History
Female 5th Decade
Complaints
- Lost her voice after a pneumonia.
- She is unable to sing.
- She has no upper range.
- Cough
- Poor vocal endurance
Medical history
- Singing: Three-and-a-half octave range. Does pop, choral, blues, gospel and rock. Frequently is a soloist
- Smoking: quit many years ago
- Fluids:
- Water: 8 cups per day
- Caffeine: no caffeinated beverages, only decaf
- Alcohol: 1 glass per month
Character
- Talkativeness: 5 on a scale of 7 (1 quiet, 7 talkative)
- Loudness: 7 on a scale of 7 (1 is soft, 7 is loud)
- Vocal commitments at Work: 7 hours per workday
- Singing commitments: 2 choirs for total of 5 hours per week and daily practice of one hour. Performances several times per month, heavier around the holidays.
Vocal capabilities
See Vocal capabilities testing guidelines for explanations
- Reading pitch: clear
- Anchor pitch: G3
- Range: A2 – C5
- Max phonation: 11 seconds @ G3
- Loudness: robust, but cuts out
- Swelling tests: A4 positive
- Neurogenicity: none
- Psychogenicity: none
- Valving: excellent
- Respiration: normal
Stroboscopic Examination of the Larynx
| Evaluation |
Rigid endoscopy |
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In ABduction the elevations are visible in the middle of the vocal cords.
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Phonatory onset at pitch F4 (middle of the vocal range). There is a gap anterior and posterior to the vocal folds.
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At pitch A4# the swellings touch each other and stop soft vibrations. This is the pitch that the swelling test becomes positive.
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| Post therapy |
Rigid endoscopy |
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Abduction. Elevations are still present but a bit smaller. Her vocal range with soft singing has increased.
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Strobe: Pitch D5 - folds pulled tighter - elevations begin to stop phonation at soft singing. This pitch is 5 semitones higher than pre therapy.
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Strobe: Pitch A4 to compare the same pitch as pre treatment.
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Treatment
- In this instance, this vocal overdoer has responded to 6 weeks of speech therapy directed at decreasing the amount of vocal use and other vocal habits.
- If she can maintain the singing which she wants to do with this degree of improvement then no further intervention is necessary. The swellings are smaller, but still present.
- She should continue to monitor her vocal swellings with the swelling tests performed daily, to provide her with feedback if she overdoes it.
- If unsatisfied with her performance ability, then surgical removal could be considered.
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