Velopharyngeal Insufficiency in Woodwind and Brass Players

Abstract

Velopharyngeal insufficiency (VPI) has received little attention in the medical literature. The aim of the present study was to determine the extent to which VPI constitutes a problem for woodwind and brass musicians. A total of 148 musicians (professionals from a symphony orchestra and students, the latter mainly from a national youth orchestra) were asked if they were aware of the phenomenon of VPI and whether they experienced it. Intraoral pressure measurements were performed to determine pressure peaks, mean pressure, and maximum attainable pressures. Of the 148 musicians, 81 were aware of the VPI disorder, and 24 of them showed symptoms of it themselves. Six of the affected musicians reported that VPI occurred in association with colds or stress or the playing of extremely high notes. One musician noted that it occurred only on return from vacation leave. Of the symptom-free musicians, 15% reported that they noticed symptoms of VPI during their musical training but that these gradually dissipated of their own accord. VPI in woodwind and brass instrumentalists is obviously more common than previously recognized. Despite reports in the medical literature that predominantly young musicians are affected, in our study only 47% of the individuals with symptoms were school pupils or music students (who overall constituted 41% of the study subjects). Oboists and clarinettists were the most frequently affected, perhaps because they develop relatively high mean pressures. Although VPI frequently occurs when woodwind and brass musicians are undergoing training and then regresses, it may persist, particularly in instrumentalists in whom high mean pressures form. To prevent persistent VPI, it seems advisable for music teachers to perform pressure measurements during instructional periods.