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Protocol page initiated Aug 2024 Evgeniya Molotkova BS, Henry Hoffman MD

 

Definitions

Euphonium and Tuba have common musical ancestors and are considered to be a part of the "tuba family" of brass wind instruments. These instruments differ in key ways (Steen, 2024)

• The tuba is larger than the euphonium and creates a sound that is an octave lower 
• The tuba is a bass-voiced instrument, and the euphoium is a tenor-voiced instrument
• The tuba has a larger mouth piece requiring a very loose embouchure (James 2023)

Embouchure (from the French "bouche" = mouth) refers to the positioning of perioral and facial muscles, including tongue and teeth, to play a wind instrument

• Definition proposed by Woldendorp and colleagues (2016)
  • "The process needed to adjust the amount, pressure, and direction of the air flow ... as it travels fhrough the mouth ... between the lips by the position and/or movements of the tongue, teeth, jaws, cheeks, and lips to produce a tone in a wind instrument"
• As per Termsarasab and Frucht (2016)
  • "The embouchure refers to the complex pattern of muscles of the face, jaw, tongue, and pharynx used to control the force and amplitude of airflow into the mouthpiece of a brass or woodwind instrument"
• Storms and colleagues (2016) quote Philip Farkas (1962) defining embouchure:
  • "The mouth, lip, chin, and cheek muscles, tensed and shaped in a precise and cooperative manner, and then blown through for the purpose of setting the air-column into vibration when these lips are placed upon the mouthpiece of a brass instrument."

Breath support refers to using the muscles of respiration (including the diaphragm, abdominals, etc.) to create sustained control of the breath, which influences the tone quality, range, dynamics, and projection of the produced sound (Thorpe et al, 2001)

Aerophor (aerophore, aerophon, aerophone) is "a device designed to provide an auxiliary breath supply to aid players of wind instruments in performing extended notes or passages (Wikipedia contributors, 2024)"

Circular Breathing refers to a technique used by some wind instrument players to produce a continuous prolonged tone; as per Wikipedia contributors (2024): "accomplished by inhaling through the nose while simultaneously pushing air out through the mouth using air stored in the cheeks"

Respiratory Muscle Training (RMT) (also respiratory muscle strength training/RMST): a collection of exercises and techniques designed to strengthen the respiratory muscles. These techniques are often employed in conditioning athletes but are also useful in treating patients with COPD, asthma, or respiratory muscle weakness (from prolonged hospitalization, critical illness, etc.) (Winkle and Sankari, 2024)

 

Background

The brass family of instruments (including the euphonium and tuba) describes instruments that produce sound by the vibration of air in a reasonant, tubular system (Wikipedia contributors, 2024). In order to create and modulate sound, musicians must be able to modulate their breathing pattern. Breath support is an important technique to maintain that breathing pattern, but there are also additional techniques that can help musicians better accomplish this feat. 

 

Breath Support and Pulmonary Issues for Brass Players

Breath Support

The generation and maintenance of subglottic pressure is one of the most important factors for sound production. Subglottic pressure is created by a complex interplay between the different respiratory muscles, including the diaphragm, abdominal muscles, and internal/external intercostals (Leanderson and Sundberg, 1988). Modulation of subglottic pressure allows both singers and wind/brass musicians to generate different sound level, frequency, and reasonance (Yilmaz et al, 2022). If the generated column of air is not powerful enough, musicians will compensate with their embrochure. This is evident with "visible tightening of the lips [and] increased pressure of the mouthpiece against the mouth" and maybe less evident with resultant "tongue retraction, tightening of neck muscles, and pharyngeal constriction (Sataloff et al, 1990).

Breath support techniques are an integral part of the pedagogy of brass/wind instruments and are routinely utilized by musicians (Leanderson and Sundberg, 1988). However, musicians may benefit from additional formal training in breath support. One study by Phillips and Sehmann investigated the efficacy of a breathing instruction program on college level brass players. Students recieved 15 minutes of breathing instruction as part of their weekly lessons for 5 weeks. This intervention significantly improved breath management and musical range of trombone players. 

