Current Trends in Treating the Palatal Air Leak (Stress Velopharyngeal Insufficiency) Dr. Chris Gibson Associate Professor of Music Northwest Missouri State University

What is a Palatal Air Leak? Physical defect, injury or dysfunction. Air leaks through the nose while blowing through the mouth.

S V P I Dysfunction Incompetence Inadequacy Stress VeloPharyngeal Insufficiency

Velopharyngeal Area Soft Palate Trachea

Characteristics  Young adults, typically students  Intensive practice schedules  Sustained high intra-oral pressure:  Oboe, clarinet, bassoon  Good tonal concept, but with a fault in some small aspect of tonal production  Speech is normal

First Onset Periods of stress or change such as:  Intensive short-term performances  Audition or recital preparation  Changes in routine  Changes in equipment

Current Understanding  Causes not well understood  Relatively few musicians have SVPI  Not all seek treatment  Research limited to case studies  Individualized interventions  Many interventions at least partially successful

Non-Medical Interventions Careful Evaluation of:  Posture  Breathing and breath support  Embouchure  Formation  Instrument Setup

Non-Medical Interventions Additional Steps  Alexander Technique  Inner smile  Muscular retraining  Relaxation training

Medical Interventions Ear-Nose-Throat Specialist  Physical evaluation  Referral to other professionals Speech Pathologist/Therapist  Evaluation  Variety and combination of strategies  Individualized to address weaknesses Surgeon – typically last resort  Pharyngeal wall augmentation  Lengthening too-short soft palate  Correcting weakness in sphincter muscle

 Exercises seen:  “Hard”  “Ahhh”  “Kick”  Tongue against soft palate (peanut butter)  Silent blowing through mouth Endoscopic Video: Normal Soft Palate

 Exercises seen:  “Duhna”  “Kick”  Nasal speech  Clarinet warm-up with air leak  “Ahhh”  “Pop”  Sucking  “Ahhh”  Mozart with air leak Endoscopic Video: SVPI

Conclusion  Current research still primarily case- study or small groups  Nonmedical strategies may be effective  Especially muscular retraining  Newer medical procedures offer hope  Fiberoptic endoscopy  Laparascopic (micro) surgery

Future Research  Controlled studies with larger sample sizes.  Studies involving newer technology.  Survey of the population to determine scope and effect.

Thank You Dr. Sheri Rolph ENT Surgeon (retired) and Clarinetist Billings, Montana Northwest Missouri State University Maryville, Missouri

Dr. Chris Gibson Phone Fax