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Valentina Carlile Osteopata
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  • Writer's pictureValentina Carlile DO

Osteopathy and Voice: Functional dysphonia, history of P.

Osteopathy and Voice: Functional dysphonia, history of P.

P. 20-year-old student, presented to my office spontaneously after being seen by the phoniatrician for a voice evaluation. His problem was an intermittent loss of voice accompanied by weakness, fatigue, of the tongue.

The disorder had lasted for about 3 months at the time of consultation.

During the visit P. recounted that the first vocal interruption had occurred about a month after starting school.

The episode had lasted about 2 days and P. had attributed it to a flu that had occurred the week before. The greatest fatigue he had was in beginning words.

Then over time his voice continued to deteriorate, involving difficulty moving his tongue to articulate words. P. had already gone through an ENT examination in which he was told he had laryngitis and was prescribed a course of antibiotics and to rest his voice.

After this treatment, his voice had not improved. Meanwhile, his voice had become difficult to hear. Another otolaryngologist then performed a re-evaluation with a nasal endoscopy, which, however, did not find anything special at the level of laryngitis. At this point he was recommended speech therapy.

P. had previously had no episodes of vocal disorders, did not suffer from reflux, and had no allergies. He had never had head or throat surgery. He was not taking any kind of medication. In the past two months he had increased the amount of fluid ingested. He did not exceed his alcohol consumption and did not smoke.

Slowly the disorder had also affected the relational component as he had difficulty communicating with his friends.

P. was a gym member where he practiced weight training, and the progressive isolation led him to implement gym hours. At the time of the osteopathic evaluation P. was very confused about what was happening to him he was convinced that he now had to live with this disorder.

When he spoke he moved his tongue very little with a resulting impaired articulation. While swallowing, on the other hand, tongue movement would appear.

During functional osteopathic evaluation P. often cleared his voice. On palpation he complained of pain in the lateral and anterior region of the neck, neck stiffness, and dryness.

The phoniatrician had not been able to assess vocal frequency due to voice fluctuation and likewise had not been able to assess range.

However, agony and strain had been rated 5 (severe). One thing that stood out glaringly at evaluation was labored breathing with full recruitment of accessory musculature. On laryngeal mobility tests, the c.cricoid was fully down with no fluctuation in either inhalation or exhalation. The mobility between the hyoid and c.thyroid was comparable to a cogwheel in which the hyoid movement started first and then followed the thyroid movement, which, however, then recovered on the stroke allowing a synchronous end of movement. However, both components moved on an inclined plane with left superiority.

Both diaphragmatic domes that were very stiff without large respiratory excursion.

Equally rigid were all the suboccipital muscles.

Giving corrective inputs to these obtained in P. a feeling of greater fullness and lingual presence. The skull base was worked completely and special attention was given to all neurological emergencies that were very 'sacrificed' by the significant myofascial tension.

The respiratory diaphragms were rebalanced and the laryngeal components were coordinated.

At the end of the osteopathic treatment P. was able to speak not with a normal but well audible, sonorous frequency.

This was followed by 4 osteopathic treatments and a phoniatric examination that reestablished and evaluated the vocal functioning that had been recovered in the meantime.

At the end of this P. was sent to a physiotherapist for postural reeducation, which was followed by a recommendation to modify gym work.

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