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

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

3. S V P I Dysfunction Incompetence Inadequacy Stress VeloPharyngeal Insufficiency

4. Velopharyngeal Area Soft Palate Trachea

5. 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

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

7. 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

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

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

10. 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

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

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

15. 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

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

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

18. Dr. Chris Gibson reeds@nwmissouri.edu Phone 660-562-1607 Fax 660-562-1346