An oboists journey - improving velopharyngeal control

through exercises. Linda Walsh and Rachael Swanson

This article is submitted exclusively to the Australian Journal of Music Education and, if
accepted for publication, it is agreed that it will become the copyright of the Australian
Society for Music Education.
Word count 4751

Author Details:
Linda Walsh

Senior Lecturer in Music, University of Newcastle

Linda.Walsh@newcastle.edu.au

Postal Address: 7 Park St Arcadia Vale NSW 2283; tel 0412 994834
Australian oboist Linda Walsh is a Senior Lecturer at the University of Newcastle,
Australia, where she teaches performance, improvisation and video editing.
Linda has performed with the Australian Chamber Orchestra and Sydney
Symphony Orchestras and is well known for her solo performances of
contemporary repertoire. As a videographer, Linda produced a 96 minute
instructional DVD on oboe reed making in 2008, which has been translated into
French, German and Spanish. Further details of the DVD can be found at
www.oboereedmaking.com. Current interests include exploring new modes of
expression for the oboe using computer sound processing and video in
performance.

Rachael Swanson

Student, Youngstown, Ohio USA

Rachael Swanson is currently completing a degree in Music Education at
Youngstown State University, USA. She has performed with the Cleveland Opera
Circle, Dana Festival Orchestra, the 28th Annual New Music Festival and has
appeared as a soloist with the Greenville Symphony and Packard Band. Rachael
works as a private teacher of oboe, piano, music theory and aural skills in Ohio
and Pennsylvania. In her graduate studies, Rachael intends to focus on research
in oboe performance, music history and music theory.

An oboists journey - improving velopharyngeal control through

exercises.
(AUTHOR NAMES REMOVED)

Abstract
Velopharyngeal insufficiency is a fairly common problem among musicians
who sing or play wind instruments. The symptoms of this problem are
unwanted emission of air through the nose and distracting snorting
sounds, which can seriously disturb performances and limit a musical
career. Surgery can solve the problem in some cases, but before
considering such a drastic measure, the use of exercises to improve the
condition should be fully explored. This paper presents a set of specific
velopharyngeal exercises we designed and tested in a case study with a
student oboist over a five-month period. We describe the exercises,
explain the rationale behind them, and discuss the encouraging results of
our case study.
Keywords
Oboe; velopharyngeal control; soft palate; nasal noise; wind playing
Introduction
Velopharyngeal dysfunction, velopharyngeal insuffiency, and
velopharyngeal incompetence are terms that refer to the inability of the
velopharyngeal mechanism to completely close off the nasal cavity from

the oral cavity during speech, singing or playing a wind instrument.

Several taxonomies of classification have been published (Loney & Bloem,
1987) (Trost, 1981), but even among medical specialists, the use of these
terms is not completely standardised (Folkins, 1988). However, for clarity
in this paper, aimed largely at performing musicians, we have adopted the
term velopharyngeal insuffiency (VPI).
For musicians, velopharyngeal insuffiency translates as an unintentional
and extraneous release of air through the nasal cavity during
performance. This is due to the inability of the soft palate, lateral
pharyngeal walls and posterior pharyngeal walls to attain a tight seal
between the oral and nasal cavities, either as a result of structural
abnormality, or issues with coordination and strength of any part of the
velopharyngeal valve (Moon & Kuehn, 2004). The problem can be traced
to multiple muscle areas of the oral and nasal cavities that deal with
resonance and airflow. The soft palate (velum) and sphincter muscles of
the velopharyngeal mechanism play a crucial role in controlling the
passage of air while playing woodwind instruments or singing. If any of
these muscle systems cannot attain closure or separation properly, nasal
emission can occur, often accompanied by snorting sounds (Anderson &
Shames, 2010).

Figure 1: Velum in lower position

allowing airflow through nose

Figure 2: Velum in raised position

allowing airflow through mouth

Diagrams adapted from Cleft Palate and Craniofacial Anomalies: Effects on

Speech and Resonance (Kummer, 2007).