Previous studies have concluded that these musicians benefit from having a wide lung volume range and good breath support to control the respiratory pressures needed to perform. The breathing maneuvers used by these musicians to generate sound has been compared to a continuous form of respiratory muscle training (a type of pulmonary rehabilitation).Yilmaz and colleagues (2022) found that respiratory muscle training (RMT) can significantly improve phonation of the highest and lowest pitch sounds within a vocal register (Yilmaz et al, 2022).

The aerophor was invented in 1912 and is composed of a small foot pedal that pumps air into a musician's mouth, allowing them to utilize it as an auxiliary breath supply. The aerophor was not widely utilized due to the ability to achieve a similar effect with circular breathing and is described as an interesting historical oddity today (Wikipedia contributors, 2024).

 

Medical Conditions Affecting Performance

Asthma is one of the most common obstructive respiratory conditions in the United States. Muscial performance, including playing a wind or brass instrument, has been identified as a potential trigger for asthma. When performing, musicians may experience symptoms such as "lip tension, weakness, or pain, loss of range, decreased endurance, and sore throat" in addition to the more typical symptoms of asthma such as dyspnea, wheezing, or cough (Sataloff et al, 1990). The treatment of musicians with asthma must take into account additional considerations. In singers, inhaled steroids may cause propellant-induced dysphonia, atrophy of the laryngeal muscles, or Candida overgrowth. Similar considerations are offered in the treatment of wind/brass musicians. 

 

Long-term Effects of Wind/Brass Playing

Current research has conflicting findings when it comes to the long-term effects of playing a wind or brass instrument on musicians' respiratory health. Historically, it has been hypothesized that long-term, these musicians experienced a decline in their pulmonary function. More recent studies have indicated that these effects are not quite as drastic. 

See also: Pulmonary Function Testing (PFT) made simple

• Deniz and colleagues (2006) compared spirometric findings in healthy, non-smoking, male wind players in a military band to a control group of healthy, non-smoking males. Spirometric values, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow rate, and forced expiratory flow in 25, 50, 75% of FVC were all significantly diminished in wind/brass players. 
• Fuhrmann and colleagues (2011) conducted a similar study with more robust measurements comparing healthy, non-smoking wind/brass musicians to healthy, non-smoking non-wind/brass musicians. This study found no difference in spirometry or lung volume outcomes. However, there was a significant difference in respiratory system resistance between these two groups.

Past studies have suggested that wind/brass players slowly develop pulmonary abnormalities secondary to asthma or barotrauma from playing (Deniz et al, 2006). More contemporary studies suggest that wind/brass players do not have outright altered lung function, but may have some degree of ongoing chronic inflammatory or pulmonary remodeling processes (Fuhrmann et al, 2011). 

There have been several case reports/case series identifying hypersensitivty pneumonitis in wind/brass musicians (Møller et al, 2017)(Soumagne et al, 2019)(Ziegler et al, 2019). Soumagne and colleagues identified that 95% of wind instruments from a sample of musicians in Eastern France were coloned by fungi and that the musicians playing these instruments were sensitized to these fungal antigens. Failure to dry the instrument was identified as a significant risk factor for fungal colonization. 

In one recent study by Niarchou and colleagues, large scale analysis of musicians who sought out care in the Vanderbilt University health system identified that brass players were significantly more likely to have allergic rhinitis when compared to healthy controls. However, little literature exists to further substantiate or explain this relationship.

 

 

References

Mitani Y, Kitagawa T, Matsugi A, Mukai K. Effect of Posture during Trumpet and Marching Euphonium Performance on the Trunk and Lower Limb Musculoskeletal System. J Phys Ther Sci. 2013 Sep;25(9):1115-7. doi: 10.1589/jpts.25.1115. Epub 2013 Oct 20. PMID: 24259926; PMCID: PMC3818765.

