title: Stress velopharyngeal incompetence: Two case reports and options for diagnosis and management.
abstract: Stress velopharyngeal incompetence (SVPI) commonly affects brass and wind musicians. We present a series of two patients who presented with nasal air emission following prolonged woodwind instrument practice. Neither patient demonstrated audible nasal air emission during speech, but endoscopy revealed localized air escape/bubbling from different sites for each patient with instrument playing only. Both underwent tailored surgical treatment with resolution of symptoms during performance. Diagnosis of SVPI requires examination during the action that induces VPI to allow for directed management. Treatment should be targeted based on nasopharyngoscopy findings.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Nikhila
authors.initials: N
authors.lastname: Raol
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Gillian
authors.initials: G
authors.lastname: Diercks
authors.affiliation: Department of Speech Language Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hersh
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA. Electronic address: Christopher_hartnick@meei.harvard.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D000293:Adolescent; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D009146:Music; D013312:Stress, Physiological; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis* / Q000601:surgery*
keywords: Speech disorder; Stress VPI; VPI; Velopharyngeal incompetence