Figures one and two show the velum or soft palate, the fleshy area at the
back of the mouth that moves upwards to close off the nasal cavity, and
moves downwards to open the nasal cavity, allowing air to flow through
the nose. In normal speech, the position of the velum is frequently being
adjusted to direct air to the appropriate cavity. For example, when we say
the word hang, the velum moves from the raised position required to
aspirate the h, to the lower position at the start of the ng sound,
directing airflow and resonance into the nasal cavity.
For musicians, nasal emission is most often displayed during high stress
performances as the release of a nasal noise - the sound being audible to
the individual and sometimes the audience. The cause of nasal emissions
can be influenced by multiple factors, making appropriate treatment of
VPI difficult to determine. In addition to improper closure due to a short
velum or lack of coordination in the velopharyngeal mechanism, air can
escape if the performer experiences muscle fatigue. Over-practising,
inconsistent practice or applying more air pressure against the
velopharyngeal valve than necessary can tire the muscles, reducing the
ability to create a firm of closure (Schwab & Schultze-Florey, 2004). It is
important to note that some structures in the oral cavity do not have

skeletal support and may suffer damage if internal air pressures are too
high (Watson, 2009).
High intraoral pressure is required for playing oboe, trumpet and horn,
placing extreme demands on the functionality of the velopharyngeal
mechanism, so performers on these instruments are particularly prone to
experiencing difficulties with VPI (Ziporyn, 1984). Oboe, trumpet and
clarinet playing all require relatively high backpressure, resulting in high
risk of strain on the muscles that control separation and closure in the oral
and nasal cavities. The pressure required for playing is many times
greater than that of normal speech. Weber and Chase (1970) suggest that
intraoral pressure in normal speech is in the range of 5-10mm Hg,
whereas wind instrument playing can require up to 155 mm Hg.
Consequently, individuals who may not exhibit any symptoms of VPI
during normal speech can still experience nasal emission when playing a
high-pressure wind instrument.
The control of resonance is an important element in the diagnosis of VPI.
The strenuous activities of vocal training or playing a musical instrument
demand high level functionality and control of the resonating cavities of
the vocal tract and its muscle systems. Altering the shape of the oral
cavity, as required constantly during musical performance, may expose
weak points in any of the velopharyngeal mechanisms (Watson, 2009). To
negotiate extreme registers and volume changes from forte to pianissimo
one must precisely adjust many parts of the vocal tract, including the
shape of the oral cavity and the position and shape of the tongue and lips.

We can conclude that for musicians, if any of these additional

manipulations used specifically for music making unmask any weaknesses
in the velopharyngeal mechanism, nasal emission can occur (Watson,
2009).
Nasal emission can heighten performance anxiety and cause unnecessary
distractions to the individual, other performers and audience members. It
can interrupt airflow during delicate phrases, inhibiting musicality and
physical comfort. For the professional musician, VPI can prevent a
performer from reaching their full potential. This paper presents
techniques to improve coordination and strength of the velopharyngeal
mechanism aimed at reducing the number of nasal emission occurrences.
Although there are surgical treatments available for VPI, exercise therapy
may offer a solution if no structural abnormality is present (Blakeley,
2000).

Background
VPI is a relatively common problem for wind players. Evans, Driscoll and
Ackermann (2011) reported that 39% or their 77 surveyed students had
personal experience of VPI, while Ingrams, McFerran and Graham (2000)
found that 17% of their surveyed students had some form of the problem.
Severe cases of VPI have been successfully treated with surgery (Dibbell,
Ewanowski, & Carter, 1979; Ingrams et al., 2000). Surgery can involve
lengthening the soft palate, tightening the muscles that close the
velopharyngeal port, or augmenting the posterior pharyngeal wall by

injecting substances such as human fat, Teflon or Botox. Surgery is a

drastic step and usually results in months of recovery time, during which
playing an instrument is impossible. Clarinetist Kensley Behel (2013)
reported that it took a full year to return to normal playing after surgery.
Her recovery included two months without playing at all, followed by
many frustrating and painful months that involved relearning not only how
to play but also how to speak (Behel, 2013). A more rapid recovery was
reported after less invasive surgery on a twenty-three year old oboist who
was back playing her instrument after six weeks (Dibbell et al., 1979).
Non-surgical treatments are not as well documented as surgical
treatments, but exercises involving blowing, swallowing, sucking on a
straw, or repeating sounds such as k have been suggested to improve
the problem (Gibson, 2008). Exercise focuses on improving control of the
set of muscles that work together to raise and lower the velum, and
building strength in those muscle areas so that closure of the
velopharyngeal port is reliable, even under pressure. Exercises to treat VPI
have also been developed specifically for singers (Estill, 2005), which can
also be relevant for instrumentalists to help develop awareness of the
velum area and how it functions while playing.

