Neurology Clinic for Musicians Restores a Flutist’s Ability to Play

When flutist Cynthia Ellis developed uncontrollable movements that made it impossible to play, neurologist Xenos Mason, MD, of the USC Musician’s Neurology Clinic, found the answer and brought her back to music.

In the fall of 2023, musician Cynthia Ellis noticed some shaking in her mouth and lips when she tried to play the piccolo or flute. For a member of the Pacific Symphony, as well as a flute instructor and musical director of the ensemble Laguna Flutes, this was a troubling problem.

Cynthia had been experiencing temporomandibular joint issues (commonly known as TMJ) from an orthodontic retainer that didn’t fit properly. After seeing a neurologist to rule out degenerative neurological disorders like multiple sclerosis and myasthenia gravis, she sought help from numerous specialists over the next several months, including physical therapists, dentists and a chiropractor. They all offered expertise in treating musicians for TMJ, but the uncontrollable shaking progressed.

By February 2024, Cynthia’s oral tremor was so bad that she could no longer play the flute. She was experiencing profound weakness, leaving her unable to form the correct embouchure to play. “My jaw was also not moving correctly, affecting the entire musculature of my embouchure,” she adds.

“It was so frustrating to be away from my performances,” she says. Cynthia continued to research her problem, including specialists who might be able to help.

In the summer of 2024, her research led her to the USC Musician’s Neurology Clinic, part of USC Neurosciences and Keck Medicine of USC.

She asked her general practitioner if she should seek care at the clinic, and he gave his immediate approval. His own son was receiving treatment at USC Norris Comprehensive Cancer Center, also part of Keck Medicine, and he thought highly of the health system and its staff.

A neurologist for the music makers

Xenos Mason, MD, is a perfect fit for the USC Musician’s Neurology Clinic. As a horn player with Orchestra Nova Los Angeles (formerly the Los Angeles Doctors Symphony Orchestra), the neurologist is well-versed in the challenges that brass and woodwind players face. He is also a leading expert in movement disorders.

Music requires artistry, but also a particular type of athleticism. All musicians must develop strength, dexterity, precision of movement and endurance, plus an impressive level of breath control for brass, woodwind and voice. The USC Musician’s Neurology Clinic was developed to diagnose and treat neurological disorders that specifically affect professional, student and amateur musicians, including musician’s dystonia, nerve injuries, nerve entrapment and pain management.

To achieve optimal results, experts include not only neurologists, but also neurosurgeons, physical therapists and occupational therapists. The clinic is also an affiliate site for the Dystonia Coalition, an organization dedicated to advancing research, improving treatment therapies and finding a cure for dystonia.

When a patient like Cynthia comes in, Dr. Mason conducts a comprehensive evaluation to diagnose and understand the neurological root of their problem, whether it’s an unexplained decline in technique, loss of tone or pitch control, spasms or pain.

In Cynthia’s case, Dr. Mason identified a neurological disorder called focal dystonia, which causes sustained involuntary movements in a specific body part. The specific type that affected Cynthia’s lips and mouth is known as embouchure dystonia.

“The diagnosis was a game changer,” Cynthia says. “Dr. Mason was able to refer me to the leading physical therapists who work with embouchure problems, and their help was invaluable.”

Having developed a global network of experts in musician care over the years, Dr. Mason was also able to connect her with support groups and a nonprofit organization called The Embouchure Project, which helps musicians with all kinds of embouchure dysfunctions.

An artist reclaims control of her instrument

With Dr. Mason’s recommended supports in place, Cynthia’s recovery gradually picked up tempo.

As her muscle and ligament strength improved, she was able to start practicing again in small increments. Over time, her practice sessions grew longer and more frequent. By July 2024, she was able to go back to work part-time.

“My first performance in six months brought me to tears; I was so grateful,” Cynthia says.

Just one year later, Cynthia was back on her full schedule, only needing a few extra breaks to maintain her stamina throughout the day.

The flute player remembers how Dr. Mason and his team helped her maintain the mindset she’d need to rebuild confidence and perform again.

“They were so kind,” she says. “By telling me I’d get through this, they gave me a strong sense of hope.”

Today, Cynthia continues to practice her physical therapy exercises daily without fail. Her symptoms still come and go, but Dr. Mason says that she could eventually transition to a recovery pattern of “persistent improvement” that would lead to a full recovery.

When people ask Cynthia how she’s doing now, she simply answers, “Stronger and more positive each day.”

And to other musicians dealing with similar embouchure challenges, she advises: “Make sure you are seen by a provider experienced with working with musicians.”

To learn how musicians and medical professionals are working together to support and advance treatments for those with embouchure syndrome, visit TheEmbouchureProject.org.

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