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Tuba Spells Trouble for Young Musician
Date:2/11/2009

Too much air pressure caused rare problem with salivary gland

WEDNESDAY, Feb. 11 (HealthDay News) -- A wind instrument turned into the wrong instrument for a 13-year-old boy who blew his tuba so hard that he sent air into his salivary gland, where it didn't belong.

Doctors diagnosed the condition after the boy developed swelling and pain around his jaw.

"We didn't suspect such a rare problem," said Dr. Deepa Mukundan, who wrote about the case in the Feb. 12 issue of the New England Journal of Medicine. "The cure in this boy's case was to stop playing the tuba for some time."

Glassblowers and people who play brass instruments are prone to the unusual condition, known as pneumoparotid. Even kids who hold their breath can get it, said Mukundan, an assistant professor of pediatrics at the University of Toledo College of Medicine in Ohio.

Mukundan was called in to see the boy, who was suffering from pain and mild swelling on the left side of his face around the jaw. A CT scan found air in tissues below the skin, a potentially dangerous problem that could lead to infection, she said.

But the boy didn't have a fever and "looked pretty normal," Mukundan said. "That raised a flag to me that this is probably not an infection, that we have to explore other causes of air under the skin."

Doctors talked to the boy and discovered that he'd just started playing the tuba a week or two earlier. This revelation led to the diagnosis -- air in one of his salivary glands.

"Normally, the gland produces saliva and sends it to the mouth through a duct. It's like a valve and doesn't allow anything to go backwards, only forwards," Mukundan said.

But the pressure of blowing on the tuba forced air in the wrong direction, filling the gland, she said.

In this case, the cure was to tell the boy to stop playing the tuba so the air could seep out of the gland into surrounding tissue and disappear, Mukundan said. That worked, although the boy later developed an infection and had to have a salivary gland removed.

While it's very rare, pneumoparotid can strike tuba, trombone, trumpet and even harmonica players because they blow so hard, said Dr. David Myssiorek, a professor of otolaryngology and head and neck surgery at New York University Langone Medical Center.

Imagine the photos of the late, great trumpeter Dizzy Gillespie with his cheeks puffed out, Myssiorek said. "I would be surprised if he never got that [condition]."

By contrast, "instruments like the clarinet and flute require less pressure," Myssiorek said.

It's not clear how to prevent the condition, although music teachers can train musicians to blow their instruments in a different way, if necessary.

The good news: Air in the salivary gland usually isn't a serious condition. "The pain would just resolve with time, and the air finds its way out, the way it came in," Myssiorek said.

More information

Learn more about salivary gland problems from the U.S. National Library of Medicine.



SOURCES: Deepa Mukundan, M.D., assistant professor of pediatrics, University of Toledo College of Medicine, Ohio; David Myssiorek, M.D., professor of otolaryngology and head and neck surgery, New York University Langone Medical Center, New York City; Feb. 12, 2009, New England Journal of Medicine


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