VIDEOENDOSCOPIC DIAGNOSIS AND CORRECTION OF VELOPHARYNGEAL STRESS INCOMPETENCE IN A BASSOONIST

Musicians who play woodwind or brass instruments must generate extreme ly high intraoral pressures to achieve normal tone and volume in their music. Intraoral pressures of 130 mm Hg can be reached, while normal speech rarely exceeds 6 mm Hg. The inability to maintain an effective seal between the soft palate and the pharyngeal wall can manifest as d ifficulty in holding high notes or in playing sustained music composit ions, or noise production from turbulent nasal cavity emissions. Throu ghout the literature, there are few reports of these entities. We will present the case of a 31-year-old concert bassoonist who complained o f ''noise from her head'' only when she played the bassoon. This resul ted in numerous failed auditions and threatened her professional caree r. The diagnosis of velopharyngeal stress incompetence, as well as the Teflon injection augmentation procedure, was done under local anesthe sia with the subject playing the bassoon. The use of videoendoscopic t echniques allowed accurate, reproducible assessment of the defect and the operative procedure, and assisted in postoperative evaluation.