Casos Clínicos Intervención del Área Voz

Fonoaudiología
Clinical case 1:

Patient 6 years old, with a history of constant dysphonia. He attends first grade and has
been singing at community festivals since he was 4 years old. His family takes him to the
speech therapist because they want him to learn good "vocal technique." In the initial
interview, you observe that it is very urgent for the parents that the minor perform all the
requested tasks.

Questions

1.- What is the diagnostic hypothesis in this case?

2.- Would you make referrals? Fundamentally.

3.- In addition to the background you handle, what aspect would be important to evaluate
in the family environment?
Clinical case 2:

A woman comes to his office very distressed about "not having a voice." She explains,
through gestures and writing on paper, that this problem arose after fighting with her
husband and that it had never happened to her before to this extent. Among the relevant
morbid history, he presented untreated nocturnal bruxism, irritable bowel syndrome, and
stomach ulcers. In the initial interview, she appears very distressed about her vocal
problem, since she cannot function as she wishes in her family and social environment.

Questions

1.- What other questions would you include in the anamnesis? Mention 3 most relevant.

2.- Indicate the diagnostic hypothesis for this case.

3.- What task could I ask you to corroborate your diagnosis?

Clinical case 3:

They ask him to work with a group of chorus girls whose age ranges between 16 and 22
years old and who must appear in a competition in less than 2 hours. The only precedent it
has is that this is the final stage of the competition and that the students have not been
rigorously evaluated. The singing teacher who guides them has been on leave for 3
weeks. By getting to know them, you realize the level of importance this has for them, and
the insecurity with which they present themselves to the evaluation. In the work room, the
only materials available are a keyboard and a large mirror.

Questions

1.- If you only have 2 hours to work, what intervention content would you prioritize? Justify.

2.- Mention two facilitating techniques that you would apply in this case.

3.- If you continue working with them after this presentation, prioritize the contents of the
evaluation.

Clinical case 4:
Female patient, 42 years old, works as a quality control secretary in a pharmaceutical
company. Referred from ENT due to polypoid lesion of the right vocal cord and nodular
lesion due to contracoup in the left vocal cord. The NFLC examination mentions existing
band work in phonation, edema and congestion of both arytenoids and posterior
commissure. As relevant history, the patient is allergic to spring, takes medications such
as: desloratadine, ketoprofen, muscle relaxants, 'stress', omeprazole and aerogastrol. She
presents lumbago whenever she is under stress, mainly associated with her work. She
describes the beginning of the problem about 6 months ago after a specific event
(argument with her eldest son), which was not noticed by her but by her husband. As
symptoms of the disorder, he reports having constant thirst and that the quality of his voice
improves when drinking water. Within the psychosocial aspects, she says that her voice
changes when she is very angry since “her voice doesn't come out.” She suffered
postpartum depression after her last pregnancy (4 years ago) for which she was in therapy
for 7 months. Within the postural evaluation is found in the lateral plane: head forward,
anterior tilt of the pelvis and knee extension. In the anterior and posterior planes, there is a
raised left shoulder, a raised left iliac crest, and a larger triangle on the left. In breathing,
high costal respiratory type, which does not vary in tone and intensity; Muscular
contraction present in external intercostals, serratus, pectorals, trapezius, scalenes and
ECM. Poor respiratory support, TME: 12 seconds. Hyolaryngeal system: contracture and
pain of most of the suprahyoids. Hyoid height at C3 but in phonation it rises to C2.

Questions

1.- Possible speech therapy diagnosis of the patient. Fundamentally.

2.- Explain each vocal parameter to be evaluated and indicate how you would find them.
Fundamentally.

3.- Mention the referrals you would make.

Clinical case 5:
Female patient, 23 years old, theater student. He comes to the voice consultation because
he has articulation problems with /s/ and /rr/, in addition to wanting to evaluate his voice.
Within the relevant medical history, he had a recurrent tension headache. You have body
pain when doing physical activity in your shoulders. He speaks approximately 12 hours a
day, describing his voice as 'bipolar', hoarse and sometimes soft. Her voice teacher told
her that 'that voice was not hers'. He smokes 7 cigarettes a day, consumes drinks, water
and green tea every day (approximately 2 liters). He stays up late almost every day, with
his last meal at midnight. As for psychosocial background, he describes himself as an
extroverted person. He also comments that lately he has had difficulty sleeping, muscle
tension in his neck and shoulders, difficulty concentrating, impatience and desire to
overeat.

