Inspiratory speech as a management option for spastic dysphonia. Case study

A case study is reported of a subject who has used inspiratory speech (IS) for 6 years as a means of overcoming the communication problems of long-standing adductor spastic dysphonia (ASD). The subject was studied to confirm his use of IS, determine the mechanisms of its production, investigate its effects on ventilatory gas exchange, and confirm that it was perceptually preferable to ASD expiratory speech (ES). Results showed that the production and control of a high laryngeal resistance to airflow were necessary for usable IS. Voice quality was quantitatively and perceptually poor; however, the improved fluency and absence of phonatory spasm made IS the preferred speaking mode for both the listener and the speaker. Transcutaneous measurements of the partial pressures of oxygen and carbon dioxide in the subject's blood were made during extended speaking periods. These measurements indicated that ventilation was unchanged during IS, and that ventilation during ES was similar to the "hyperventilation" state of normal speakers. The reasons for the absence of phonatory spasm during IS are discussed, and the possibility of its use as a noninvasive management option for other ASD sufferers is addressed.