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A clinical case of polyp to the vocal cords.
The clinical case presented in the following article concerns a modern singer who was diagnosed with a polyp on the vocal cords, following a phonatory effort and the success of the only classical speech therapy treatment in care without intervention.
The accident, which took place in December last year, caused a breaking of the blood vessel and determined the presence of polyp to the angiomous vocal cords, positioned on the right vocal rope with edematous resentment of the edge.
Following the Eziopathogenetic event, the patient immediately accused of the foundation effort, vocal breaks and difficulties in managing the acute register of extension, with loss of the acute register of falsetto and difficulty in the execution of songs. Following the event, the patient turned to the Foniatra for a visit, who confirmed the presence of the angiomous polyp by an effort to the average III of the right CV, and prescribed speech therapy cycle.
Subsequently, the patient came to a speech therapy visit for an evaluation. The speech therapy evaluation aims to identify the patient's vocal characteristics and establish the starting point for the treatment. From control through spectrography, the presence of vocal breaks (breakages) and a phonatory effort, with an unstable and fluctuating product signal is confirmed. The postural evaluation did not show particular problems and the presence of competent diaphragmatic breathing is evident.
In self -assessment, the patient has reported difficulty especially in the physical and functional area but not in the emotional one: however the patient reports a sense of discomfort in living a difficult voice to be issued and with worsening of the fundamental frequency.
To help a better definition of your own voice and internal state, in addition to the evaluation classic process, the self -assessment of self -assessment for the modern singer (CSHI) and the SDA card for awareness on the awareness on Car listening [1], according to a counseling approach. Following a first budget, a 'sandwich' therapy was set (preoperative treatment - operation - post -operative treatment) to prepare the patient for any operation.
The path started with psychomotor relaxation and the setting of correct pneumophonic coordination. At this stage the patient has become aware of his vocal organ and his own psychomotor balance. Subsequently, vocal hygiene and environmental standards were then provided to limit the Surmenage (phonatory effort intended as excessive use), slowly inserting techniques of heating and vocal cooling.
On the level of the vocal army, the patient did not make efforts and mainly worked on the soft attack, on sweet emissions and chewing for the purposes of muscle relaxation of the jaw and to soften the peripheral articulation.
In the exercise, words that begin by vowel have been inserted to encourage the dissolution of tensions at the level of the jaw and a work on the prosody and awareness of the frequency and intensity used.
Being the patient a jazz singer, he expressed his need to work on the registers and in particular on the notes of passage towards the falsetto.
At first I not recommended the work on the cantat to avoid excessive tensions issued in a not properly euphonic situation, however mass exercises have been recommended with small glissted to encourage the stretching of the rope. General relaxation exercises have also been inserted, with rotations of the head and trill according to the protocol of Dr. Mara Behlau.
Finally, further on the course, I inserted some exercise of sovere (exercises in vocal tract semi -occuse [2]) to help the patient in the issue and enhancement of resonances, with excellent findings and feedback on the proprioceptive level. The set of these techniques, provided in order and according to an orderly but not necessarily rigid sequence, have made it possible to achieve excellent results without the need to resort to the surgical operation. The patient feels very satisfied with the path and has carried out everything with motivation and diligence, being also used to vocal didactic work.
In achieving an optimal outcome, the alliance between clinician and patient, linked to the use of a common language and an active listening by the therapist, has certainly played an important role, placing the patient in his environment and planning the treatment keeping account of environmental and contextual situations. On the other hand, the patient has carried out an optimal work independently, driven by strong motivation and the desire to return to sing: during the whole period of therapy, vocal rest, adequately respected, was prescribed.
To date, the polyp at the vocal cords has completely reduced following the visit to the otolary made in May and the use of surgery was no longer necessary, thus confirming the success of the only speech therapy cycle for the purpose of overcoming the organic pathology, beyond that the importance of the human relationship and the collaboration based on empathy and listening between the participants in the care path.
Federica
Speech therapist meda and artistic vocologist
[1] 'Counseling in speech therapy therapy', Annamaria Cimmino, Raffaele Sperandeo, scientific ed. N ° 1, published by ISM, 2010.
[2] 'Voice Quality After Semi-Occ fine Vocal Tract Exercise Witha Fans Mask in Contemporary Commercial Sinters: Acoustic Analysis and Self Assessments', Marco Fantini, Giovanni SuCco, Erika Crosetti, Alfonso Borragan Torre, Roberto Demo, Franco Fussi.
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