Questions

1.- What other questions would you include in the anamnesis? Fundamentally.

2.- What is the possible Diagnostic Hypothesis for this case? Fundamentally.

3.- Describe the evaluation process you would carry out.

Clinical case 6:
Patient, 31 years old, male, tropical singer who also works as a waiter and personal
trainer. He attends the consultation to improve his vocal technique, since he reports
difficulty reaching high tones and a low amount of air towards the end of his emissions. His
medical history includes low back pain and occasional migraines, which he treats with
migranol. He consumes his last meal between 11 p.m. and 1 a.m. every day. He sings 3
hours twice a week, in a gym where he rehearses with the band. It does not use a
microphone, so it requires a high intensity to be heard. In the evaluation, he had a mixed
respiratory type, with a TME of 32 seconds, FMT of 20 seconds, using abdominal,
scalene, pectoral and trapezius muscles. At low intensity it has 0.5 cm H2O of subglottic
pressure, at its usual intensity it achieves 1.5 cm H2O and at high intensity 4.5 cm H2O. In
the suprahyoid musculature, it presents shortening of the cricothyroid spaces, height of the
hyoid C4 at rest and ascends to C3-C4 during phonation.

Questions

1.- How are your evaluated parameters compared to normality? Explain possible reasons.

2.- Mention which aspects are abuse and which are vocal misuse.

3.- Analyze the sample of /a: / below.

Clinical case 7:

A 40-year-old male patient attended his consultation with the diagnosis of

musculotensional dysphonia with anteroposterior shortening. In the evaluation it is
observed that the subject has a costodiaphragmatic respiratory type and adequate
posture. However, the position of the hyoid at rest is elevated and slightly posteriorized.

Questions

1.- What is the position of the hyoid due to?

2.- What signs or symptoms at the level of voice emission would you expect? Argue.

3.- What muscles are responsible for maintaining the stability of the cervical spine?

Clinical case 8:
25-year-old patient who works as an English teacher. You arrive at your consultation with
the aim of increasing the intensity and duration of your voice. In the anamnesis, he
reported that his voice did not change during the day and he did not mention any signs or
symptoms of vocal fatigue. The voice sounds normal, both in terms of tone, timbre and
intensity.

Questions

1.- What parameters would you consider most relevant in the evaluation?

2.- How would you evaluate each of them?

3.- At the level of normative data, what is normal for subglottic pressure, vocal intensity
and average spoken tone?
Clinical case 9:

45-year-old patient who has been diagnosed with functional dysphonia. In the evaluation it
is not possible to investigate postural balance, since it presents a constant scoliotic
attitude that makes the procedure unreliable. At the respiratory level, it is striking that its
maximum expiratory time does not exceed five seconds. The patient does not report lung
damage or consumption of any medication that reduces muscle activity.

Questions

1.- What musculoskeletal factors would you consider to know the cause of this value?

2.- On average, what is the value considered normal for this parameter?

3.- How are functional dysphonias different from DMT?

Clinical Case 10 (Exam essay)

Female patient, 42 years old, mathematics teacher. The laryngoscopic examination
revealed a bilateral lesion at the junction of the anterior third and posterior two thirds of the
vocal cords, causing grade II dysphonia without the presence of diplophonia.

What type of organic dysphonia is compatible with this vocal cord injury?

A. vocal nodules

B. Contact granuloma

C. Papillomatosis

D. Vocal polyps

E. Sulcus vocalis.
Clinical Case 11 (Exam essay)

A 60-year-old male patient with muscle tension dysphonia (MTD) and depression
secondary to work stress. You must receive speech therapy treatment.

What types of relaxation treatment could you recommend for this type of dysphonia?

