Persistent Hypernasality Following Adenoidectomy in Children without Palatal Defects

Background: Many patients who underwent adenoidectomy experience persistent hypernasality and velopharyngeal incompetence (VPI) after adenoidal tissue removal. Velopharyngeal insufficiency is a disorder marked by hypernasal speech, nasal emission and turbulence, and occasionally, the nasal backflow of liquids. This often occurs when the removal of tissue, which previously aided a poorly functioning palate in attaining nasopharyngeal closure, exposes an underlying palatal tissue. However, it is found that hypernasal speech can also occur in children with apparently normal palate and normal palatal functions. Aim of the work: The research seeks to examine the cause of persistent hypernasality following adenoidectomy in children lacking obvious palatal defects as a predisposing factor. Patients and methods: A cross-sectional study was executed on 50 patients experiencing open nasality following adenoidectomy, whether done alone or with tonsillectomy, who presented to Ain Shams University Hospitals from September 2024 to March 2025. Nasopharyngoscopic examination of the velopharyngeal port and the pharynx at the level of the tonsils was done for all cases. A nasometry tool was also used. Results: A high significant correlation between the presence of adenoid remnants, nasalance score and velopharyngeal closure was found with a P value <0.001. There was a non-significant association among the presence of tonsils and velopharyngeal closure (P value >0.53). Conclusion: Adenoidal tissue remnants in the nasopharynx may affect good velar closure and following adenoidectomy in children without obvious palatal defects, they may cause persistent hypernasality.