)

Nasalance		Recommended options of treatment
Below 20 %	No nasality
20 ~ 35 %	Mild nasality	Speech therapy
35 ~ 45 %	Moderate nasality (marginal VPD)	Speech aid appliance with speech therapy
45 ~ 60 %	High nasality	Surgery or speech aid
Over 60 %	Severe nasality (VPD)	Surgery