Voice and Resonance Disorders 77The goal of this implant is to increase the size of the para lyzed vocal cord and move it closer
to the midline so that the normal vocal cord has less distance to travel to approximate it. It was
hoped that this procedure would increase the loudness and improve the quality of Bryan’s voice.
The laryngologist first injected a solution into the vocal cord that eventually would be absorbed
by his system. This was done to determine the amount of permanent solution that would be
necessary to achieve the best voice quality. Later, the correct amount of the permanent solution
was injected into the para lyzed vocal fold. This procedure significantly improved Bryan’s voice.
His conversational and shouted loudness increased by several decibels, and his voice quality
improved. Several more voice therapy sessions were conducted to maximize the results of the
medical procedure.
Bryan was discharged from voice therapy with near- normal voice quality. Although his habitu-
al pitch was lower than before and his vocal quality was hoarse, Bryan’s ability to talk was socially
and vocationally functional, except for his inability to talk loudly at job sites. However, persons
meeting Bryan for the first time sometimes asked if he had a cold, never suspecting that his voice
quality was the result of a terrible motor vehicle accident.
Case Study 4-3: A 23- Year- Old Preacher With Vocal Nodules
Joseph was the youn gest person in the small but growing fundamentalist church to ever have
his own congregation. He was just 22 years old when his minister father died, and Joseph was the
natu ral choice to replace him because he had been the youth minister for several years. Joseph had
never questioned his religion, as did some of his boyhood friends, and he knew from a young age
that the ministry was his calling.
Joseph’s father had groomed his only son to follow in his footsteps. When Joseph was very
young, he traveled throughout the Midwest with his father to revivals, which were usually held
in huge tents on the outskirts of small towns. They were well attended by the faithful, and Joseph
admired his father’s preaching skills. He had the power to bring the audience to a frenzy, usually
culminating in the “rebirth” of several men and women. As a result of the revival, many persons
whose lives had lost meaning took a dif fer ent road and, in Joseph’s eyes, a better one.
In ju nior high school, Joseph took several church jobs, and soon people saw his special gift.
Many believed he had a God- given power of speech. Even as a teenager the church was packed dur-
ing his guest sermons. Later, when he became the youth minister, the young people of the church
marveled at his command of the language and his ability to bring God into their lives. He even
appeared to have been blessed as a faith healer.
When Joseph was ministering, he lost himself in the power of God. He never paused to search
for the correct words. They just seemed to appear in his mind; each word was said clearly and
emphatically. The sermons f lowed from his lips with grace and ease, and he had a power ful voice.
He emphasized impor tant ideas by prolonging vowels and making the first and last syllables
of words louder. Joseph never needed a microphone. His booming, low- pitched, resonant voice
reached the back of the church, and even those on the sidewalk could hear his words. Sometimes
Joseph was so caught up in the message of God that he broke into “tongues,” uttering words having