Guest Post: On Surgically Overcoming Performance-Inhibiting Ailments

by Emily Fagan

An Oboist (not Emily) receiving a surgical injection. Source: Mayo Clinic

An Oboist (not Emily) receiving a surgical injection. Source: Mayo Clinic

When my mom, a middle school band director, helped me choose to play the oboe, she warned me how difficult it would be. Aside from the instrument itself, she told me that I was going to have to deal with pesky reeds, and that I would have to be patient with the difficulty of reed-making.

What she didn’t tell me was that I would have to deal with running super-expensive reed-making machines which, when off by just a few millimeters, could destroy a whole month’s worth of reeds; or that I would have to deal with an instrument so finicky that it could shrink or warp, causing an especially dry or humid day to completely inhibit my ability to play; not to mention that one wrong scrape could ruin a reed I had spent hours on. The oboe is definitely no walk in the park.

My mother was completely in the dark, however, about a physiological deformity that would eventually keep me from finishing performances, or at times, even starting them. Unfortunately, I have not found perfect solutions for the first few problems. Thankfully, though, I am now freed from the last one.

Around my freshman year in high school, when I finally got serious about playing, I started noticing that, when I would get fatigued from playing, the air from my lungs would gradually stop coming out of my mouth and start leaking out my nose. As I would try to keep playing, I would make an audible gurgling and choking sound in my throat. Eventually, I would feel a break and all of the air would go through my nose, leaving me with no sound coming out of my instrument. If I would first try to speak afterwards, my voice would sound strikingly nasal, as if I were talking with my nose plugged.

Because these occurrences were completely out of my control, my fear of them happening grew. They wouldn’t only occur in practice sessions, but also during rehearsals and concerts. I have some very haunting memories of performances when I would be playing a solo, then suddenly there would be half oboe tone and half groaning from my throat, and then no sound at all.

I started to plan my life around trying to prevent these instances from happening. They often happened when my facial muscles would start to feel tired, but really they could happen at any time. Sometimes I could play for four hours with no problem, and sometimes it would happen within half an hour of playing. I performed the Mozart Oboe Concerto with my youth orchestra my senior year of high school, and I remember worrying not about playing the right notes or remembering the piece, but about whether or not my throat would stay closed.

My high school oboe teacher was completely at a loss about what to do, and research from both our ends brought up hardly anything, except for several other people who felt similarly lost. I figured that I would have to just grit and bear it. Right before I started college, however, my mom found a video of another oboist who had the same issue. The video showed her receiving surgery at the Mayo Clinic to attempt to fix the problem. She seemed to be happy with the procedure, but the surgery was in its first year so the long-term results were unknown. At this point I still didn’t really want to admit that I had a serious issue that I couldn’t control, so I stored the video away as a distant memory. I was starting college, and surely they could show me how to fix it there, right?

Unfortunately, once I started performing more frequently in college my issue got worse. I remember playing a Haydn Symphony my sophomore year in which I played a two-minute solo with half oboe tone, half throat-groaning. The musicians around me were totally freaked out, although fortunately the audience only noted that I sounded “quieter.” Still, I was mortified: the issue was completely controlling my performances. I would start to take breaks at parts where I would normally be able to play because I would worry about making it to the solos. I could improve my muscular endurance so that my lips or air would not give out, but I could not improve upon my throat; to the people around me who had no idea what was going on, it seemed that I simply didn’t practice.

Then the issue took a turn for the worse. During my last two years of college, my lack of control over my air stream became even more unpredictable: I did not even have to be physically tired – it could happen within the first fifteen minutes of my playing, then stop and not happen for the next hour. There was absolutely nothing I could do to prepare for it. Out of frustration, I started to blame others around me, particularly ensemble directors, for giving me too much music to play. I did not want to face the fact that, no matter how much I practiced, I could not get through it all; I didn’t want to be “that kid” who couldn’t fulfill her responsibilities. I would have to end rehearsals early because I couldn’t play anymore, and I had to start manipulating the way I played in attempts to control the issue. I was dreading the reputation I felt I was getting because of my inconsistent playing.

