Falsetto register in a man with unilateral vocal fold paralysis

We present a case of a 78-year-old man with a long-standing right vocal fold paralysis. He uses an abnormally high-pitched voice in falsetto register to compensate for it, which satisfies him. After two sessions of voice therapy, the fundamental frequency decreases from 197 to 154 Hz. The patient refuses type I thyroplasty, which would improve glottic closure in modal register. He decides to keep the falsetto register to eliminate the breathiness resulting from the paralysis.