A. Schultz Method, Jacobson Method, Sophrology, Chanted Voice

B. Schultz method, Jacobson method, Sophrology, Lax-vox

C. Schultz Method, Jacobson Method, Chanted Voice, Massage Therapy

D. Schultz Method, Jacobson Method, Chanted Voice, Lax-vox, Massage Therapy

E. Schultz Method, Jacobson Method, Sophrology, Massage Therapy

Clinical Case 12
Patient 6 years old, with a history of constant dysphonia. He attends first grade and has
been singing at community festivals since he was 4 years old. His family takes him to the
speech therapist because they want him to learn good “vocal technique.” In the initial
interview, you observe that it is very urgent for the parents that the minor perform all the
requested tasks.

Questions

1. What is the diagnostic hypothesis in this case?

2. Would you make referrals? Fundamentally

3. In addition to the background you handle, what aspect would be important to

evaluate in the family environment?

Answer

1. Vocal nodules due to the minor's constant dysphonia and the activity he performs.

2. Psychologist for parental anxiety and child labor, ENT for vocal diagnosis,
SENAME for child labor evaluation.

3. The aspects of vocal abuse and misuse, history of dysphonia in the family,
medications taken by the minor, environment in which they rehearse (acoustic
level).
Clinical Case 13

A 28-year-old patient, she works as a Physical Education teacher at a school and as a

spinning instructor at a gym. Consultation for dysphonia that increases as the workday
progresses. He comments that at school he works with small children so he must
constantly shout to make himself heard. Her work day at school is from 8 in the morning to
6 in the afternoon. During this day she points out that she literally “does not stop talking”,
since after classes (where she must give instructions and get the attention of the
students), children for their behavior) goes to the staff room where he talks with his
colleagues. In relation to his work at the gym, he points out that he does classes in a
closed environment, where they use air conditioning and that he must give instructions
while doing the class (which generates great physical effort), constantly competing with the
music that is at full volume, it indicates that on occasions he has had to leave class
because his voice cannot be heard. He also says that after class he quickly goes home,
without changing clothes or warming up, which has brought him more than one cold.
In relation to her habits, she admits to drinking little water, she likes to drink coffee more,
since it keeps her awake.

Questions

1. Carry out vocal hygiene guidelines

2. Mention which aspects are abuse and which are vocal misuse.

3. Possible speech therapy diagnostic hypothesis of the patient. Fundamentally.

Clinical Case 14
A 35-year-old woman, she works as a singer in pubs. He consults because he feels that
his voice is no longer the same as always: he indicates feeling “air” in his voice when
singing, less intensity and great difficulty in achieving high notes in his presentations. In
the anamnesis he refers to working from Monday to Saturday, from 9:00 pm to 3:00 am. In
relation to the workplace, he indicates that it is always very full of smoke, despite using a
“very powerful” air conditioning, with a lot of ambient noise because it is filled with people,
who speak at a very high volume. Between the songs he hydrates himself with some
“cocktail” that the bartender prepares for him. Consume very little water. Usually at the
end of the day he ends up singing with great effort, with a burning sensation in his throat,
with constant throat clearing and a dry cough. He complains of constant shoulder and back
pain.

Questions

1. Carry out vocal hygiene guidelines

2. Mention which aspects are abuse and which are vocal misuse.

3. Possible speech therapy diagnostic hypothesis of the patient. Fundamentally.

Clinical Case 15
Patient with initials CR 30 years old, music teacher.
During the anamnesis, he reported that a few months ago, after waking up in the morning,
he woke up with moderate neck pain (this pain is caused by a very small and too soft
pillow, as well as sleeping in a “face down” position).

The patient reports feeling discomfort when speaking since his throat feels tight, which he
compensates by consuming coffee most of the day. He smokes about 2 packs a day.
He doesn't exercise as he spends all day in his office.
He usually goes to night parties on Saturday nights, having an alcoholic intake of around 4
glasses, and mentions going to the stadium every time his favorite team plays or watching
all of their soccer games on television.
The subject reports not consuming water.
He comments that he gets tired repeatedly when speaking, feeling pain and itching at the
laryngeal level, with frequent throat clearing and a foreign body sensation.
Due to the above, he comments that he has to force his voice more and more to be heard
by the class.

