The authors retrospectively reviewed the clinical records of 320 paediatric patients who underwent either tonsillectomy, adenoidectomy or adenotonsillectomy, under a single paediatric ENT surgeon. Patients with pre-existing velopharyngeal insufficiency (VPI) were excluded, as assessed by preoperative testing for nasal air emission during phonation. This test was repeated postoperatively at three weeks, and again at five months if VPI was detected. Patients undergoing adenotonsillectomy were at a significantly higher risk of having VPI at three weeks postoperatively (13.6%). Adenoidectomy and tonsillectomy alone carried similar rates of early VPI (3.2% and 2.2% respectively). The majority of patients with detectable VPI were asymptomatic. Of those with clinical VPI at three weeks, 70% had normal nasal air emission tests at five months. This study is limited by its single-operator retrospective design, although the methodology was applied consistently, and the sample size was sufficiently large. The authors found that age, sex, adenoid or tonsil size, and surgical indication did not affect the risk of VPI. It demonstrates that the incidence of detectable VPI is relatively high, especially in adenotonsillectomy. However this is rarely a significant clinical problem, both because it is frequently subclinical, and also due to a high rate of spontaneous resolution. It also shows that VPI can occur with similar frequency after tonsillectomy or adenoidectomy, highlighting the importance of thorough informed consent in such cases.