Background: The effect of hypertrophied tonsils on velopharyngeal closure and resonance of speech has been a matter of controversy for a long time.
Objective: The aim of this work is to investigate the effect of tonsillar hypertrophy on the pattern and degree of closure of the velopharyngeal valve and resonance of speech.
Methodology: A hundred child, in the age range of 4 to 10 years, with tonsillar hypertrophy (grade 3 or 4), with average
intelligence, normal hearing, and intact structure of the velopharyngeal valve have been assessed by nasoendoscopy and
nasometry. All patients have been reevaluated 3 months after tonsillectomy.
Results: Seventy-two patients (72%) showed coronal pattern of closure and twenty-eight (28%) showed circular pattern of closure. The degree of closure was II/IV in 7 patients (7%) and III/IV in 93 patients (93%). The mean nasalnce score of thenasal sentence and oral sentence was 57.48% and 16.17% respectively. In the postoperative evaluation 83 children
 exhibited a coronal pattern and 17 children showed a circular pattern. The closure was competent in 96 children and was
III/IV in 4 children, with significant reduction of the nasalance score postoperatively.
Conclusion: Hypertrophied tonsils may affect the pattern and degree of velopharyngeal closure and subsequently
resonance of speech even in children with normal palate.