Questions

1. Carry out vocal hygiene guidelines

2. Mention which aspects are abuse and which are vocal misuse.

3. Possible speech therapy diagnostic hypothesis of the patient. Fundamentally.

Clinical Case 16

CMA 30-year-old woman, chemistry teacher.

In her classes she usually speaks loudly so that her students can hear her, which results in
a partial loss of her voice at the end of the day.
The patient reports frequent neck and back pain. It has been observed that he carries the
weight of the backpack on one side of his body and that he has no knowledge of how to
care for his spine. Additionally, he also reports bruxism, which has not been treated.
He usually drinks cold drinks before doing the first classes of the day. He reports
consuming coffee and alcohol frequently.
The patient reports talking constantly even when she has a cold. Additionally, she points
out that she is allergic and that she is being treated with rhinoval.
Finally, the patient mentions that she wakes up with a burning sensation in her throat in
the morning and that she suffers from constant heartburn.

Questions

1. Carry out vocal hygiene guidelines

2. Mention which aspects are abuse and which are vocal misuse.

3. Possible speech therapy diagnostic hypothesis of the patient. Fundamentally.

Clinical Case No. 1 Voice Intervention 2013
Clinical Case 17

Female patient, 31 years old, married without children. He comes to his office out of
'curiosity' and because sometimes he feels like he is straining his 'throat' when singing.
He states that he has not studied singing, but that he has been carrying out this activity
for about 5 years, classified as mezzo-soprano by a singing teacher. He sings
approximately 3 hours a day, without performing any routine before or after using his
voice. As problems when singing, he refers to effort (dry throat), difficulty reaching high
tones, tonal breaks when he stops singing (in spoken voice), sometimes loss of
brightness and a noticeable difficulty controlling his voice.

Questions

1. Possible speech therapy diagnostic hypothesis of the patient. Fundamentally.

2. Explain each vocal parameter to be evaluated and indicate how you would find
them. Fundamentally.

3. Mention and explain what other aspects you would evaluate

Answer

1. Disodea. Since their difficulties are in singing voice.

2. TMH: Normal. Ext. Tonal: reduced. Brightness: tendency to be strident. Light

color. Resonance: oral-pharyngeal. There should be no major alterations in the
spoken voice parameters.

3. Anamnesis, respiration (structures and functions: dorsal vertebrae, muscles,

respiratory type, respiratory mode, TME)
Clinical Case No. 2 Voice Intervention 2013
Clinical Case 18

Initial BA patient, male, 19 years old, 1st year theater student. He came to the
consultation as a referral from a voice teacher, due to excessive tension in the jaw and
increased dorsal curvature, which made his voice work difficult. As a medical history, he is
allergic to 'almost everything', manifesting it in respiratory and dermal ways. He also
reports presenting GER without treatment. He describes his voice as hoarse, clogged and
unclear. He defines his personality as shy and does not talk much. In the postural
evaluation, a large head forward, increased dorsal curvature, and elevated right iliac crest
were evident. Decreased cervical flexibility ranges, shortening of the pectoralis major,
minor and latissimus dorsi muscles. As vocal parameters, the patient presents a TH in
C2, tonal extension from F#1 to D3, timbre with mixed resonance (oral and hypernasal),
with opaque mordant and dark color. His voice is not stable, it presents variations in tone
and intensity.

Questions

1. Explain what a /a: / for this patient would be like in PRAAT. Fundamentally.

2. What is the Diagnostic Hypothesis for this case? Fundamentally

3. How does contracture of the pectoralis major and minor muscles affect breathing?
Fundamentally.

Answer

1. Possibly with a nasal formant, breaks in tone and variations in intensity, poorly
defined formants, undefined harmonics and more present in the middle
frequencies.

2. Dysphonia secondary to muscle misuse or Functional Dysphonia due to triggering

factors.

