An unusual breathing problem

Tom was a strapping lad in his early 20s with rosy cheeks, Hugh Grant floppy hair and a wide, beaming smile. He looked so robust and healthy I couldn’t begin to imagine why he was sitting in a chair opposite me.

It didn’t take long for Tom to fill me in. From early childhood he’d loved the bassoon. Bassoon playing was his passion and it had always been his intention to make music his career. Tom also played several other wind instruments, including the clarinet and oboe, but the bassoon was his favourite.

Tom pulled a sheet of paper out of his pocket. “I’ve been diagnosed with stress velopharyngeal insufficiency,” he read out the cumbersome label. “It’s most peculiar, but air has started to leak through my nose when I’m playing.” Apparently, the condition was causing him great annoyance and embarrassment, with sounds ranging from a mild hiss to a loud snort spoiling his recital efforts.

I listened with mounting interest and a degree of dismay. This was not a condition commonly seen in clinical practice. Tom’s palatal air leak had only recently begun to cause him trouble. He had been playing well for years, so this sudden change was intriguing.

On examination, I could see no physical defect. There was no sign of a short soft palate. Tom’s tonsils and adenoids were intact, so scar tissue could be ruled out. The most likely cause would seem to be air escaping into the nasal passages while Tom was blowing through his mouth. Though Tom’s velum, or soft palate, was functioning normally most of the time, an inadequacy had obviously developed when he attempted to play his instruments.

Fingering and reeds make bassoons one of the more difficult woodwinds to perform on. Tom was playing four to 12 hours a day, so he was moving a lot of air and giving his abdominal muscles a good workout.

In a normally functioning pharynx, the soft palate remains tightly closed when blowing through the mouth. In Tom’s case, however, his soft palate had lost its capacity to seal efficiently or to maintain tight closure when blowing through his mouth. Therefore, air was escaping through his nose and vibrations in his nasal passages were producing strange and unwelcome sound effects.

The diagnosis had been made by an ear, nose and throat specialist who felt that surgery was the only option — though success was not guaranteed. The thought of surgery on his throat and airways troubled Tom greatly. “I really, really want to avoid physical interference if at all possible,” he begged.

Elastic answers

Assessing the situation in purely mechanical terms, I suspected that loss of tissue elasticity could well be at the root of Tom’s difficulties. The ability of elastic tissues to “deform” under physiological conditions, and to subsequently release stored energy to drive passive recoil, is vital to the function of many dynamic tissues in the body, the cardio-respiratory system being a prime example. On several occasions in the past, we have treated people who’ve awakened from their sleep, momentarily unable to speak or breathe. These clients have always responded well to synergistic calcium supplementation.

In Tom’s case, a 25-hydroxy D3 test was of paramount interest as there’s no point augmenting calcium if a person’s vitamin D3 level is inadequate. Indeed, doing so can cause harm. To Tom’s great surprise, his 25-OH D3 reading was a low 23nmol/L (lowest end of the normal scale being 50nmol/L). To make matters worse, the young bassoonist also failed a number of vitamin D3 synergists. His boron, magnesium, silica and vitamin A levels were also highly inadequate. Priority was therefore given to dietary enhancement of all the missing factors that would specifically help build up a budding professional bassoon player: kohlrabi and English spinach (vitamin A); hazelnuts for boron; black sesame seeds for magnesium; and alfalfa sprouts for silicon.

Tom was in a great hurry to resolve his breathing problems as he had been given the opportunity to audition for a choice career move in England. He was more than willing to take some supplements in the short term to speed things along.

My choice included prohormone cholecalciferol to underpin calcium and phosphorus metabolism; retinol, a leading D3 synergist; vitamin K to support the respiratory chain enzyme system; genthelvite, whose components play a structural role in the cross-linking mechanism in collagen, elastin and mucopolysaccharides; cysteine to encourage protein cross-linkage; ascorbate to enhance connective tissue integrity; zinc, which provides a structural role for regulatory proteins; and a comprehensive enzyme formula to ensure adequate absorption.

Tom responded much more quickly than I had hoped; he only needed one course of each of the nutritional supplements. Within a very short time he was playing triumphal bassoon compositions completely cured of the worrisome air leaks that had darkened his career prospects. To this day, he continues to play without any breathing problems.


Karin Cutter runs a naturopathic clinic in Port Macquarie, NSW, Australia. T: +61 2 6582 4435

Karin Cutter

Karin Cutter

Karin Cutter ran a naturopathic clinic in Port Macquarie, NSW, Australia.

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