The final straw was when my throat opened during the first five minutes of my college senior recital. Although it stopped after the first piece, I was thrown off for the rest of the performance and was mortified with the overall outcome. Afterwards, my teacher sat me down and told me that I had a real issue. While he had never personally experienced the problem, he had a colleague who did; she explained to him that the loss of air was caused by a physical deformity in the soft palate. My teacher assured me that no amount of practice or pure desire was going to get rid of the issue – it wasn’t my fault. The only answer was surgery. I thought back to the video my mom had found in high school and realized that it was time to deal with the problem: there was simply no other way.

I reached out to the doctor mentioned in the video, Dr. Shelagh Cofer, who was happy to help. The next week, my mom and I drove to the Mayo Clinic in Rochester, Minnesota for a consultation with her and a speech pathologist. First, they wanted to see if air was leaking out all the time or just when I played, so they had me talk while wearing a nasometer, a machine that measures the amount of air coming out of your nose. It ended up that I had over-average air leakage, but they did not think I had a huge speech issue. Next, Dr. Cofer had me speak while she put a scope through my nose to examine vocal chords. There seemed to be no problem there either. Finally, she examined me with the scope while I was playing my oboe and English horn. She immediately saw tiny air bubbles coming up from one of the areas where my soft palate meets the sides of my throat. After a few minutes of playing, she could see a huge gap where air was leaking through, and eventually, all of my air went through the gap instead of through my mouth.

Dr. Cofer confirmed that I had a real issue here, but also that, more importantly, it could be FIXED! While some people have soft palates that don’t fit their throats from birth, she thought my issue was from the accidental removal of extra tissue during my tonsil and adenoid removal surgery when I was 14. She would be able to perform her procedure on me, and it would completely fix my problem!

The procedure was founded and performed by Dr. Cofer. She had been doing it for about five years, mostly on patients with speech issues, but had worked on one other oboist and one trumpet player. Both patients seemed to have no problems since. The procedure entailed an injection of filler (like Botox, but a medical kind that should last permanently) into the throat to make it fit the soft palate.

I went back a week later to undergo the throat reconstruction procedure. In order for her to find the gap again, I had to play DURING the surgery! This means I could not be put out under general anesthesia; I had to be awake. I was heavily sedated and heavily numbed, but awake enough to be able to play. I don’t remember much about the surgery, only that there was an extra nurse there for the sole purpose of standing next to me to make sure I didn’t drop my English horn (I have to say, the clinic staff was always so good at making sure my instruments were taken care of!). When she had finished, I grabbed Dr. Cofer in a big bear hug and told her that she had just changed my life.

I was unable to play for a week, but after that she thought I should be fine. Dr. Cofer said that she would rather have injected too little than too much and cause a gap elsewhere, so that if it wasn’t perfect I could come back and she would add a little more. But when I played for the first time a week later, THE PROBLEM WAS COMPLETELY GONE!

I have not yet performed a concert with my new throat, but I have played for several hours a day many times, and I have not once had an issue. There were times where I felt like it was going to happen, but nothing ever did. Now I am trying to relearn how to play, because I had formed bad habits of tightening certain parts of my mouth and throat to try and stop the issue from happening. But so far, I feel like I sound a lot better and playing is much easier. The best part of the surgery is the relief I feel knowing that I am in complete control of what my body will do while I play.

While this whole situation has been a real pain, I am so thankful that I underwent the procedure. I have a new appreciation for what it takes to play the oboe, and now have the chance to be able to learn to play and sound exactly how I want, now that I am in control of my body.

The biggest lesson for me, though, was to just listen to my body. If something is going horribly wrong, don’t just sit there for years trying to get through it. DO SOMETHING ABOUT IT! Your body is your friend and is there to work for you. Playing an instrument, although immensely difficult and at times immensely frustrating, should be natural. Your body wants to work for you, you just have to make sure that it is in a position to be able to do it.

Although I have many other demons to exorcise with the oboe, knowing that I can physically do it is an overwhelmingly joyful feeling, and one that I still need to remind myself of from time to time.

Now I wake up in the morning feeling confident that I can do what I was born to do, and there is no better feeling than that!


Emily Fagan is a 22 year old oboist and English hornist. She recently graduated from Northwestern University and will be continuing her performance education at the University of Houston in the fall.

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2 thoughts on “Guest Post: On Surgically Overcoming Performance-Inhibiting Ailments

  1. Susan says:

    Would love to speak with Emily about her experience. My daughter, another oboist, is set to have the same procedure soon. Please contact me by email. Thanks!


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