Playing brass instruments takes a toll on the body – but for a very small number of people, it can alter the anatomy of the neck, resulting in a rather unusual condition where their throat bulges like a bullfrog when they play their instrument. Known as a pharyngocele, it’s caused by a weak spot in the pharynx where the nose and mouth meet the voice box and esophagus.
Pharyngoceles are rare and may not even be noticeable to the person affected by the condition. This was the case for a 20-year-old musician described in a case study published in the BMJ who didn’t become aware of his inflating neck until his classmates pointed it out.
His neck would inflate like that of a frog sending out a mating call, but only when he was playing his trumpet. Despite the rather dramatic effect playing the brass was having on his neck, he only experienced mild discomfort.
“My first recollection of knowing about the swelling was when people began to point it out at school, although I couldn't feel anything abnormal in my neck,” he explained in a Patient’s Perspective. “When I got older it felt uncomfortable every so often, such as when the airflow feels more constricted which can happen if I'm not warmed up or am out of practice.”
He also spoke of a story for trumpet player Wayne Bergeron who speaks about people asking him to "do that bullfrog thing" (starting at 5 minutes in the video below).
The neck inflation’s cause became apparent when doctors got him to play his trumpet during a CT scan. It revealed an area of his throat that was inflating abnormally whenever he forced out air.
While rare, this individual is far from the only person whose brass career had led to a pharyngocele. The condition was first described in 1886, and several similar case studies can be found in various medical journals.
“Doctor I have a frog in my throat,” a paper published in the Journal of Laryngology & Voice, tells of a 51-year-old trumpeter who was struck by the same condition as he developed pharyngoceles on both sides of his neck. When blowing into his instrument, the paper describes how his neck would swell “reminiscent of a ‘bullfrog’".
It’s thought that pharyngoceles can form as a result of sustained positive pressure in the neck cavity caused by straining and exhalation, and is sometimes called Occupational Overuse Syndrome. The breathing techniques needed for brass instrument playing can put those who play regularly at risk of developing a pharyngocele.
Pharyngoceles most commonly affect just one side of the neck, but can be bilateral, meaning both sides of the neck inflate during instrument playing. Other pastimes associated with the rare condition include glass blowing and playing woodwind instruments, but even a persistent cough can trigger it.
The subsequent bullfrog bulging effect is easily revealed by doing something known as the Valsalva Maneuver, in which a person attempts to breathe out with their nose and mouth firmly closed. The maneuver is also sometimes used as a method to slow a racing heart.
However, instruments aren’t the only way to develop a bullfrog aesthetic, as the first description of a pharyngocele involved a military officer who took great pride in controlling military parades using only his voice.
While some cases of pharyngocele have limited symptoms, others can trigger regurgitation and a loss of appetite among other symptoms. It’s also important to get checked out, as other, potentially more dangerous conditions such as a laryngocele can appear similar.