Following medialization thyroplasty for a paralyzed vocal fold, which therapeutic strategy is most appropriate?

• A. Digitally manipulating the neck to reduce strap-muscle tension
• B. Assisting the patient to produce a soft glottal attack
• C. Employing techniques aimed at increasing airflow
• D. Assisting the patient to produce a hard glottal attack

Answer: (D)

After medialization thyroplasty, the goal of therapy is to capitalize on the improved glottal closure by training a strong, abrupt onset of phonation. A hard glottal attack achieves this by bringing the vocal folds together quickly at the start of voice, which makes the most of the surgically enhanced closure. This leads to a crisper, more efficient voice with less air escape and better loudness and quality. A soft onset would leave the folds closing more gradually and can result in a breathier, weaker sound, which doesn’t take advantage of the surgical result. Techniques that aim to increase airflow would counteract the benefit of better closure, and neck manual manipulation isn’t a targeted strategy for optimizing phonation after this procedure.