Voice sounds strenuous and speaking requires to much effort

Problem: the voice sounds strenuous and speaking requires too much effort

Hypertonicity is the main cause of increased effort in voicing. This phenomenon becomes obvious mostly immediately after (primary or secondary) insertion of the voice prosthesis, but also may become apparent at a later date, e.g. after the end of post-operative radiotherapy. The solutions are described in the sections hypertonicity, speech therapy, and videofluoroscopy. Here it suffices to mention that proper speech therapy should be attempted, before advancing to the more invasive options of Botox injection or myotomy. However, treatment of hypertonicity is very worthwhile and rewarding.