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 VPI post adenoidectomy
Author: jenqa 
Date:   2021-08-29 01:48

Hey everyone,

3 years ago I got my adenoids removed, and after ~1 month without being able to play at all, I got able to produce sound again, but I always heard the noise of air passing to my nose, reducing the air pressure that goes into the clarinet and causing me to have to do breaks mid-playing more often than usual.

My doctor always said there was no problem, and this should pass with time, but here I am, still with the problem. Although it wasn't as bad as a year ago or so, with the increase of demand in my classes my practice sessions can never be too long because of this (sometimes even long pieces with few rests get me).

I do some speech therapy exercises, and an exercise that consists in closing the nasal passage with my soft palate. No improvements so far.

I've been using a Rico Reserve X5 mouthpiece (1.05mm tip) since some months after the surgery, because the B45 I had borrowed from my band was in a bad shape (plus it was a very open mouthpiece). I've talked with some teachers besides my own (who has had experienced SVPI in the past, however due to the nature of the issue not being a surgery, but an increase in practice time, several months later it passed - but he never even noticed it at all, only the people that were hearing him) and one of them said that one potential helper would be changing to a more open mouthpiece (like a BD5) to permit the airflow to go more to the "front" and not build up more intraoral pressure that gets disposed by forcing the soft palate to let air to pass, which leads to the pharyngeal wall and the palate, that should be moisty, to dry and make the leak even greater. I've also changed from traditional 3.0 vandorens to 3.0 V12s, and now recently to 3.0 Reserve Evolution (Orange Box) as they are more consistent and a bit weaker, which is also another of the recommendations I see on the internet about this issue

My question here is if anyone has come through the same and managed to overcome this or atleast minimize it. I've noticed that drinking water regularly in between playing helps hold on the soft palate shut for a bit longer. Perhaps changing to a weaker material could aid in overcoming it?

PS: I am not affected in normal speech by any way.

Thanks in advance for any replies!


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 Re: VPI post adenoidectomy
Author: kdk 2017
Date:   2021-08-29 03:13

After my tonsils and adenoids were removed - in May 54 years ago - I couldn't produce a sound on a clarinet for three or four months because of the pharyngeal leak. I only gradually regained enough of a seal to play uncomfortably for short stretches. I was a college junior at the time and had become a co-principal in the university orchestra, so I did the best I could by September and took long rests during tuttis and multiple-bar rests. Fortunately, the orchestra director was willing to let me self-limit. Over the next couple of months my pharyngeal strength began to build and by Spring semester I was able to manage a typical rehearsal or concert (where you aren't playing all the time). But I was still somewhat limited in continuous playing time.

As the years have have gone by, I've found a couple of things are true: (a) If I don't play, either individual practice or consistent ensemble rehearsal, I lose a lot of that continuous playing ability, and (2) I have a great deal more trouble during the summer when allergies cause me to have a continuous and annoying post-nasal drip.

I do find that drinking water while I play helps - I've always felt as though is cleared the thicker mucous secretions that feel like they're interfering with the seal.

But by far the more important preventive is to stay "in shape." If I take a week's travel vacation I need three or four days to get back to normal playing time. And even in shape, I can't get through two hours of continuous playing. Fortunately, you don't in a 2.5 hour rehearsal play nearly two hours non-stop and there's enough recovery time built into the music and the customary (and union-required) rehearsal break to keep me out of trouble.

I do play on very responsive reeds on close-tipped mouthpieces. I also try to pay close attention to my breathing so that the reed responds as efficiently as possible.

I have a young teenaged student who last Fall during the pandemic had her tonsils removed (but not her adenoids). She has been through a very similar progression to mine. She has been to the ENT specialists and the speech therapists, etc. none of whom really helped her very much - some of whom told her there wasn't a problem. In the end it has been time that seems to be healing her. She practices regularly on a medium-faced mouthpiece with rather soft reeds and is improving steadily in strength and confidence that she can actually hold up for an hour lesson or a normal school rehearsal. It has been a frustrating several months for her.

Check yourself to be sure that (a) you're practicing regularly and that (b) you're playing on a reed/mouthpiece combination that doesn't require a lot of forceful exhalation. I don't know how the open mouthpiece works out because I've never played on anything with a tip opening of more than 1.05mm or so. But whatever you use, it can't be something that you have to blow hard to play. Try to focus on relaxing the inside of your mouth and blowing as naturally as possible. 3 years seems like a long time. Chronic VPI can be very frustrating. Good luck with it.


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 Re: VPI post adenoidectomy
Author: SecondTry 
Date:   2021-08-29 04:33

Please do not try this without consulting with a physician who "green lights" it but as described to me above it seems like exhaustion is arising because, at least in part, the muscles used to expel air can't build up the same pressure in the oral cavity as--for the same effort-might be the case for someone not suffering from VPI.

With this said, (and I must admit forming a mental image given the recent Olympics and those tight nose plugs worn by synchronized swimmers so as to not get water up their nose when they spin under water and not nasally expel precious air) how might nose plugs help here if at all?

