T. 8-year-old boy came to my office upon referral from his speech therapist. The reason for the consultation was chronic hoarseness accompanied by intermittent aphonia. His speech therapist had already seen him for three sessions. After the third session he began to question the effectiveness of his treatment due to a lack of progress. T. came to me accompanied by his mother, who was very useful for the clinical history.
T.'s voice has always been hoarse, in memory of his mother. What he had noticed differently was a gradual increase in the effort that T. used to produce the voice, with no particular seasonal correlations. According to Mom, T. didn't seem overly concerned about his ailment, but every now and then she complained that her throat was dry and tired and occasionally, it was hard for him to get his voice out.
An otolaryngologist, who performed a laryngeal rhinoendoscopy before referring it to the speech therapist, reported fullness at the medial margin of both vocal cords in the anterior third, and at the junction of the posterior two-thirds. Furthermore, the phonation was accompanied by an anterior-posterior 'squeezing'.