Question
I am a SLP in a public school and a 6th grade girl just came to me about her voice change since her tonsillectomy recently. Not sure how long it's been since the surgery, but I'm guessing not long. Is there a certain amount of time that this can occur and
Answer
Few issues to consider with the 6th grade female after tonsillectomy:
her 'voice' change is actually resonance changes not vocal fold changes so no vocal hygiene is necessary.
if the adenoids were removed as well as the palatine tonsiles, then there could be some velopharyngeal incompetence and hypernasality. If this is the case, palatal strengthening exercises (puff up cheeks, plosive phonemes, etc) would be useful to help the palate adjust to the new depth of the nasopharynx.
If it truly sounds like a voice disorders (ie hoarseness), the resonance issues from the tonsils could have been masking the voice disorders previously and traditional voice therapy would be useful.
Recommended approach:
assess hypernasality with mirror test if no equipment available,
voice evaluation to determine if it is a true voice disorder,
facilitative strategies for voice and hypernasality to identify perceptual qualities that are acceptable,
referral to ENT to evaluate VPI and voice if unable to facilitate acceptable voice/resonance
Lori Lombard, PhD is an associate professor at Indiana University of Pennsylvania specializing in voice and laryngectomy rehab. Previously, seven years experience at the University of Pittsburgh Medical Center.
Lori Lombard, Ph.D
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