Experts Discuss How to Approach Challenging Dysphonia Cases

by Thomas R. Collins •

Dr. Johns added, “It’s important to make sure the patient knows that they have a diagnosis. Because otherwise if they aren’t very clear that they have a diagnosis, then they’re going to leave the office and they’re going to go home and say, ‘They found nothing wrong,’” and probably won’t do what they need to do to get better.

Dr. Courey said it is important to describe the root of the problem. “Learning how to use your vocal folds efficiently,” he said, “you have to recognize the cause of how the inefficiency started.”

In cases when essential tremor is possible, panelists said, prolonged phonation, laryngoscopy at glottic and non-glottic sites, and a good family history are important tools. “Patients are exceptionally good at masking tremor during free-running speech,” Dr. Johns said. “You really need to push these patients for prolonged phonation. You’ll hear tremor, and patients who even have subtle tremor will stop phonating when they start hearing the tremor. You really have to push them.”

Thomas R. Collins is a freelance medical writer based in Florida.

Take-Home Points

  • Listen to patients perform non-voice laryngeal tasks to evaluate their range before assessing them with an endoscope.
  • In cases of possible scarring, a good patient history can often be telling.
  • When it comes to delicate conversations about muscle tension dysphonia, telling patients their voice mechanics are simply in a “bad posture”—but a fixable one—can be helpful.
  • Prolonged phonation is critical in assessing patients for possible essential tremor.