I ask from a point of ignorance, and again, I do not advise this without it getting cleared first from the doctor on the case.

Sure, it rules out circular breathing, both something tells me this isn't the OP's primary focus right now.

Good luck.

Post Edited (2021-08-29 04:35)

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 Re: VPI post adenoidectomy
Author: kdk 2017
Date:   2021-08-29 06:35

SecondTry wrote:

> how
> might nose plugs help here if at all?
It's no help for the VPI - the air leak is in the throat. Once it gets past the valve into the nostrils, it doesn't matter much if there's an exit open or not. And if you block the exit with clips/plugs, the result is a painful and potentially dangerous buildup of pressure into the Eustachian tubes and sinuses that, if you persisted, could probably cause damage to the eardrum.

You can simulate the effect just by holding your nose closed, closing your mouth and blowing.

My student actually tried this once - and only once. I didn't suggest it to her. She told me about it after the fact.


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 Re: VPI post adenoidectomy
Author: jenqa 
Date:   2021-08-29 14:19

> might nose plugs help here if at all?

Haha, I tried that recently. Not effective since the pressure that causes the snorting is strong enough to open a small passage on my nostril for air to get out.

As for kdk's first reply, thanks for the time invested into the response! I also agree that maintaining daily practice does stabilize the issue way more than doing several day breaks, i could notice this specially during schooltime because I practiced every day and at wednesdays, in which I had all the activities that require playing in the conservatory in the same chunk, I can handle 2:30 hours playing with this problem only getting worse at the last 30.

I also started going to a different band, as the one I currently was on is pretty much dead, and during this time I practiced every day, I remember being able to handle the entire 2 hour rehersals (with breaks, of course) without any snorting issues, which gives me hope. A month ago I also participated on an orchestra stage (I'm from Portugal by the way) and during the 3/4 days I had to be playing I only had a small snort at the concert, which I managed to control voluntarily.

I try to relax my playing a lot, but I tend to get stressed about the snorting, which greatly affects staccato. I also notice (and I can't control this) that my neck gets really puffed when blowing through the clarinet, as much relaxed as I can be.

Looking forward for more replies!


Reply To Message
 Re: VPI post adenoidectomy
Author: SunnyDaze 
Date:   2021-08-30 05:23

Hi Jenqa,

I'm not sure about the clarinet playing side of things but we do have family experience of adenoidectomy to pass on in case it helps.

One of my family members had great difficulty with adenoids, and had to have them out twice in two years. However, he subsequently gave up eating wheat and the problem went away, only returning if wheat was reintroduced to his diet.

I had always had tonsil trouble, which also went away when I gave up wheat.

The flip side of excluding wheat is that a new iron/vitamin source needs to be found, as all wheat flour is legally required to be fortified with vitamins and iron (in the UK at least).

I just wondered if I could mention in case it helps you to avoif further trouble? We had a really long and difficult time figuring it out the hard way and I'd be glad to help someone else avoid that.


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 Re: VPI post adenoidectomy
Author: jenqa 
Date:   2021-09-05 23:04

afaik I don't have any allergy, and I never had this issue before the adenoidectomy, so maybe that's not the cause, but thanks for reply!

Now here's another question: would a "rehabilitation" of the palate (starting with long tones, then articulation, then etudes, then pieces, gradually) possibly be a fix for this? Stopping playing atleast daily only worsens the issue, so maybe by practicing only until the leak starts showing and doing so every day or with large breaks, the palate would start sealing properly/for longer periods of stress?


Reply To Message
 Re: VPI post adenoidectomy
Author: kdk 2017
Date:   2021-09-05 23:52

jenqa wrote:

> Stopping playing at least daily only worsens the issue, so maybe
> by practicing only until the leak starts showing and doing so
> every day or with large breaks, the palate would start sealing
> properly/for longer periods of stress?

My experience says that the answer is yes, that's exactly what you'll need to do. And, at least for awhile, play on the lightest reed you can get a satisfying result from. That may take some experimenting.

The student I described in my first post has been stuck for some time between a Lurie #2.5 and #3. #2.5 was thin-sounding and flat above C6. #3 was too resistant. Luries don't come in quarter strengths. I did a little searching online and found a chart on the D'Addario website that compares 16 different reed brands and models at all of their strength designations. I found five reeds with strengths that were actually in between Lurie 2.5 and 3. It turned out that there were several Vandorens and a couple of D'Addario models that were in between. I bought a couple of sample cards for her to try, and the one she liked best (and sounded very good with) were the Vandoren Juno #3s.

The chart, which I think someone else here mentioned, is at https://www.daddario.com/globalassets/learn-more/woodwinds/daddario_woodwinds_strength_chart_clarinet_8.5x11.pdf.

Your choice would, of course, depend on your mouthpiece. Eventually, you should be able to choose a reed based on other factors, but for now, you may want just to find something that works.


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