Skin, eye and cerebral problems
- a) Cheilitis.
Wind and brass players in particular can suffer from inflammatory problems of the lips and adjacent skin due to close contact with the mouth piece of their instrument. (29).
Brass players can develop red dry lips and calluses due to friction, and clarinettists and oboeists may develop a callus on their upper lips. Horn players may develop atrophy of the central upper lip due to pressure from the mouthpiece, and wind and brass players may develop soft tissue trauma on the lips which can be mitigated by lip shields.
Contact cheilitis due to sensitivity to nickel and chromate has been seen in flautists, trumpeters, clarinettists, horn players and even in one case a harmonica player. Flautists can also develop an eczema-like reaction on their chins.
Other problems include cane reed sensitivity in saxophone and clarinet players which causes redness and scaling of the lower lip, and rarely recorder players can develop an allergic contact dermatitis to exotic woods.
- b) Dermatitis
Musicians are at risk of dermatitis from a number of causes:
- bi) Allergic contact dermatitis
Rosin, nickel and cane reed allergy are all causes of allergic contact dermatitis in musicians.
- bii) Irritant contact dermatitis
Flautist’s chin is an acne-like rash associated with hyperpigmentation. It is thought to be caused by a combination of saliva, condensation of the breath and direct pressure from the flute.
Clarinettist’s cheilitis is an irritant contact dermatitis affecting the area from the middle of the lower lip to the chin, and again is thought to be due to a combination of moisture, pressure and friction.
Violinist’s chin (also known as fiddler’s neck or violin hickey) is common in violinists and especially violists and consists of an area of redness, inflammation, lichenification and hyperpigmentation on the left side of the neck where the player holds their instrument. Some violinists regard this as a ‘badge of honour’ as it is usually the result of many hours of practice, although it can become very sore and infected. The causation is again multifactorial and includes pressure, allergy and at times some grumbling infection and inflammation.
Cellists can suffer from ‘cellist’s chest’ and ‘cellist’s knee’ from holding their instruments for long periods.
- c) Anthrax in drummers.
Two cases of fatal anthrax in players of African drums have occurred in recent years in the UK, one in 2006 in Scotland, and one in 2008 in London (30). There were 3 similar contemporaneous cases in the USA.
- d) Callus formation.
Callosities can occur in cellists using the thumb position, and drummers can develop drummers’ digit, which is a callosity on the lateral side of the left index finger. Violinists can also develop Garrod’s pads, which are dorsal swellings on the PDP joints of the left second and third fingers.
- a) Raised intra-ocular pressure (IOP).
Studies have shown that brass and woodwind players have a temporary increase in IOP and BP when playing. (31). For brass players, there is a significant increase in IOP when playing high and middle frequency tones, with sustained high notes causing a significant increase in IOP. Woodwind players only have a rise in IOP when playing high frequency tones.
Brass and woodwind players are thus at increased of glaucoma, and therefore need regular monitoring of their IOP.
- b) Injuries.
Playing an instrument can be surprising risky to the eyes, with hazards from flying bows to avoid for string players in orchestras playing on cramped stages, to broken strings.
- a) Stroke.
There have been at least 5 documented cases over the years of strokes attributed to playing the trumpet. It is thought that the raised pressure in the neck and chest when playing leads to the rupture of cerebral vessels.
- b) Risks of brain surgery.
Recently there have been cases of musicians who require brain surgery playing their instruments during surgery to ensure that the parts of the brain needed for their specific skills are not damaged at operation if at all possible.