Case Study #3

Sudden Loss of Voice

This motivational coach and public speaker had noted a sudden loss of voice while 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 raspy.

Soft-phonation

Loud-phonation

Notes

  • Voice use over loud volumes (ambient noise, music) may lead to injury
  • A raspy voice often indicates an injury
  • Injury can show up as 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

Approach

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.

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Details

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 injury is irreversible and can make it very difficult to continue as a public speaker.

Early intervention is critical to improving the speaker’s awareness of how to speak, how to schedule speaking gigs, and how to recognize early 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 a sudden injury. Managing this aggressively helped to reverse the injury.

This patient was fortunate in that a sudden event triggered a worsening that brought them to attention. While the injury was managed, the more important tasks of 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. 

Pre-treatment view

Post-treatment view

Challenges and Considerations

Co-existing Medical Problems

Many medical problems increase the risk of vocal injury or cause vocal inefficiency. Inefficiency is due to swelling of the vocal cords, which the user responds to with increased push. Pushing the voice when there is swelling causes 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. Further, it can take time for the medical issues to resolve, during which time the voice user is still performing at a high intensity, risking 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 reflux.