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Voice Case of the Week: Who Needs a Laryngeal Surgeon?

About Dr. Reena Gupta

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at OHNI. Dr. Gupta has devoted her practice to the care of patients with voice problems. She is board certified in otolaryngology and laryngology and fellowship trained in laryngology, specializing in the care of the professional voice.

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About Dr. Ryan Osborne

Ryan F. Osborne, M.D. is the Director of Head and Neck Surgery at OHNI and is an internationally renowned expert in head and neck oncology. He has developed a special interest for the treatment of parotid gland tumors and focuses on the use of minimally-invasive techniques in the care of patients needing parotid surgery.

The patient is a 34 year old male professional singer who presented with difficulty in his vocal break. His speaking voice sounded slightly raspy to him but more troublesome was that he could not do his vocal exercises as easily as he used to be able to. He noted the onset of his symptoms after a cold. During his illness, he had an important gig and so he did the show but had to push through it to perform.

As you may be able to hear on the following exam clip, his speaking voice was close to normal.

However vocal task testing unmasked the compensation that he was using to make his problem less audible. This is what he sounded like on vocal glides:

Videostroboscopy was performed:

vocal-polyp

Stroboscopy demonstrates a hemorrhagic polyp of the left vibratory margin. A trial of vocal therapy was recommended. However, he was counseled that therapy very rarely results in a resolution of a polyp. It was suggested that he still complete the full trial but with the mindset of helping him develop good techniques for recovery after surgery.

On the day before his surgery, he was scheduled for a pre-operative repeat strobe. This is my standard protocol, to ensure that there are no surprises during surgery. He noted he was feeling much better vocally and was having second thoughts about surgery. I was glad to hear this and felt even more resolute about taking another look at his vocal cords. This is his repeat strobe:

vocal-polyp-treatment

Amazingly, his polyp is completely gone. While there is still some residual stiffness and hypervascularity, it is an incredible result. We happily cancelled his surgery and will be following him over time.

This case demonstrates the remarkable effects that may be achieved through vocal therapy, when done by a skilled therapist. When we go even further back, it also demonstrates how important task testing is to elicit vocal findings. His referring vocal coach did not hear any significant hoarseness in his speaking voice, and neither did we. However when she had him glide, she heard something beyond what would be expected from poor technique alone. Her intuition to not continue to work with him but rather to send him for an evaluation is what resulted in him getting the care he needed.

To learn more about Dr. Reena Gupta or comprehensive vocal evaluation, please visit www.voicedoctorla.com.

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