CASE STUDY # 3
PUBLIC SPEAKER WITH SUDDEN LOSS OF VOICE
THE STORY
This motivational coach and public speaker had noted his deteriorating voice, worse when he was out at a networking event. He has a history of losing his voice at these types of events but it usually returns. This time, it hasn’t returned and he is worried because he cannot project his voice easily and he sounds very weak.
Configuration of laryngeal muscles during soft volume phonation
More muscular compression of laryngeal muscles during loud (projected) voice use
NOTES
Using your voice in a noisy environment may lead to injury
A raspy voice may indicate an injury
Signs of Injury include prolonged recovery, frequent voice loss, and voice fatigue because the voice is less efficient when it is injured
Public speakers are at high risk for vocal injury due to the volume, duration, and frequency of voice use
Professional speakers often speak at a raised volume. A raspy voice is often acceptable in public speakers (i.e., politicians). However, a hoarse voice is not just harsh to listen to. It indicates injury which produces an inefficiency that is very fatiguing for the speaker. The goal is to improve the quality of the voice, make it easier to use, and educate the patient about how best to use their voice.
The goal is to improve the quality of the voice, make it easier to use, and educate on best practice.
THE BREAKDOWN
Pre-operative stroboscopy shows a granuloma
Postoperative stroboscopy shows non-surgical resolution
While public speakers can more easily “get away” with hoarseness than singers and actors, they often feel very fatigued by their voice demand. Micro-injury accumulates as they speak loudly and at back-to-back events, resulting in an increasingly raspy voice. This is irreversible and can make it difficult to continue public speaking.
Early intervention is critical to improve the speaker’s awareness of technique, how to schedule speaking gigs, and to recognize injury. Aggressive management of medical problems, like allergies and reflux, improves the health of the vocal cords, making them more resilient. This patient had significant reflux, which made his risk of injury much higher and caused the formation of a vocal granuloma. Managing this aggressively helped to reverse the injury.
This patient was fortunate their voice worsened suddenly, so they came for evaluation and treatment. The injury was managed and vocal hygiene and voice protection were addressed. This has led to an improved voice, comfort during speech, and enhanced longevity for this very public figure.
CHALLENGES AND CONSIDERATIONS
CO-EXISTING MEDICAL PROBLEMS
Many medical problems increase the risk of vocal injury or cause vocal inefficiency. Inefficiency is caused by swelling of the vocal cords, making the speaker push their voice. This may cause injury.
When correctly identified, the management of medical problems can significantly improve vocal ease, voice quality, and reduce the risk of injury.
VOICE USE WHILE SWOLLEN
The management of medical problems is complex, as some treatments have side effects on the voice. It can take time for medical issues to resolve. If high intensity voice use continues during this time, there is risk of injury. Dr. Gupta managed this patient's medical problem utilizing a two-tier approach for urgent improvement and then gradual resolution, reducing the risk of injury while safely managing the patient’s medical issues.
UNTRAINED VOICE USE
Projected (loud) voice use is strenuous. Most public speakers are untrained in technique to support a projected voice healthfully, and instead rely on forceful vocal cord closure. Reversing this muscle memory as part of the treatment plan will prevent recurrence and improve the speaker’s ease and comfort.