Chapter 7: Voice Management (Case Study)

Question 1

What would the general focus of hygienic therapy be for this case?

Answer 1

identify primary and secondary behavioral causes of the voice disorder and then modify and eliminate

Question 2

What are 4 possible primary and secondary behaviors to address with hygienic therapy include?

Answer 2

1. smoking
2. laryngeal dehydration (hydration, caffeine, medications)
3. voice abuse (talking loudly, coughing/throat clearing)
4. inhalation of large quantities of powder/dust

Question 3

What would the general focus of a symptomatic therapy approach be for this case?

Answer 3

Use facilitating techniques to:

• raise pitch
• reduce loudness
• reduce laryngeal tension and effort

Question 4

What would the general focus of a psychogenic therapy approach for this case be?

Answer 4

exploring the psychodynamics of the voice disorder

Question 5

How would psychodynamics be explored/used for this case with a psychogenic therapy approach? (5)

Answer 5

1) detailed patient interview to determine cause/effects of stress, tension, and depression
2) determine exact relationship of emotional problems and voice problem
3) counsel the patient regarding the effects of emotions on the voice problem
4) direct reduction of musculoskeletal tension
5) support of ongoing psychological counseling

Question 6

What would the general focus for the physiologic therapy approach for this case be? (2)

Answer 6

evaluate the present physiologic condition of voice production and develop direct physical exercises or manipulations to improve that condition

Question 7

What 3 physiologic components/issues did this pt present with?

Answer 7

1) increased mass and stiffness of VFs changing physical dynamics of VF vibration
2) required greater subglottic air pressure to initiate/maintain vibration causing her to speak too loudly
3) attempt to overcome 1 and 2 by making physical adjustments such as increasing supraglottic tension

Question 8

What might a physiologic management program include for this pt and why? (2)

Answer 8

1) vocal functional exercises and resonant voice therapy to improve: laryngeal muscle control, strength, and stamina to balance airflow, laryngeal muscle activity, and resonance
2) hydration program and decrease in caffeine to improve lubrication