Stress Velopharyngeal Incompetence in an Adolescent Trumpet Player

Abstract

The youngest reported patient with stress velopharyngeal incompetence is presented. The patient's symptoms responded to rest with a possible contribution from palatal exercise. Surgical correction would appear to best be reserved for the professional musician with this unusual condition.

Lipoinjection Augmentation of the Soft Palate for Velopharyngeal Stress Incompetence

“…Conley et al 3 advocated a conservative approach to musicians with VPI (palatal exercises, speech therapy); however, we think that conservative management, although appropriate for the occasional or recreational player, is unlikely to be of real benefit to a professional musician. In addition, the usefulness of palatal exercises in increasing palatal movement and closing velopharyngeal gaps has been questioned.…”

“…High intraoral pressures are required by wind and brass musicians to produce high or intense sounds, often for extended durations in performances (Table I). Velopharyngeal incompetence during these high pressures can occur in individuals with overt cleft palate 3 or repaired cleft palate (patient 1) or in those with no congenital or postsurgical structural abnormalities but with an obvious functional weakness (patient 2). Musicians typically have mild incompetence that is only brought on by the extreme intraoral pressures of performance not experienced in everyday speech patterns.…”

“…Only a handful of reports exist in the literature describing stress VPI seen in professional musicians. 1–3 The present study reviews the diagnosis and historical surgical treatment of VPI with particular attention to the subset of professional musicians and introduces a novel method for treating this subtle but potentially career‐ending problem.…”

Non-cleft causes of velopharyngeal dysfunction: Implications for treatment

“…Because of this, velopharyngeal incompetence secondary to stress on the velopharyngeal valve sometimes occurs in musicians when playing these instruments, even though they do not exhibit velopharyngeal incompetence in speech [50][51][52][53][54][55]. Stress VPI has also been noted with singers, particularly those with less experience (personal observation).…”

Treatment of Stress Velopharyngeal Incompetence With Injection of Hyaluronic Acid

“…Stress velopharyngeal incompetence (VPI) is a specific disorder of velopharyngeal dysfunction that tends to occur most frequently in brass and woodwind instrument players who experience a loss of intraoral air pressure while playing the instrument as a result of air leaking into the nasal cavity (Conley et al, 1995). The increased intraoral air pressure required to play these types of instruments can reach up to 30 times that of normal speech and may compromise velopharyngeal closure (Conley et al, 1995; Raol et al, 2015; Schwab and Schultz-Florey, 2004; Weber and Chase, 1970). One study reported that up to 34% of collegiate wind instrument players reported symptoms consistent with stress VPI (Malick et al, 2007).…”