Trumpet Neck Puff: Why Do Brass Instrument Players Develop Swelling in the Throat Like That of a Bullfrog?

Playing musical instruments has many benefits, such as spatial reasoning, increased verbal memory, and enhanced literacy skills. However, some musical instruments can expose a person to certain conditions affecting their health.

Case Reports of Pharyngocele

In 1886, W.I. Wheeler first described a medical condition known as pharyngocele. Also called a lateral pharyngeal diverticulum, it was observed in an army member who commands an entire brigade in the parade ground using his voice. Over the last 133 years, only 60 cases have been reported, including the brass players and glass blowers. It occurs more frequently in men than women and usually happens during the fifth and sixth decades of a person's life.

In a report published by BMJ Journals, a 20-year-old trumpet player they were learned that he had a rare medical condition resulting from playing a brass instrument. He experienced neck swelling for five years, which he overlooked until his classmates pointed it out.

The patient's neck inflated only while playing his trumpet, making him experience mild discomfort. After a CT scan revealed an abnormal dilation in an area in his throat, doctors diagnosed him with a pharyngocele.

In another case report, a 32-year-old male professional musician complains about the large swelling in both sides of his neck every time he plays his trumpet. Although he has no severe symptoms such as dysphagia, throat pain, or regurgitation, the patient was diagnosed with large bilateral pharyngoceles.

The Journal of Laryngology & Voice also reports the case of a 51-year-old recreational trumpeter with a similar diagnosis after being referred to the Queen Elizabeth Hospital voice clinic due to intermittent neck swelling. His other symptoms include regurgitation of food accompanied by dysphagia, although these signs do not concern him significantly.

What is Pharyngocele?

Pharyngocele refers to the dilated outpouching from the pharynx's normal shape due to the thyrohyoid membrane's laxity. It is associated with muscular weakness in the pharyngeal wall or occupational exposure to increased intrapharyngeal pressure.

The pharynx is a hollow tube inside the neck that connects the mouth and nose to the esophagus and larynx. Commonly known as the throat, this muscular, funnel-shaped passageway serves an important job in the respiratory and digestive systems by carrying air and food to the lungs and stomach.

Pharyngocele can be classified as internal, external, or mixed, depending on its location in the pharyngolaryngeal area. It arises from the posterior faucial pillar and the upper or lower portion of the pyriform fossa.

This condition is usually asymptomatic and symptomatic patients normally complain of nocturnal coughing, regurgitation of food, and dysphagia. Pharyngocele differs from laryngocele, although the latter can also occur in musical instrument players and glassblowers.

A person suspected of having pharyngocele may undergo different imaging studies such as x-rays, magnetic resonance imaging (MRI), and barium swallow. Asymptomatic patients can undergo conservative management, such as good oral hygiene and wearing a scarf around the neck. On the other hand, surgical treatment is advised for symptomatic patients or those with significantly large neck swellings.