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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.

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current trends in treating the palatal air leak

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
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
S V P I

Stress

Velo

Pharyngeal

Insufficiency

Incompetence

Inadequacy

Dysfunction

velopharyngeal area
Velopharyngeal Area

Soft Palate

Trachea

characteristics
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
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
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
non medical interventions9
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

Medical Interventions

Surgeon – typically last resort

  • Pharyngeal wall augmentation
  • Lengthening too-short soft palate
  • Correcting weakness in sphincter muscle
endoscopic video normal soft palate
Endoscopic Video: Normal Soft Palate
  • Exercises seen:
    • “Hard”
    • “Ahhh”
    • “Kick”
    • Tongue against soft palate

(peanut butter)

    • Silent blowing through mouth
endoscopic video svpi
Endoscopic Video: SVPI
  • Exercises seen:
      • “Duhna”
      • “Kick”
      • Nasal speech
      • Clarinet warm-up with air leak
      • “Ahhh”
      • “Pop”
      • Sucking
      • “Ahhh”
      • Mozart with air leak
conclusion
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
Future Research
  • Controlled studies with larger sample sizes.
  • Studies involving newer technology.
  • Survey of the population to determine scope and effect.
thank you
Thank You

Dr. Sheri Rolph

ENT Surgeon (retired)

and Clarinetist

Billings, Montana

Northwest Missouri State University

Maryville, Missouri

dr chris gibson

Dr. Chris Gibson

reeds@nwmissouri.edu

Phone 660-562-1607

Fax 660-562-1346