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Stress Velopharyngeal Incompetence: Prevalence, Treatment, And Management Practices

Deonne Malick, Jerry Moon, John Canady

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Objective: Stress velopharyngeal incompetence is the unwanted coupling of the oral and nasal cavities while brass and woodwind musicians play their instruments. This study investigated both (1) the prevalence of stress velopharyngeal incompetence in college musicians, delineating symptoms and situations possibly associated with the condition; and (2) physicians’ experiences with musicians exhibiting stress velopharyngeal incompetence, including typical treatment and management techniques. Methods: Questionnaires were distributed to 297 brass or woodwind student musicians at three public universities and to 998 plastic surgeons and otolaryngologists. The musician questionnaire focused on demographic data and identification of symptoms that might indicate the presence of stress velopharyngeal incompetence. The physician questionnaire addressed demographics of the physician and his or her practice, familiarity and experience with stress velopharyngeal incompetence, and treatment and management suggestions for individuals experiencing the condition. Results: Thirty-four percent of the responding musicians reported symptoms of stress velopharyngeal incompetence, most often after 30 minutes of playing. Forty-five percent of the responding physicians reported being familiar with the term stress velopharyngeal incompetence, although only 27% reported ever having seen a patient with the condition. The seven most frequently reported intervention strategies were referral to a speech language pathologist (47.50%), sphincter pharyngoplasty (30.00%), pharyngeal flap (26.88%), referral to a cleft palate team (24.38%), watch and wait (18.75%), posterior wall fat injection (12.50%), and palatal lift (10.00%). Conclusions: Stress velopharyngeal incompetence is a potentially career-ending (or career-preventing) problem that currently may be undertreated and that is in need of more systematic study both in terms of its physiologic underpinnings and its management.