JW, who is a 40-year-old recruitment consultant, suffers a condition following a thyroidectomy. A weak and rough voice characterized the early signs and symptoms of his conditions immediately after this thyroidectomy. Besides, owing to the fact that his day today role usually involves considerable use of his voice, his voice is both unstable and breathy and happens to worsen after talking. Another symptom of his voice condition is exemplified in the fact that with longer periods of voice use, JW experiences some form of aching in his throat.
By definition, voice is the sound that the listener perceives when the adducted vocal folds are driven into vibration by the pulmonary air stream (Watts, 2016). This being said, JW's current voice problem can be explained using the myoelastic-aerodynamic theory of phonation which explains the vocal fold oscillation (Rosenberg, 2014). According to the theorists, this current theory is based on the premise that Bernoulli forces or better known as negative pressure cause the vocal folds to be sucked together, and this created closed airspace below the glottis. Thus, based on this premise, the theory is that normal vocal fold vibration involves the coordination of muscle tension as well as breath pressure. According to this theory, the elastic muscular movement of the structures composing the vocal mechanism is also crucial, and the entire process is dynamic involving movement and change (Ebersole, Soni, Moran, Lango, Devarajan, & Jamal 2017).
Additional Information You Would Seek From JW and Outline Your Assessment Plans With Appropriate Rationale
With regard to JW's case, there are a couple of areas that require further investigations. For instance, as a medical professional, more information ought to be provided with regard to JW's condition after the flexible nasendoscopy which revealed a right vocal fold palsy in the paramedian position. In particular, JW's General Practitioner based his diagnostic procedure on the flexible nasendoscopy, which is the primary examination technique for the upper aerodigestive tract. Besides, further investigation is appropriate for the examination of the results of the nasendoscopy which revealed a right vocal fold palsy in the paramedian position.
Vocal Fold Palsy in the Paramedian Position
Better known as vocal fold paresis or paralysis, scholars contend that the vocal fold palsy is as a result of an abnormal nerve input into the voice box or the larynx muscles, which are referred to as the laryngeal muscles. Following this condition, paralysis is said to be the total interruption of the normal nerve impulse which results in no movement. On the other hand, and with reference to JW's case, paresis is said to be the partial interruptions of the nerve impulse and unlike the paralysis, Petty (2013) contends that this results into a weak or an abnormal motion of the laryngeal muscles. More fundamentally, Kapsner-Smith, Hunter, Kirkham, Cox, & Titze (2015) explain the process of a vocal fold paralysis giving the process of the entire formation process. A human being's vocal folds are usually inside the larynx. When a person talks, air moves from the lungs through the vocal folds to the mouth, and during this process, the vocal folds vibrate and sound is produced. Therefore, building upon this particular conceptual base, more information can be learnt about JW's situation in the sense that, his voice disorder and complications might have been as a result of a condition that made it harder for the vocal folds to vibrate. Besides, Van Leer & Connor (2010) contend that a palsy, similar to that of JW, may happen when one, either the right or the left, or both folds are not able to move. In a similar regard, this condition may also cause breathing and swallowing problems for the patient.
Treatment of Vocal Fold Paralysis
Owing to the fact that there is both a bilateral and unilateral vocal fold paralysis. Scholars contend that there are two very different methods of treatment. For instance, in the case of bilateral paralysis, Ahlander, Rydell & Lofqvist (2012) point out that the causes and symptoms are deemed a lot more serious than those of the unilateral vocal fold paralysis, and for this reason, one requires special medical treatment. To treat this condition, one may need to have a tracheotomy to enhance their eating process. Also, there is some existing literature which points out that one may also need to undergo a surgery process which helps to bring one or the two vocal folds closer to the middle.
JW's condition is a unilateral paralysis owing to the fact that the flexible nasendoscopy revealed a vocal fold palsy only on the right side. To treat JW's condition, the treatment process might include a muscle-nerve transplant, or in some cases, this may need surgery to move the paralysed fold towards the middle. According to modern day literature, to treat JW's condition, something might be injected into the paralyzed fold to make it larger. This, in essence, will allow the other fold to move closer to the paralyzed one and hence rectifying the patient's voice. Nonetheless, in cases where the palsy is mild, the patient may go through voice therapy. In many cases, the voice therapy includes working with a Speech Language Pathologist (SLP), who helps in changing one's pitch and also helps the patient in getting more breath support to speak louder. Thus, in the case of JW, who has already undergone surgery, the specialist may want him to try voice therapy to rectify his right vocal fold palsy, before seeking another surgery or any other intense medical treatments (Bankoski, Salim & Faigen, 2014).
