A., 42, came to my office yesterday to have osteopathic counseling for spasmodic dysphonia. The disorder vale of A. has been present for almost three years. It all started about three years ago with a colds laryngitis. From that moment A. began to have dysphonies that manifested themselves more and more frequently and regularly with breaks in the voice, the sound came out but at times. The aggravation was accompanied by vocal lowering. When he came to my office, A. spoke and still speaks in a low voice, this is because to speak in a 'sonorous' way he has to exert a strong effort which then leads to pain in the neck and throat. I asked A. if from the beginning the worsening were still continuing or if it had been like now for a while and he replied that it has been like this for 7-8 months.
In the survey A. reported a very interesting thing: lying down, with his head very bent, he can calmly read a book, even for a prolonged period of time.
I then asked A. if he had already been an ENT / phonologist and he replied that he had changed several of them who had told him at the beginning that he could have an irritation caused by the concomitance of reflux, then a problem of glottic hyperpressure, then he was given a Botox chordal infiltration, all without result and, obviously, the drug therapies were all 'tried', arriving as a last resort to the diagnosis of spasmodic dysphonia.
I then moved on to the osteopathic evaluation. Starting from a cranial listening, the skull showed an RLS with OM compression on the right, associated with a LVS ++ right. The cervical spine was decidedly dysfunctional and rigid in its middle and lower parts, with marked reduction of the curve. The thorax presented clavicle and upper left ribs in supero-anteriority with consequent reduction of mobility of the girdle muscles of the neck on the same side. the thorax was overall very rigid and the diaphragmatic excursion very reduced both anteriorly and posteriorly.
As the last thing I went to do the laryngeal evaluation: the hyoid bone was in the correct position, while the c.thyroid and c.cricoid were clearly inferior. In the mobility tests with breathing aid, a correct hyoid functioning was found, even if reduced, while the thyroid and cricoid performed only the inspiratory flexion without returning to neutrality in exhalation.
All this fully justifies the reason for its interrupted and extremely low sounds.
Osteopathically, the treatment consisted of a cranial normalization and of the thorax-diaphragm-abdomen complex followed by a work of the mobility / synchrony of the vocal box with particular attention to the sterno-cricoid and sterno-thyroid muscle components that were strongly responsible for this strong traction. downwards according to an ascending functional pattern from thoraco-abdominal origin.
At the end of the session the skull had recovered its physiology even if with restricted mobility and the same also the chest which however remained very rigid. As for the vocal box, the correct mobility of the individual components has been recovered, also still with severe restrictions.
I foresee that A. will have to be treated again in 2-3 weeks and in the meantime I have advised him to perform at home the articulation exercises of the language and the sounds that he had been taught by the various speech therapists he had been from (8 months of speech therapy for more than 60 sessions). With those exercises he never had any improvement and indeed, he always had throat fatigue. Now surely, since he is freer, they too will be able to make their contribution to the success of vocal recovery.
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