Our Study

Rachael XXXXXX (student and co-author of current paper) is a twentythree year old oboist from Youngstown Ohio, who visited the University of
XXXXXXX for a 15-week semester. She presented an oboe audition on
arrival to XXXXX XXXXX (teacher and author of current paper),

demonstrating clearly noticeable velopharyngeal insufficiency. Her

standard of playing was quite advanced, but loud nasal noises were very
audible every few minutes in her playing, which would obviously seriously
limit her potential for professional employment as an oboist. The noise,
somewhat similar to grunting, was distracting to the audience as well as
to herself, and occurred particularly towards the end of long phrases.
Rachael had experienced this problem since the age of about thirteen, but
had not yet had an opportunity to focus on finding a solution. She
reported that she could hear the noise of the nasal emission so loudly that
at times she could not hear the pitch she was playing. It was a source of
stress during performance and made focusing on the music difficult. Her
speech was normal, but due to the high air pressure required to play the
oboe, the weakness in her air control was evident while playing.
During Rachaels studies, both teacher and student worked together to
devise a set of exercises to try to improve the problem. Each week a
simple exercise was set, that Rachael was to spend about ten minutes
working on each day, to gradually build awareness of what was causing
her problem. Each exercise was done for about a week before moving to
the next exercise. The first few weeks of exercises were simple breathing
exercises without the oboe, to focus attention solely on the body. Once
control over the velopharyngeal port was established and becoming
reliable, we added exercises on the oboe, starting with simple short tones,
and gradually building up to longer tones, then phrases. This was a
deliberately slow and measured process to allow time to break ingrained
habits, and allow time to think about new concepts and apply them. While
8

working on these exercises, normal practice continued, but a specific

period each day was set aside, separate to practice time, to focus solely
on this problem. Each month we measured the incidence of nasal
emission over a ten-minute period of playing to determine whether the
exercises were working. The following section describes our procedure,
explains the exercises we developed and discusses our results.

The exercises
As with any exercise, the importance of good breathing and posture
cannot be overstated. Before describing the exercises in detail, a brief
discussion of oboe breathing is necessary, as this is fundamental to all
aspects of playing. Correct breathing for oboe playing is a complex
interaction of several muscle groups in the chest, back and abdomen. The
most important of these are the diaphragm, abdominals, intercostals and
latissimuss dorsi. The action of these muscles can be felt by placing the
hands on the sides of the chest at the bottom of the ribs, with the fingers
forwards and thumbs towards the back. As the diaphragm flattens on
inhalation, air is sucked into the lungs, causing them to inflate and
expand. As the volume of the lungs increases the fingers should feel the
expansion, and move forwards and outwards. This expansion of the lungs
should be as low in the chest as possible. On exhalation, the abdominals,
intercostals and latissimus dorsi all exert pressure on the lower ribcage,
creating a well-supported, pressurised air supply. The thumbs should feel
a strong push from the lattissimus dorsi at the back of the ribs during

exhalation. The top of the chest should move only very slightly as it fills
with air, and the neck and shoulder muscles should remain still and
relaxed. It is important to stand up straight and tall, and avoid tilting the
head forwards in order to maintain the maximum diameter of the
windpipe and unrestricted airflow. Imagining a string attached to the top
of the head pulling upwards can be helpful in elongating the neck and
spine, avoid slouching and achieve good posture.
Another important consideration before undertaking the exercises is that
the reed must be free blowing and comfortable to play. We particularly
noted that if the reed was too closed, excessive backpressure was created
because the reed would not accept the required airflow, thereby
accentuating velopharyngeal problems.

We use the following notation for the exercises:

M = Mouth
N = Nose
MO = mouth open
MC = mouth closed
= inhale
= exhale
3x = repeat three times

Exercise 1: Relaxed, slow breathing away from the instrument.

Repeating each step three times helped to focus the attention on
awareness of movement.
a) Breathe in and out slowly through the nose, with the mouth closed (MC).
b) Open the mouth (MO), then breathe in and out slowly through the mouth.
c) Keeping the mouth open, breathe in and out through the nose. This
requires the velum to return to the lower position, as in Fig 1. The

10

sensation of this movement to uncover the entry to the nasal cavity and
block of the oral cavity can be felt in the back of the throat.
The above steps can be notated as follows:
a) MC [N

3x

b) MO [M

] 3x

c) MO [N

] 3x

Exercise 2: Slightly more complex than the first exercise, keeping the
mouth open at all times. After trying this exercise, the student observed
that the left side of her throat felt more uncomfortable than the right as
if the closure of the vent was uneven. This seemed to indicate that the
vent was not completely closing on left side.
a) Breathe in through the nose, out through the mouth: MO [N

