Page 74 - 18-4 April 28 2021

Deviating from my usual style, I would like to introduce a couple of cases which I have
treated as examples of actual therapy.

Shimon, an 11-year-old boy, came to me to be treated for vocal cord nodules. His father
complained of hoarseness and difficulty in bringing out the voice. Indeed, evaluation revealed a
hoarse and breathy voice as well as anterior neck tension, and poor efficiency of air support.

Over the course of 9 sessions, Shimon was taught how to use his voice appropriately by
training to employ more appropriate resonance when speaking. As well, diaphragmatic
breathing was employed as well as techniques to reduce the neck tension. Additionally,
appropriate vocal hygiene was implemented; all this resulting in significant improvement in
Shimon’s voice.

Eli, a 15-year-old boy came to me for evaluation due to significant strain of his voice.
While he was correct about his own characterizing of his voice, he was surprised to hear that I
suggested to see a certain well-known ENT for further assessment due to the nature of Eli’s
vocal quality. Subsequently, I received a call from Eli that he indeed had a vocal cord polyp
which required surgical removal. Eli opted to do the surgery which yielded excellent results.
Eli’s vocal quality was back to normal and after just 6 sessions of voice therapy to retrain Eli for
appropriate vocal usage, Eli was back to himself.

Shaindy, a 14-year-old girl came to my office as she was diagnosed with a vocal cord
polyp and was told that while surgery was a possibility, it was recommended that a course of
voice therapy be implemented first to determine if surgery was avoidable.

Through a 12-session period, Shaindy was taught appropriate breathing technique,
daily vocal warm-ups, vocal hygiene, as well as optimal voice usage. Subsequently, Shaindy was
recommended to return to her ENT for follow up. Videostroboscopy coupled with laryngoscopy
revealed complete elimination of vocal cord polyp. Surgery was no longer necessary.
While in Shaindy’s case the voice had improved significantly, there was yet a small level
of tension which she exhibited when speaking. Nonetheless, I felt that the amount of effort
Shaindy would have to exert to reduce the tension was too much for a such a small amount of
tension that it would not be worth the effort.

Shaindy was dismissed from therapy and follow up revealed that she indeed had no
issue maintaining her appropriate vocal quality.