Surgery to quieten the yelling of a demented old man.

The 84-year-old man's incessant yelling caused him to be unmanageable in all settings--at home with his aged wife, in nursing homes, and on the medical and psychiatric floors of a Veterans Administration Medical Center. A host of behavioural and pharmaceutical interventions were attempted unsuccessfully. Finally, it was proposed that a single, recurrent laryngeal nerve be crushed in order to 'render his voice to be a very acceptable soft tone'.