Stress Velopharyngeal Incompetence in an Oboe Player

Abstract

Velopharyngeal incompetence is usually manifest in speech and is seen in patients with cleft palates, submucous clefts, trauma, tumors, surgical resections and neuro-muscular disorders (1, 3, 5, '7). Patients with ve— lopharyngeal incompetence are unable to generate high intra—oral pres— sures needed for playing wind instruments. The purpose of this article is to present a case of velopharyngeal incompetence which does not fit into the above categories and which occurs While playing the oboe. To our knowledge this type of velopharyngeal incompetence has not been previously reported. Methods The patient was seen in the Stanford Cleft Palate Clinic. The evaluation consisted of a history and physical, an endoscopic examination, a speech evaluation by speech pathologists, respiratory studies, a voice ciné radiography, and cephalometric films. Results Case presentation: The patient is a 23 year old white female graduate student in music with a 6 year history of nasal snorting while playing the oboe. The snorting begins after 10 minutes of continued playing. There is no history of nasal emission with speech, no cleft palate or previous sur— gery. The patient had the usual childhood illnesses with no serious se-quelae. There are no cases of cleft palate or problems of hypernasal speech in her family. Physical examination revealed a healthy young female with no neuro-logical abnormalities. Oral examination showed a high arched palate of average length and thickness. The posterior edge of the hard palate was felt to be normal, and the uvula was not notched. Palatal motion appeared to be normal with average quickness and amplitude. Endoscopic examina— tion with the Taub panendoscope revealed velopharyngeal closure with a sustained " ah. " After ten minutes of playing the oboe a continuous nasal