3. It mainly affects the mobility of the rib cage (flexibility) causing less expansion of
the thorax and, therefore, an increase in inspiratory muscle overstrain.

Clinical Case No. 3 Voice Intervention 2013

Clinical Case 19
Patient, 31 years old, male, tropical singer who also works as a waiter and personal
trainer. He attends the consultation to improve his vocal technique, since he reports
difficulty reaching high tones and a low amount of air towards the end of his emissions.
His medical history includes low back pain and occasional migraines, which he treats with
migranol. He consumes his last meal between 11 p.m. and 1 a.m. every day. He sings 3
hours twice a week, in a gym where he rehearses with the band. It does not use a
microphone, so it requires a high intensity to be heard. In the evaluation, he had a mixed
respiratory type, with a TME of 32 seconds, FMT of 20 seconds, using abdominal,
scalene, pectoral and trapezius muscles. At low intensity it has 0.5 cm H2O of subglottic
pressure, at its usual intensity it achieves 1.5 cm H2O and at high intensity 4.5 cm H2O.
In the suprahyoid musculature, it presents shortening of the cricothyroid spaces, height of
the hyoid C4 at rest and ascends to C3-C4 during phonation.

Questions

1. How are your parameters evaluated compared to normality? Explain possible

reasons
2. Mention which aspects are abuse and which are vocal misuse.
3. Discuss the sample of /a:/ below.

Answer
1. TME: increased, TMF: normal, support: inadequate. PS: decreased at all
intensities. Hyoid height: elevated.

2. Abuse: medications, last meal time. Misuse: singing without a microphone.

3. Oscillogram. Waveform: inconsistent. Hard phonatory start. Contours: irregular.

Spectrogram. Tone: 144Hz, stable. Harmonics: present throughout the entire
emission, in low, medium and high frequencies. Formants: F1 – F5. Without
subharmonics and presence of noise in the emission, more so in the high
frequencies.
CLINICAL CASE N°1 INTERVENTION IN VOICE JANUARY 2014
Clinical Case 20

Patient 26 years old, single. Consultation for difficulties in his articulation and voice. She
works as a waitress in a bar, 3 nights a week. He consumes cigarettes frequently, as well
as alcohol every weekend. Among the symptoms in his voice, he reports constant throat
clearing and cough. In the voice evaluation, his hyoid height is at C4, contracture of the
thyrohyoid and cricothyroid muscles with reduction of the respective spaces.

Questions

1) Indicate possible Diagnostic Hypothesis. Justify

2) Explain how cigarette smoking affects voice production.

3) Mention 2 initial aspects that should be addressed in the treatment. Justify

Answer

1. Dysphonia secondary to vocal misuse and abuse, due to the patient's work, the
consumption of cigarettes, alcohol, throat clearing and cough

2. Because tobacco increases the amount of secretions at the respiratory mucosa

level, lowering the TMH and leaving the cords more exposed to injury.

3. Vocal Hygiene: because it presents vocal abuse and misuse behaviors that affect
the production and use of the voice. Laryngeal Manipulation: since the evaluation
presents shortening of extrinsic laryngeal spaces and contracture of laryngeal
muscles.
CLINICAL CASE N°2 INTERVENTION IN VOICE JANUARY 2014
Clinical Case 21

A 42-year-old patient comes to your consultation by referral from the ENT with a small
polypoid lesion in the right vocal cord and a nodular lesion due to contracoup in the left
vocal cord. Upon entering the consultation for the first time, you notice that the patient is
quite worried about her problem, she appears restless and anxious about the intervention
time and the improvement in her vocal quality, which, according to what she says, is very
deteriorated. She works as a secretary.

Questions

1) Indicate the patient's diagnosis. Justify

2) Mention referrals you would make with the patient. Justify.

3) Mention 2 facilitating techniques you would use.

Answer

1. Dysphonia secondary to organic injury or functionally based organic dysphonia,

since it is based on what was diagnosed by the ENT. In the case of the second
diagnosis, the patient's own characteristics could have led to hyperfunction and
thus generated an organic lesion.

