The patient is a 60-year-old, male, high school sociology teacher with a 14-month history of progressive dysphonia. The patient was diagnosed with a large substernal thyroid by a laryngologist and underwent thyroidectomy surgery 7 months ago. The patient notes that voice problems have persisted for about a year. The patient reports that prior to the thyroid surgery, his voice problems were more severe than his current voice quality. Immediately after surgery, there was an improvement in the voice quality, however, in the following months the voice quality declined.
The patient expresses concern for his voice and desires to be able to talk normally again. The patient describes his voice as effortful, …show more content…
The patient struggled with this task and instead produced normal phonation rather than glottal fry.
Inhalation Phonation (10:37)
This speech task required the patient to produce phonation on the inhalation. This task assesses the ability of the true vocal folds without the involvement of any supraglottal activity. The patient had difficulty with this task and phonated on the exhalation rather than the inhalation.
Laryngeal Massage (10:56)
This speech task involved the clinician performing a laryngeal neck massage as they elicited phrases from the patient such as, “Who did it?” and sustained /m/. The patient noted feeling a difference in the quality of production after the laryngeal massage.
Tongue Protrusion (11:30)
This speech task involved protruding the tongue and simultaneously producing the word “me” repeatedly. This task opens up the back of the throat. Perceptually, the patient’s speech was produced more clearly and with less effort after this speech task.
Nasal and Glide Stimulation …show more content…
Glottal fry assesses the individual’s ability to prolong the closure interval of the true vocal folds. The patient had difficulty performing this tasks, which suggests an inability to sustain a closed vocal fold position. Additionally, the patient’s performance on the inhalation phonation speech task supports the suspected diagnosis. Inhalation phonation assesses the individual’s true vocal fold function alone and removes and supraglottic activity that may be involved. The patient was unable to phonate on the inhalation, suggesting that the true vocal folds are unable to adduct without the help of the false vocal folds.
Finally, the endoscopy revealed the false vocal folds pressing on the true vocal folds which indicates muscle tension dysphonia. There were no observable masses or lesions on the vocal folds, which eliminates many problems that may affect the voice. It may be concluded that spasmodic dysphonia is not affecting the patient’s voice quality. With spasmodic dysphonia, we expect to see the voice quality unchanged by trial therapy, however, our patient was observed to be stimulable to several speech tasks.