Clinical Case Scenario #3
Outpatient treatment plan for a patient with a voice disorder
Ann L., a 31-year-old school teacher, is referred by her otolaryngologist to the voice clinic for treatment of phonotrauma. Over the past two years Ann has found it more and more difficult to speak loudly in front of her class and by the end of the day her voice is completely lost. She constantly feels as though she has something in her throat and as though she needs to cough or clear her throat. The otolaryngologist’s examination revealed nonspecific inflammation of the vocal folds and diagnosed the patient with a hyperfunctional dysphonia. She is very frustrated and eager to get her “normal” voice back.
The speech-language pathologist (SLP) uses Rehabilitation Reference Center (RRC) to review the latest evidence based information about assessment and treatment of phonotrauma and hyperfunctional dysphonia in adults.
Searching in RRC
From the Home Page, the SLP searches Dysphonia and from the results selects Clinical Review: Phonotrauma, Adult (AN: 5000010459) and Clinical Review: Dysphonia, Muscle Tension (AN: 5000010249). He reads about the causes, signs and symptoms, assessment, and treatment of voice disorders caused by phonotrauma and hyperfunctional voice use. He learns that professionals that engage in extensive vocal use (such as teaching, singing, acting) and the female gender are both risk factors for voice disorders that result from muscular tension/hyperfunction.
After reviewing the Examination section of the Clinical Review, he plans a thorough evaluation of Ann’s voice including laryngeal examination, use of self-rating scales/measures, and trial voice therapy.
Clicking on Assessment/Plan of Care, the SLP reviews the Treatment summary and learns that voice therapy for patients with phonotrauma resulting from hyperfunction usually focuses on increasing the patient’s awareness of muscular tension during speaking tasks, relaxation of the laryngeal musculature, and respiration and easy-onset phonation to reduce tension around the laryngeal muscles. Additionally, the SLP plans to educate Ann about vocal hygiene (e.g., increased intake of water, reduction of vocal abuse behaviors) in order to heal her vocal cords and prevent further damage in the future. He refers to the Treatment Chart and recommends the use of electronic amplification for Ann while speaking to her class to preserve vocal functioning.
The SLP returns to the Results List and chooses the Patient Education tab to print Loss of Voice (AN: 2010151975) for Ann so that she can read more about the causes of and treatment for dysphonia as well as preventative measures or the future.
At the end of therapy the speech-language pathologist has planned a re-evaluation of the patient’s voice and vocal functioning based on the Desired Outcomes/Outcome Measures section of the Clinical Reviews to include the Voice Handicap Index (VHI) and the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).
The speech-language pathologist adds the collection of evidence-based papers to a designated Voice Disorders folder in RRC.