Post-pharyngocele music-making

Since posting this, I’ve had a surprising number of people around the world (shout out to the bassoon community is Kazakhstan) contact me with questions about pharyngoceles and laryngoceles. I assumed this was kind of a niche thing, but it seems there’s a community of folks out there looking for ways to recover and retain a meaningful musical life post ‘cele.

First, and most importantly, anyone that is experiencing acute pain when playing, should seek the care of a physician immediately. If at all possible, stop playing. Rest, and learn more before risking greater harm.

Next, know that having a ‘cele (even one that is currently causing pain) is not necessarily the end of your playing life. It is possible to recover from the pain of a pharyngocele and regain or retain a meaningful music life. I can’t say for certain how common recovery is, but I am living proof that it is possible.

Based on my own experience, the experiences of some dear friends who have had similar injuries, and some principles of human behavior, I’ve got a few ideas that I hope may help others navigate a musical life post-injury. Aside from surgery, I’ve tried each of the suggestions below. I’ve worn a doodad, I’ve changed mouthpieces many times, I strategically limit time spent in the tippy top of my range (especially at loud volumes), and I’ve gone through the long slog of changing how I play the instrument. The following possible courses of action are suggested in order of increasing risk to your musical life.

Take Time Off

This one is scary for many musicians. Here’s a great (and depressing) article about how student musicians experience injury. Although it’s hard for many of us to imagine taking weeks away from our music-making, the big truth is that time off after an injury is the best and easiest first option. The decision to play through pain carries the risk of irreparable damage. Time away from practice and performance can be a healing and liberating experience.

Try a Wearable

One of my classmates at Juilliard suffered from pharyngocele pain while pursuing a graduate degree. Among his strategies for mitigating the pain? Tie a necktie tightly around the neck where the tissue bulges to prevent the herniation. Although constrictive to the breathing apparatus, this is the perhaps the first strategy to try after time off. It is cheap, easy, and minimally invasive. Admittedly, it may also be a little embarrassing, but the tie need not be the final solution. If preventing the bulge is effective in mitigating pain, a product like this may be worth considering:

The Modal, designed and built by James Tuttle, is a custom wearable that isolates the support precisely where it is needed, leaving the surrounding tissue unconstricted. It’s got kind of a Tron-vibe curb appeal and is less uncomfortable than a tie. Be forewarned that both a tie and the Modal are likely conversation starters at your next rehearsal. I can say from experience that there may be some derision. Sadly, injury is not always handled well by the musicians around us.

Modify Your Gear

Depending on characteristics of you, your budget, and your musical demands/interests, there is reason to believe that modifications to your typical equipment may help reduce the compression you experience when playing. Reducing the pressure may change the way the herniated tissue actuates. If it dilates less, you may be less likely to experience pain and other ill-effects of a ‘cele.

In practice, the modifications will vary greatly between individuals. Some may find success with bigger equipment, allowing more air to pass through, where others want smaller equipment, encouraging an efficiency of movements. Having an air of experimentation is likely a good idea. Think, listen, and feel carefully to connect how different gear affects your sound and what your body does to make the sound you want. This is a minimally invasive way to experiment with variables that may be easy and happy compared to the harder and riskier suggestions below.

Modify Your Task (play different music)

For the trumpet players reading this, imagine you woke up tomorrow and played music just as beautifully as you currently do, but without your current highest octave. What kind of music could you play? Could you be happy playing lower or softer notes? Could you find work?

Changing the music we play can seem terrifying. In many musical communities, there’s a lot of identity (and employability) wrapped up in the style of your playing. Principal players are a special breed. So are lead trumpet players. They identify as people who can confidently play difficult music under stress, because they often succeed at this task. Human self-concept is defined in large part by past successes and failures. If an injury causes a constraint (like the loss of range) learners may now fail at tasks that were previously possible, challenging their self-concept. Over time though, new experiences can lead to new successes creating a new, modified identity. For some, injury can be a catalyst to redefine themselves, finding new kinds of music to flourish with. Happy musical lives can look and sound lots of different ways!

Modify Your Motor plans (play music differently)

This is the most effortful option for many musicians. I can’t be sure, but the story I tell myself and others is that this was the solution I chose. I stopped playing for many months and relearned how to play the trumpet with less backpressure. An extended break allowed me to feel like a beginner equipped with lots of knowledge about how to develop skill.

Problematically, the thousands of hours of playing I accumulated made change difficult. Over the 12 years I had spent on the horn, I built habits that were no longer viable. I had to learn new actions, new perceptions, and new responses to environmental cues. All told, it took years of frustrating practice for me to feel successful again. I did not return to the way of playing I had learned earlier, but instead was on a new path that afforded me a happy and fulfilling musical life. I do not regret choosing this, but it took a long time. Those rebuilding years were a luxury I had that is not likely available to all.  

Surgery

I’m not a medical doctor, but surgery should be a last resort. Cutting open a human neck to rearrange stuff is complicated and risky, always. Please consult with an ENT about your specific pathology, possible risks and long-term costs and benefits. For my pharyngocele, surgery would have come with a non-zero risk of requiring a feeding tube for the remainder of my life. This was a non-starter. I’d much sooner quit performing. Food is way too important to my well-being.

I’m always happy to chat about this weirdness if anyone is injured and looking for support. Reach out.