] [M

] 3x
b) Breathe in through the mouth, out through the nose: MO [M

] [N

] 3x

Exercise 3: This exercise added the consonant k to give a physical

awareness of the location of the velum. The students observation here
was that the k created a puff of air that increased the awareness of how
the air feels when being directed into the oral cavity. With mouth open,
breathe in through nose, pause before expelling the air through the
mouth, starting with a k sound: MO [N

pause] [M k

] 3x

Exercise 4: Still without the oboe, we now introduce an element of

rhythm to the exercises. The purpose of this was to establish more

11

accurate control and time-related closing and opening of the port. This
activity is related to what is required when playing a piece of music, when
physical actions must occur precisely at a given moment in time. This
helped to increase muscle strength and accuracy. The observation by the
student here was that this was much more difficult than the first three
exercises, so we concluded that it was worthwhile spending several weeks
on the simpler exercises before moving to exercise 4. Breathe in
continually over three beats, then exhale on the fourth beat as indicated
in example a), then change the rhythm pattern to start with a short
inhalation and a longer exhalation.

a)

Beat :
MO

[N

MO [M
b)

Beat :

] [M

] 3x

] 3x

MO

[N

MO

[M

[N
3

[M

] 3x

[N

] 3x

The tempo of exercise four should start with a manageable slow pulse
around MM=60. When this was mastered, faster tempi were tried, up to
about MM=100. The student also devised rhythmic variations on this
exercise to add a higher level of challenge, such as alternating between
mouth and nose and transitioning between them while maintaining
continuous airflow.

Exercise 5: This is a singing exercise aimed at strengthening the

velopharyngeal muscles. The nursery rhyme Twinkle twinkle little star is
12

hummed but with each note shortened deliberately to about one quaver.
To create this exaggerated staccato humming, and stop each note
suddenly, the velum must move quickly to from the lower position (Fig 1)
the raised position (Fig 2). It must then rapidly return to the lower position,
enabling airflow through the nose for start of the next note. We noted that
this exercise was extremely tiring and could only be done for a few
minutes before the muscles became fatigued. The fact that initially
Rachaels nasal noise tended to occur toward the end of phrases
suggested that muscle weakness or fatigue could be a factor.

Exercise 6: This is the first exercise actually using the oboe. It is

important to remember that good posture and correct breathing are
crucial as outlined earlier, and that tension anywhere in the body must be
avoided. This exercise aimed at transferring the experience and new
knowledge from the earlier exercises to the domain of oboe playing. We
started by playing long notes, approximately 10-15 seconds duration, and
simply observing if and when any weakness occurred and how it felt. We
then played comfortable middle range long and short notes but avoided
playing anything difficult. Having completed the first five exercises, the
student had a clear idea of what muscles needed to move and could now
visualize the position of the velum. The intention was to largely focus on
observing existing behavior with this new awareness of the position and
movement of the velum. Self-observation was used to identify what was
happening, and then we considered what steps might help to improve any
weakness.

13

The student observed that small air leaks often occurred if she did not
really concentrate on directing a constant stream of air through the oral
cavity. This stemmed in part from the existing bad habit of allowing some
air to escape through the nose at the ends of phrases. To improve this, the
student found it useful at the ends of notes to focus on the physical
feeling of the throat supporting the airstream (muscle memory) and also
to purposefully wait until the mouth was off the instrument before
exhaling through the mouth. For these initial simple exercises, taking in
sufficient air, but not too much helped to build control and confidence.

Exercise 7: Expanding on the previous exercise, we now add diminuendo

on the instrument to develop awareness and control of the changing air
supply required. Long notes of 10-15 seconds duration were played,
starting fortissimo and ending pianissimo with a gradual and even
diminuendo. The main reason we worked on diminuendo was that one of
Rachaels previous teachers had suggested that she intentionally release
a little bit of air through the nose to achieve a diminuendo. We found that
this approach contributed to the problem of nasal emission, and that
diminuendo should be achieved by reducing the volume of the airstream
through the mouth, while maintaining adequate air pressure and
embouchure support. The student reported that visualising directing the
airstream through a narrow hose helped her to maintain efficiency of the
airflow and control of the throat muscles. Figure 3 is an example of the
diminuendo exercise, which should be applied to a range of pitches.
Figure 3. Example diminuendo exercise:

14

A variation on this exercise was to pinch the nose closed with the right
hand while playing. This can be achieved by resting the bell of the oboe
on a low table or chair, thus freeing the right hand. The notes a, b, and g
can then be played using the left hand only. Holding the nostrils closed in
this way prevented any possible air emission from the nose, and any slight
hint of attempted emission can be felt by the fingers on the nose. This
technique helped the student to identify that the nasal leaks were
occurring mainly towards the end of notes when the velopharyngeal
muscles were fatigued. A nose peg for use during normal trumpet playing
has been discussed by Whitehand and Gates (2009).

