Patients with laryngeal dysfunction may present initially to a pulmonary practice with complaints of hoarseness, hypophonic pressive speech, aphonia, cough, or aspiration. The goals of this study were to identify a primary diagnosis, establish a program of goal directed therapy, and assess clinical response.
Patients were evaluated and treated by a pulmonologist and speech-language pathologist with outside consultations by ENT specialists. Treatments included: (1) Recruitment and habituation of the muscles of articulation, phonation and respiration resulting in improved clarity of articulation (Lee Silverman Voice Techniques); (2) Softening of glottal attack (resonance training, lingual hyperextension, open glottal exercises); (3) Vocal elicitation (gravity resistance exercises, vegetative and glottal sound production).
Fourteen patients were evaluated and treated. Diagnoses were: neuromuscular disease (Parkinson’s disease, von-Recklinghausen’s disease, idiopathic vocal cord paralysis), vocal cord injury (radiation necrosis, atresia, intubation injury, carcinoma with scar tissue formation), hypertonic vocal cord strain, functional vocal cord weaknesss (presbyphonia, vocal cord misuse and overuse, phycogenic etiologies).Concurrent pulmonary diagnoses included COPD, severe kyphoscoliosis, sinusitis, allergies and asthma.Treatment outcomes of 50% to 100% improvement in intelligibility of spoken content occurred in 13 patients, but was unsuccessful in one patient (von-Recklinghausen’s disease).
Goal directed therapy of the patient with laryngeal dysfunction, often in the setting of a concurrent pulmonary disorder, is successful in improving vocal function.
Pulmonologists should be aware of the benefit of an interdisciplinary program for the patient with laryngeal dysfunction.
Clifford Risk, None.