12/23/19: I was thrilled that I got to go to the ENT appointment with Matt since I was on Winter Break. Voice has always been a particular interest of mine in the SLP world, but I know that I came by it honestly from having a very musically-talented family (I think we only know how to sing harmonies). It is extremely uncommon for a school-based SLP to have students with voice disorders, but I’ve had TWO–so I’m kind of an expert in my district.
The ENT looks at Matt’s intake chart and comments on his sophisticated terminology: muscle tension dysphonia. Matt points to me and I confess my profession. Matt shares a few more details at the ENT’s questioning: couldn’t hold breath well, felt winded going for a run, some choking on gulps of water, hoarse voice, pain on the right side of the throat (now resolved). I mention STRESS again. The ENT says plainly, “I think it’s a paralyzed vocal cord.” ENT checks Matt’s ears, nose, mouth, and palpates the neck–nothing’s out of the norm.
Time for the scope. I told Matt that I volunteered to be the guinea pig in grad school letting a clinical fellow SLP try out her new scoping skills on me in front of the whole cohort–no big deal! A little lidocaine in the nose and the flexible scope heads to the back of the throat to peek down at the vocal cords.
The ENT asks Matt to make some vowel sounds and sing a scale and swallow and cough (or some variety of vocal cord activities). There is a ton of movement with the right vocal cord and very little to none with the left. Yep, the left vocal cord is paralyzed. It’s what has made Matt’s voice hoarse, allowed water to slip into the airway, and the right cord has been overcompensating and the overworking of that side has been the cause of the pain.
What’s this from? Probably a viral attack on the left recurrent laryngeal nerve (my undergrad studies are flooding back)–kinda like Bell’s palsy. -Yeah, Matt did have a bad cold this fall- It should resolve spontaneously in about 6 months. Or it could be a number of other things–cancer included. The ENT ordered a chest and neck CT just to see if there was anything visible impeding the nerve function.
Matt and I go get a coffee and pastry. Matt is upset: “I don’t like the big words the ENT used.”
“Oh my gosh, I did, it was so cool!”
“CANCER!?”
“Oh, NO! I meant the actual big words like, flexible endoscopic laryngoscopy. You’re fine, it’s not cancer.”
“Well I don’t appreciate how lightly you’re taking this when I’m obviously upset.”
“Sorry.”
Drives home in silence.
Matt & Annie - Journey 