Exercise 8: For this exercises we added complexity to the previous

exercise by adding a range of dynamics and changing pitch. Our aim here
was to determine whether the velopharyngeal control was sufficient to
maintain closure even when pitch and volume changes placed additional
demands on the control of the airstream. Here we are applying the new
skills and knowledge to situations that more closely resemble playing a
musical phrase. The example exercises shown should be adapted further
to a wider range of pitch and dynamics. In our case, we focused strongly
on diminuendo because it was an area of weakness for the student. The
student had more difficulties with higher pitches, so she adapted these
exercises to higher pitches as she became more confident.

15

Figure 4: Example Exercises:

Exercise 9: For this exercise we selected long phrases from repertoire

pieces Rachael was working on. Ensuring good breathing practices and
posture, we selected four or five long phrases from pieces and worked on
them slowly out of context. If there was a tendency towards a lapse in
velopharyngeal control, we identified where in the excerpt it occurred and
tried to prevent it occurring next time by visualizing the velum and trying
to control its position. Careful planning of breathing points is an important
part of maintaining control and comfort while playing long phrases. When
this was working successfully, we then played these selected long phrases
in the context of whole pages, whole movements, and then whole pieces.
In this way we gradually integrated the exercises into normal practice,
returning to earlier exercises if difficulties were encountered. The student
identified that long pianissimo phrases were the most difficult, and that
nasal leaks were still encountered when fatigued.
The Results

16

Over the five months of the study, the student gained a greatly improved
control of the velopharyngeal mechanism, and much-reduced incidence of
nasal emission and noise. Progress was evaluated at monthly intervals by
counting the incidence of unwanted nasal emissions during a ten-minute
period of playing. These measurements are outlined in figure 5.
Timeline

Exercises

Incidence of

undertaken

nasal and
throat noise
per 10 minutes
of playing

August

12-14

(Audition)
September
October
November
December

1, 2, 3 and 4
+ 5,6 and 7
+ 8 and 9
All

10
6
2-3
0-2

(Recital)
Figure 5: Progress over time, measured by incidence of nasal emissions while
playing.

At the start of this study, the frequent noise, somewhat akin to snorting or
grunting, could be heard clearly by the student herself through the
internal structures of the head. This was very distracting, hindering
concentration and musical thought processes. Over time, in addition to
the reduction in unwanted noise during performance, the student
observed additional benefits from achieving better control of the
velopharyngeal mechanism. A surge in confidence and motivation was
observed as soon as it became clear that the exercises were working. With
this came a greater willingness to undertake long performances and
technically challenging pieces. The improved air management and body

17

awareness led to better intonation and control of tone, and a significant

reduction in physical and mental fatigue while playing. At the time of the
recital in December there was only an insignificant incidence of unwanted
emissions, and these were quieter and much less obvious to the audience
than at the start of the study. The resulting increase in confidence of the
student was obvious by the final recital, in which challenging repertoire
was presented at a professional level with flair and poise.

Conclusion:
This paper presented a case study of a student oboe player with
velopharyngeal insufficiency. We outlined the physiological aspects of this
problem and its relevance to wind playing. Over a five-month period, we
devised and tested a set of specific exercises for a student oboe player
and measured the incidence of unwanted nasal noise and emissions to
determine if the exercises were effective. Over the five months of our
study, incidence of nasal emission was reduced from more than once per
minute to approximately once every ten minutes. In addition to the
reduced incidence of unwanted noise and nasal emissions, our student
gained confidence, improved tonal control and better intonation as fringe
benefits. We believe that addressing the problems with simple exercises
away from the oboe in the early stages was an important part of our
process, allowing the student to focus complete attention on the oral
cavity. Once an understanding of the physiology was in place, actual
progress on the instrument was relatively fast, and produced a significant

18

improvement over five months. Involving the student in the design of the
exercises helped her to focus on the problem and take responsibility and
credit for finding a solution. At the time of writing, the problem was not
entirely gone, but it was well under control and had become an infrequent
event. In terms of the students career choices, working as a professional
oboist has become a more realistic option through the benefits from the
exercises in our study. This study demonstrates that greatly improved
velopharyngeal control can be achieved through carefully planned
exercises, and in this case, the need to consider surgery was averted.

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