Moira is a 41-year-old mother of 2 high-school football players. She works as a financial consultant for KPMG. She is very active in her institution by making frequent presentations, provides advice to her clients, and works alongside many different groups of people throughout her workday. A few months ago, Moira was sick with a cold and “lost her voice”. She received medication from her doctor and went through a couple rounds of steroids; however, no improvements were seen. Her children, family members, and colleagues have complained that they could not hear her clearly or well enough to understand her. Personally, Moira feels as though her voice is weak and whispery and tight. She reports that her voice has been like this ever since getting a cold. Her medical and surgical history is otherwise unremarkable
functional aphonia
A 42-year-old teacher, Emily, presents with a strained, strangled voice quality, intermittent voice breaks, and a rhythmic tremor during sustained phonation. Symptoms worsen with stress and improve when whispering. Voice therapy alone is not expected to fully resolve symptoms, and management would likely include Botox to the thyroarytenoid muscles with possible speech therapy for compensatory strategies and optimizing vocal function. Emily enjoys knitting and talking to her 3 cats, but has found that it is easier to talk to them when whispering. She was reported to have an upper respiratory infection (URI) recently. She took Amoxicillin following her URI diagnosis.
laryngeal dystonia; ADLD; dystonic tremor
Fred is a 65-year-old male who retired from outside sales a year ago. Fred does not have a significant medical history. He lives alone, and a typical day for Fred involves reading the newspaper, gardening, golfing, and cooking for himself. His children live out of state, and they typically visit him every few months. When they come to visit, he has noticed that they have to ask him to repeat himself a lot because they cannot hear him. When he attempts to repeat himself, he experiences difficulty projecting his voice. He came to the clinic and expressed these concerns to the SLP.
Presbylarynx
Young boy, school-aged, frequently yells on the playground and plays a sport with lots of yelling across the field. Plays ghost in the grave yard with his siblings every night. His voice is rough and breathy. On a flexible scope, his VF are in an hourglass shape, and there are many white bumps.
nodules
57 year old male who is complaining of shooting pain to his ear. He was in a car accident, which resulted in a week long intubation. He is a high school football coach and teaches history. Besides the recent car accident his medical history is unremarkable. He currently does not receive any related services due to the accident. He lives at home with his wife and six sons and he frequently hosts dinner parties. He and his family have not noticed any changes in his voice.
granuloma/contact ulcer
Sally is a 45-year-old female. She has a history of cardiac issues and is currently taking blood thinners. Sally has been working as a Kindergarten teacher for 15 years. Recently, she has been participating in arrival and dismissal duty and has had to raise her voice more for parents and students to hear. She arrived at a clinic with concerns about her voice due to waking up one morning and not being able to phonate. She mentioned she was experiencing vocal fatigue for a few weeks leading up to losing her voice. The provider recommended vocal rest and no medication.
hemorrhagic
Joe Smiley is a 55 year-old male. He has a history of ACDF surgery, which he underwent a year ago. He currently takes cough suppressants. He is a construction worker, who is up and on his feet most of the day. Since the procedure, he has been complaining of not being heard, especially in loud environments. His wife shares that she has difficulty hearing him when background noise is present. She noticed these changes after his surgery. He also feels that his voice sounds like a whisper when talking; the longer he talks, the more tired his voice feels. He mentioned that he sometimes experiences difficulty when swallowing large bites of food.
vocal fold paralysis
Adam is an eighteen-year-old male currently in high school. He complains of difficulty breathing during exercise. He tried inhalers, but reported that those did not help. He does not have a significant medical or surgical history and is not on any medications. He reported having seasonal allergies. Adam is an athlete and often engages in exercise. He is a running back on his varsity football team. Adam went to the ER for difficulty breathing after a state championship a month ago. Perceptually, his voice is mostly unaffected, but he complains of tightness.
Vocal Fold Dysfunction (VFD)
