Question
I will be receiving a referral for a speech therapy evaluation of a patient (an inmate in a correctional facility) status/post thyroplasty, presumably for voice and swallowing issues. Can you please tell me how I begin this evaluation, what tests or measu
Answer
This is a fairly general request but let me suggest a few options. Thyroplasty has presumably been applied by an otolaryngologist to close a glottal gap that is unremitting. The reason for the gap is unknown at this point. To begin with you would need to ascertain the effectiveness of the true vocal cord closure. Can the patient approximate the True Vocal Cords (TVCs)? If the thryroplasty was successful and TVC is achievable, patients (in most cases) go on to improve their voice production and swallow successfully without much intervention.
The best method of evaluation for this is by direct inspection via Transnasal endoscopy. Through this method you can ascertain TVC closure both anatomically and acoustically- as well as check the closure patency for swallow at the same time. If this is not available to you -traditional acoustic analysis may assist you.
Depending on the nature of your findings, and the patients prior medical history- you may need to offer the patient some voice therapy activities to maximize closure - activities usually focus on reducing previously learned bad vocal habits - such as supraglottic constriction, or simply increasing effort of phonation to improve glottal closure for voicing.
If a swallowing issue persists post thyroplasty (i.e. coughing on liquids) this is usually indicative of incomplete TVC closure, new disease, incoordination due to other perhaps neurological sequelae, progression of disease, or failure of the thyroplasty to close the gap. All of which really need direct visual inspection.
Please visit SpeechPathology.com and browse our courses to learn more about this topic and to view a variety of live, recorded and text-based courses in the field.
Giselle Carnaby-Mann is an Associate Professor in the Department of Behavioral Science and Community Health and Co director of the Swallowing Research Laboratory at the University of Florida. She has over 20 year's clinical experience as a Speech Language Pathologist working in adult swallowing disorders. Dr Carnaby-Mann's research focus lies in the rehabilitation of swallowing disorders following Head / Neck Cancer and Stroke. In addition, she specializes and teaches in research epidemiology, and biostatistics. Dr Carnaby-Mann is active in numerous research projects in the areas of swallow physiology, treatment and health outcome measurement. She has attracted continuous research grant funding since 1994, and is currently funded by both the American Cancer Society (ACS) and the National Institutes of Health (NIH). She is the recipient of the life time ACS scholar award.
Giselle Carnaby-Mann Mph, Ph.D,CCC
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