Internal aspects of musicians' medicine

The cardiovascular system shows typical reactions when playing a wind instrument: Tone production and blowing pressure cause short-term physiological fluctuations in blood pressure, heart rate and heart rhythm. They vary depending on the instrument, pitch, dynamics, blowing technique and constitution. During performances, stress hormones can also lead to an increase in blood pressure and heart rate. Nevertheless, these are generally physiological reactions that are harmless in healthy people. In order to assess the stress and resilience during playing, the cardiological guidelines are followed. In addition, the individual reactions during music-making must be recorded. This is done by means of long-term measurement of ECG and blood pressure under practice, rehearsal and possibly performance conditions, sometimes also by means of ultrasound of the heart during playing. After cardiovascular diseases, reintegration with a gradual increase in the music-making load may be necessary.

Beta-receptor blockers can be used to reduce the vegetative symptoms that can be caused by the fear of performing. Musicians often resort to self-medication, even though these are prescription drugs that affect the cardiovascular system. They should be strongly advised to take beta-blockers only after consulting a doctor, especially if cardiovascular problems are involved. This ensures a sensibly coordinated therapy, and the numerous non-drug strategies for dealing with performance anxiety can also be worked out together.

According to current knowledge, respiratory diseases do not occur more frequently in wind players. The often postulated connection between the development of emphysema and oboe playing has also not been confirmed. However, the constellation of several risk factors (such as smoking and environmental influences) can lead to playing-related illnesses. In the case of childhood asthma, playing wind instruments often has a positive effect on lung function and the management of the disease. Today, it is therefore often seen as a valuable component in asthma therapy.

Hormonal and metabolic disorders are sometimes accompanied by functional impairments during music-making. Due to the extraordinary sensorimotor demands, musicians become aware of these disorders at an early stage. Thyroid dysfunctions in particular lead to complaints that are relevant to musicians' medicine, but are usually easy to treat. They can manifest themselves in a variety of symptoms, including in the area of the arms and hands or the singing voice. In principle, the treatment of musicians does not differ from that of other patients, but additional therapeutic measures such as physiotherapy or speech therapy may be necessary.

In wind players and singers, reflux with reflux of gastric juice into the oesophagus seems to occur more frequently. The mechanisms behind this are complex and have so far only been partially understood. It is known from sport that physical "endurance work" - which singers and wind instrument players also perform - plays a role in reflux. The symptoms are often exacerbated by increased breathing with deep inhalation and an abrupt or prolonged increase in pressure in the chest and abdomen. This kind of breathing effort is constantly required when singing and playing wind instruments. Reflux complaints require a differentiated musician-specific anamnesis and diagnosis. In the case of singers, this is carried out on an interdisciplinary basis by a gastrointestinal specialist and phoniatrist. They can prescribe medication to inhibit the release of stomach acid and recommend diets and behavioral measures.