Woldendorp KH, Boschma H, Boonstra AM, Arendzen HJ, Reneman MF. Fundamentals of Embouchure in Brass Players: Towards a Definition and Clinical Assessment. Med Probl Perform Art. 2016 Dec;31(4):232-243. doi: 10.21091/mppa.2016.4038. PMID: 27942703.

Termsarasab P, Frucht SJ. Evaluation of embouchure dysfunction: Experience of 139 patients at a single center. Laryngoscope. 2016 Jun;126(6):1327-33. doi: 10.1002/lary.25723. Epub 2015 Oct 29. PMID: 26511602.

Storms PR, Elkins CP, Strohecker EM. Embouchure Dysfunction in Air Force Band Brass Musicians. Med Probl Perform Art. 2016 Jun;31(2):110-6. doi: 10.21091/mppa.2016.2019. PMID: 27281382.

Steen A  and Lux M: Euphonium vs. Tuba- The Difference Explained!  Prime sound updated July 25, 2024 < https://primesound.org/euphonium-vs-tuba/ accessed 9-15-2024>.

James M: Euphonium Vs tuba, What Is the Difference?   Music Industry How To updated Dec 28,2023 <https://www.musicindustryhowto.com/euphonium-vs-tuba-difference/ accessd 9-15-2024>

Britannica, The Editors of Encyclopaedia. "euphonium". Encyclopedia Britannica, 7 Dec. 2023, https://www.britannica.com/art/euphonium. Accessed 15 September 2024.

Ziegler K, Joest M, Turan N, Schmidt D, Rath PM, Steinmann J. Hypersensitivity pneumonitis of a bagpipe player: Fungal antigens as trigger? Med Mycol Case Rep. 2019 Mar 26;24:44-47. doi: 10.1016/j.mmcr.2019.03.005. PMID: 30989036; PMCID: PMC6447729.

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Fuhrmann AG, Franklin PJ, Hall GL. Prolonged use of wind or brass instruments does not alter lung function in musicians. Respiratory Medicine 2011; 105:761-767.

Yilmaz C, Bostancı Ö, Bulut S. Effect of Respiratory Muscle Training on Pitch Range and Sound Duration in Brass Instrument Players and Singers. Journal of Voice 2022; 36:76-82.

Leanderson R, Sundberg J. Breathing for singing. Journal of Voice 1988; 2:2-12.

Sataloff RT, Spiegel JR, Hawkshaw M. The Effects of Respiratory Dysfunction on Instrumentalists. Medical Problems of Performing Artists 1990; 5:94-97.

Møller J, Hyldgaard C, Kronborg-White SB, Rasmussen F, Bendstrup E. Hypersensitivity pneumonitis among wind musicians – an overlooked disease? European Clinical Respiratory Journal 2017; 4:1351268.

Soumagne T, Reboux G, Metzger Fet al. Fungal contamination of wind instruments: Immunological and clinical consequences for musicians. Science of The Total Environment 2019; 646:727-734.

Niarchou M, Lin GT, Lense MD, Gordon RL, Davis LK. Medical phenome of musicians: an investigation of health records collected on 9803 musically active individuals. Annals of the New York Academy of Sciences 2021; 1505:156-168.

Winkle MJ, Sankari A. Respiratory Muscle Strength Training. [Updated 2024 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK603753/

Wikipedia contributors. Brass instrument. Wikipedia, The Free Encyclopedia. September 3, 2024, 15:14 UTC. Available at: https://en.wikipedia.org/w/index.php?title=Brass_instrument&oldid=124380.... Accessed September 16, 2024.

Phillips KH, Sehmann KH. A Study of the Effects of Breath Management Instruction on the Breathing Mode, Knowledge of Breathing, and Performance Skills of College-Level Brass Players. Bulletin of the Council for Research in Music Education 1990:58-71.

King J, Richardson M, Quinn A, et al Bagpipe lung; a new type of interstitial lung disease? Thorax 2017;72:380-382.

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