Which assessment tool provides the most direct dynamic view of velopharyngeal movement during speech?

Nasopharyngoscopy is the correct answer because it allows for a real-time visual examination of the velopharyngeal mechanism during speech production. This procedure involves the insertion of a flexible endoscope through the nose into the nasopharynx, enabling clinicians to observe velopharyngeal function and the movement patterns that occur during speech.

This direct observation is critical for assessing conditions such as velopharyngeal insufficiency, as it provides immediate feedback on how well the velopharyngeal structures are functioning during speaking. The dynamic nature of this assessment allows clinicians to evaluate not only the position and movement of the velopharyngeal valve but also how these movements correlate with speech sounds.

Other assessment methods, while useful, do not provide the same level of direct observation. Lateral-view x-ray offers structural imaging but lacks the dynamic aspect and does not show functional speech production. Nasometry measurements quantify nasality during speech but do not visualize the anatomy in action. Aerodynamics measures airflow and pressure during speech, which can inform about velopharyngeal function but is indirect compared to the direct visualization offered by nasopharyngoscopy.