Assessment Plans Supported By Appropriate Rationale
According to the case study, JW's chief complaint is that he reports having noticed a change in his voice six weeks after undergoing total thyroidectomy. More specifically, JW complains about weakness and roughness in his voice that has been persistent since he woke up from his surgery six weeks ago. Despite the fact that he is eating well, the patient complains of some occasional coughing whenever he drinks quickly.
Patient's medical history
With regard to JW's medical history, the changes noted in his voice happened after undergoing total thyroidectomy. Although not much has been said about his overall medical history, JW seems to have had an issue that led to his thyroidectomy surgery. Currently, JW is on Thyroxin since he has reported feeling a little lethargic. Also, his current medical diagnosis which involved a flexible nasoendoscopy indicated a right vocal fold palsy in the paramedian position. Based on this context, on adduction, JW's vocal fold closure is noted to be incomplete, and a little supra-glottic constriction accompanies this.
Relevant personal Information
JW is a 40-year-old recruitment consultant whose day to day work routine involves considerable use of his voice. Besides, he is a father of two young sons and also works as a coach of a junior football team.
The Family History
JW is a father of two young sons and does not report any cases of voice disorders in his family history.
The Review of Symptoms/systems (ROS)
General/ Constitutional: The patient reports significant changes in his voice after undergoing thyroidectomy. A rough and weak voice characterised this immediately after his surgery.
Head, Eyes, Ears, Nose and Throat: Nothing was reported about the head, eyes, and the ears but his nose and throat have proven to be problematic. For instance, although JW eats quite well, he has reported occasional coughing when he gulps something down. A significant problem in his throat. Besides, his General Practitioner (GP) decided to monitor his thyroid function through a thyroxin since JW reports to be feeling a little lethargic.
Cardiovascular: No significant findings were reported about is hearth or its functions.
Respiratory: After his diagnosis, JW did not have any chest infections or any other signs of aspiration. However, his voice is reported to be breathy and unstable, and this condition worsens with talking.
The Physical Examination (PE)
JW's PE is inclusive of the vital signs that are noticeable from a physical point of view. For instance, following the current clinical observation, JW's oral cavity was normal, his neck examination was okay, and his surgical scar was healing appropriately and was tender to touch.
Summary Statement: JW is a 40-year-old recruitment consultant who has previously undergone total thyroidectomy and hence his current voice disorder. A right vocal fold palsy also characterises his condition in the paramedian position.
Outline a management plan which reflects both a medical and social model of disability. This should address impairment, activity, and participation of the ICF while considering personal and environmental factors.
By definition, a medical management plan is a collaborative process which facilitates the recommended plans to assure the appropriate medical care is provided to the ill, disabled or the injured. In such a case, the management of JW's condition would involve planning his coordination of health care services that are effective for achieving the set goals of medical rehabilitation. According to the Stanford Encyclopedia (2016), there are different understandings of the relationship of impairment to the limitation which inform both the medical and the social models.
Regarding JW's voice disorder condition, the medical model understands his condition, or his disability as a physical impairment of him as a patient as well as the social and personal consequences of this condition. More fundamentally, this model involves the limitations faced by people with certain conditions of disabilities which primarily result or solely result from their impairments. Based on this premise, and with reference to JW's condition, the limitations that he faces are such as the inability to speak well, which is exemplified by how he associates aching in this throat with longer periods of voice use. On the other hand, the social model considers illness or disabilities as the relation between an individual and her social environment. More fundamentally, this is taken to mean the exclusion of the people who have certain physical and mental characteristics from the major domains of social life. Nonetheless, the people's exclusion is manifested not only in deliberate segregations, but in a built environment as well as an organized social activity which primarily preclude or even restrict the participation of people seen or labelled as having these disabilities. Based on this context, JW's condition can be interpreted with the social model owing to the various limitations that he faces after his surgery. For instance, being a recruitment consultant, JW is unable to go about his usual day activities which involves a lot of talking.
According to scholars, the main causes of a certain voice condition primarily determine the management of the condition. For instance, in the case of JW, the doctors and SLPs ought to consider his thyroidectomy as the main cause of his voice condition. In this regard, his doctor or the GP ought to come up with the best plan possible for improving the patient's voice. This, in essence, comprises of the person's management plan. In a similar regard, a growing body of literature has increasingly substantiated that taking care of one's voice will always be important even after the patient's dysphonia has been resolved. Thus, with reference to this contextual base, all steps in the management plan will be inclusive of proper care of the voice or even effective vocal hygiene (Weebly, 2018).
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