2. Psychologist due to excessive concern about the problem and anxiety.

3. Laryngeal manipulation, relaxation, humming (mastication), elimination of abuse.

CLINICAL CASE N°3 INTERVENTION IN VOICE JANUARY 2014
Clinical Case 22

27-year-old patient, Industrial Civil Engineer, guitarist for 19 years and secondary voice in
a band. He presents recurrent episodes of allergies (respiratory), even more so in the
spring. He has pain in his shoulders and back, which is constant and increases depending
on the hours he plays the guitar. When you wake up, you find your voice hoarse and
'raspy'; when you use your voice excessively (singing), you present symptoms such as
itching and dryness associated with vocal fatigue.

Questions

1) Mention step by step the elements of a respiratory evaluation.

2) Define vocal fatigue.

3) Mention referrals you would make with the patient. Justify.

Answer

1. First is to evaluate the structures (vertebrae, joints, spaces, at rest); pump and
bucket handle movements, muscles in motion; respiratory parameters (type,
mode, TME, respiratory support, subglottic pressure).

2. It is the inability to use the voice for long periods of time, without changing or
losing the vocal timbre that is normally used when making sounds (speaking or
singing). It is related to the capacity of the phonatory apparatus to resist the
demand or vocal load of the subject.

3. Kinesiologist for postural alterations; ENT due to allergy; singing teacher

CLINICAL CASE N°4 INTERVENTION IN VOICE JANUARY 2014

Clinical Case 23

30-year-old patient with bruxism and low back pain. Describe the problem 15 years ago,
where after talking for more than 1 hr. presents a feeling of worn out voice and pain. His
biggest concern is in his work where he must hold conferences via Skype which last at
least 2 hours. He has set meal times, drinks plenty of coffee, and smokes marijuana every
night so he can fall asleep. He has had depression on 3 occasions, all treated with
medication.

Questions

1) Name 3 modifications you would make to the patient's environment to improve the
use of their voice.

2) Hierarchize the contents to be addressed in the intervention

3) Mention how bruxism can affect your voice production.

Answer

1. Access to a microphone for conferences, eliminate possible air conditioning or

other factors that influence temperature changes, change sleeping positions
(previous referral for a relaxation plan), advance the time you sleep.

2. Postural, respiratory intervention (strength, flexibility) and vocal parameters.

3. Bruxism causes elevation of the hyoid and larynx, changes in the position of the
tongue, among others. As a consequence, it generates imprecise articulation, poor
oral resonance, and low vocal projection; added to changes in the acoustic quality
of the voice.

Clinical Case N°1 - Voice Area January 2015

Clinical Case 24

Female patient, teacher, 45 years old, married with three children. Workday of 30 hours of
classes in a girls' high school. He had a sudden loss of voice 6 days ago and did not
recover it over the weekend, blown vocal quality (++) and roughness (+). High cost
respiratory type, laryngeal tension, phonorespiratory incoordination, TMF: 9 sec., TME: 27
sec. TMH of 200 Hz, pitch extension of 18 semitones and frequent voice variations during
the anamnesis. In a speech test with auditory masking, his voice was of normal quality. At
his school he takes shifts during recess, smokes 2 cigarettes and consumes 3 cups of
coffee daily. In NFL there is no exudative lesion of the lamina propria, a longitudinal hiatus
and a normal posterior commissure are observed.

Questions

1) Indicate speech therapy diagnosis and justify your answer.

2) Select therapy approach(es). Justify.

3) Point out hierarchically raised objectives of the Speech Therapy therapeutic plan.

Clinical Case N°2 - Voice Area January 2015

Clinical Case 25
Male patient, 23 years old, single, engineering student, the youngest of 4 siblings. He
reports loss of voice in his dissertations and particularly with tonal breaks. It presents
rough (+) and blown (+) vocal quality, mixed respiratory type, moderate laryngeal tension,
adequate phonorespiratory coordination, phonatory time /a/ = 20 sec., /s/ = 30 sec. 195hz
TMH. With a tonal extension of 24 semitones. He plays sports with moderate effort, drinks
occasionally on weekends and smokes sporadically.
He was referred at the insistence of his university classmates to consult about his type of
voice. On NFL examination, there was no injury to the lamina propria and a glottic closure
defect was observed with an elevated larynx and mild inflammation of the posterior
commissure.

