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ABSTRACT
Background:
Parathyroid adenoma is a benign endocrine neoplasm that constitutes the most common cause of primary hyperparathyroidism (PHPT) (Bilzerian et al., 2018; Silverberg & Walker, 2014). While its systemic manifestations are well recognized, its impact on phonatory and laryngeal functions remains underreported (Mehanna et al., 2009). Parathyroid lesions, particularly those located adjacent to the recurrent laryngeal nerve (RLN), may result in transient or persistent dysphonia through mechanical compression, neural irritation, or metabolic neuromuscular imbalance (Dionigi et al., 2016; Herrmann et al., 2018). This case report provides an in-depth evaluation of perceptual, acoustic, and aerodynamic voice changes in a patient with right-sided parathyroid adenoma and the outcome of structured voice rehabilitation following surgical management.
Case Presentation:
A 60-year-old male presented with a two-month history of hoarseness, reduced loudness, and vocal fatigue. Laryngoscopic evaluation revealed right vocal fold sluggishness with a mild phonatory gap. Laboratory findings showed elevated serum calcium (11.8 mg/dL) and parathyroid hormone (128 pg/mL), and imaging localized a right inferior parathyroid adenoma (Mannstadt et al., 2017). Preoperative voice analysis demonstrated moderate dysphonia (CAPE-V = 90%), reduced maximum phonation duration (6.36 s), and increased jitter (4.25%), shimmer (14.54%), and noise-to-harmonic ratio (7.47 dB) (Boersma & Weenink, 2023). A diagnosis of dysphonia secondary to parathyroid adenoma was established.
Intervention:
The patient underwent focused right parathyroidectomy with intraoperative RLN monitoring (Garas et al., 2018). Post-surgical rehabilitation comprised 16 structured voice therapy sessions over two months, focusing on diaphragmatic breathing, resonant voice therapy, circumlaryngeal massage, and vocal hygiene education to enhance respiratory-phonatory coordination and reduce laryngeal
tension (Stemple et al., 2014; Verdolini & Ramig, 2001).
Outcome:
Post-therapy assessment indicated significant improvement in all vocal measures. CAPE-V scores normalized, MPD increased to 14.2 seconds, and acoustic parameters improved (Jitter: 0.42%, Shimmer: 3.10%, HNR: 20.25 dB). Laryngoscopy revealed bilaterally mobile vocal folds without phonatory gap, and the patient reported complete resolution of hoarseness and vocal fatigue, confirming successful phonatory recovery (Behrman et al., 2008).
Conclusion:
This case underscores that parathyroid adenoma can induce secondary voice disturbances through RLN compression and biochemical dysregulation. Early detection of dysphonia and a multidisciplinary approach combining endocrine, surgical, and speech-language rehabilitation perspectives are crucial for optimal outcomes (Randolph et al., 2021; Terris et al., 2020). Speech-language pathologists play a pivotal role in assessing, rehabilitating, and preventing long-term pho natory sequelae in endocrine-related voice disorders (Thomas et al., 2019).
Keywords:
Parathyroid adenoma, recurrent laryngeal nerve, dysphonia, hyperparathyroidism, voice therapy, CAPE-V, acoustic analysis.
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