A Delphi survey on diagnosis and management of stress velopharyngeal insufficiency in wind musicians

Abstract

The aim of this study was to identify current trends in clinical assessment and management of stress velopharyngeal insufficiency (VPI) in wind musicians. This was an online two-round Delphi survey of health practitioners familiar with assessing and treating musicians with stress VPI. Fourteen specialists (seven otolaryngologists and seven speech-language pathologists) from four countries participated in the Delphi survey. From the first round questionnaire, 32 items were identified as being causes, assessment tools, diagnostic indicators, and treatment methods for stress VPI. The second round questionnaire revealed that prolonged exposure to high intra-oral pressures was important in determining the cause of stress VPI. The most important assessment tools for stress VPI were case history and nasendoscopy. The most important indicator for stress VPI was self-reported symptoms. There was no clear agreement identified on the management methods for stress VPI for musicians. However, the trend followed by most of the survey participants was a combination of conservative management approaches (including rest or watch and wait, speech-language pathology intervention, velopharyngeal muscle training, and changes to the instrument or reed), and then, if symptoms persist, to use injection pharyngoplasty or pharyngeal flap. This survey demonstrates that no standard management protocol currently exists for musicians diagnosed with stress VPI, but provides current trends in the assessment and management which can be used in future guidelines for health professionals who treat wind musicians.

Keywords::

• Stress velopharyngeal insufficiency
• diagnosis
• management
• wind musicians
• Delphi survey

Acknowledgements

The authors would like to acknowledge all the participants in this study for their involvement and valued opinions. We also thank the following organizations: the Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS); Speech Pathology Australia (SPA); the Royal Australian College of Surgeons (RACS); the Special Interest Group, Voice and Voice Disorders, within the American Speech and Hearing Association (ASHA); the Australian Society for Performing Arts Healthcare (ASPAH), and the Performing Arts Medicine Association (PAMA).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.