Questions

1) Indicate speech therapy diagnosis and justify your answer.

2) Point out hierarchically raised objectives of the Speech Therapy therapeutic plan.

3) Describe 3 activities you could work on the patient

Clinical Case N°3 - Voice Area January 2015

Clinical Case 26
Female patient, 42 years old, teacher, with gradual loss of voice for 4 months, vocal
quality blown (+) and tense (+) with fatigue when speaking. It presents upper costal
respiratory type, excessive laryngeal tension, inadequate phonorespiratory coordination,
phonatory time /a/ = 14 sec., / s / = 21 sec. It has a spoken midtone of 235 Hz and a tonal
extension of 36 semitones. A carrier of gastroesophageal reflux, she drinks 5 cups of
coffee daily and at her school she has to carry out checks in the student cafeteria. .
On NFL examination, he showed posterior hiatus, without supraglottic contraction and
mild erythema in the posterior commissure. In vocal acoustic analysis using PRAAT it
presents F0= 225 hz., jitter= 0.47%, Shimmer= 3.5%. HNR= 13 dB

Questions

1) Indicate speech therapy diagnosis and justify your answer.

2) Point out hierarchically raised objectives of the Speech Therapy therapeutic plan.

3) Describe the results of acoustic analysis.

Clinical Case N°4 - Voice Area January 2015

Clinical Case 27

Patient 45 years old, married, has worked in a mine for 20 years. He consults ENT due to
problems with his voice. He says that his problem has increased recently and he has
started to feel pain, difficulty swallowing and dyspnea. I had not consulted an ENT or
speech therapist before. Dysphonia does not decrease with rest and remains constant
throughout the day. He reports that he is allergic to dust and is being treated with
medications which he took for a few months. He has smoked 6 cigarettes a day since he
was 18. He doesn't consume much fluid. NFL was performed, right vocal fold with normal
appearance and mobility, in the left hemilarynx a large lesion with a whitish appearance
and irregular shape was seen. Shortened TMF, phonorespiratory incoordination. R (2), A
(2), S (1), A (0), T (1).

Questions

1) Indicate speech therapy diagnosis and justify your answer.

2) Point out hierarchically raised objectives of the Speech Therapy therapeutic plan.

3) Describe perceptual analysis results.

Clinical Case N°5 - Voice Area January 2015

Clinical Case 28

Patient 46 years old, male. He has been a pastor in an evangelical church for 10 years.
He consults due to difficulty speaking and that it prevents him from performing adequately
at his job. He says the problem started gradually and at first he just felt short of breath.
With rest he recovered his voice, but lately it has been increasing, presenting
odynophonia and great tension at the cervical level. He points out that he talks a lot
during the week and at a high intensity due to preaching at church. He also likes to sing
and participate in different choirs, but he says he no longer has the voice for that. He does
not smoke or drink alcohol. Consume 1 liter of water a day. Suffers from gastric acidity.
On NFL examination, vocal cords with adequate mobility, a unilateral lesion was observed
in the vocal process of the right arytenoid. There are also signs of RFL.

Questions

1) Indicate speech therapy diagnosis and justify your answer.

2) Point out hierarchically raised objectives of the Speech Therapy therapeutic plan.

3) Point out suggestions and possible referrals.

Clinical Case 29

Paula is a preschool educator at a JUNJI school where she works 44 hours a week with
extended hours. For some time now he has noticed that the quality of his voice has
drastically decreased, causing him difficulties in his work environment. For this reason, he
attends the ACHS to undergo a speech therapy evaluation. Within this, a vocal evaluation
guideline is applied. In addition, a referral to an ENT specialist is requested to perform a
functional examination and confirm or rule out any associated pathology.

Questions

1. Indicate speech therapy diagnosis and justify your answer.

2. Point out hierarchically raised objectives of the Speech Therapy therapeutic plan.

3. Point out suggestions and possible referrals.