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

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

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