Speech Therapy Treatments For Voice Disorders

We use our voices to communicate with those around us.

Communication is an important tool for the expression of our thoughts and feelings.

Speech usually happens naturally as we grow up; however, some people develop voice disorders.

Some voice disorders are considered speech disorders.

Speech disorders affect the way people form words and may ultimately lead to self esteem issues and even depression.

Voice disorders are quite common and can happen at any age, and a speech therapy evaluation is the first place to start.

According to a 2024 study by Naunheim et al., voice disorders affect 29.9 million people nationwide.

If you or a loved one is living with a voice disorder, a speech therapy evaluation at District Speech & Language Therapy is the first place to start.

Keep reading this week’s article to find out more about voice disorders and how our speech therapy clinic can help.

What Is A Voice Disorder?

People with voice disorders usually differ in voice quality, pitch, and loudness compared to their peers of the same age, gender, and cultural background.

On most occasions, people with voice disorders are the first ones to notice the abnormalities in their speech, even if others around them don’t perceive it.

This kind of awareness is what usually leads to the discovery of these conditions and their diagnosis.

There are different kinds of voice disorders, according to their main cause.

Let’s take a look

What Is An Organic Voice Disorder?

An organic voice disorder is a voice disorder with a physiological cause.

That means it’s the result of abnormalities in respiratory, laryngeal, or vocal tract mechanisms.

What Is A Structural Voice Disorder?

A structural voice disorder is actually kind of organic voice disorder.

These result from structural changes, such as the alteration of vocal fold tissues caused by inflammation or vocal nodules for example.

What Is A Neurogenic Voice Disorder?

This is another kind of organic voice disorder.

It results from issues with the central or peripheral nervous system in the larynx that affects the vocal mechanism.

This can cause vocal tremors and vocal fold paralysis.

What Is A Neurogenic Voice Disorder?

This kind of voice disorder happens when the vocal mechanism is not used properly.

While there are no physical problems, people can still experience vocal fatigue, ventricular phonation, and muscle tension dysphonia or aphonia.

What Is A Neurogenic Voice Disorder?

These voice disorders are rare and are caused by psychological stressors, that lead to maladaptive aphonia or dysphonia.

Symptoms Of A Voice Disorder

If you suspect that you or someone you know might have a voice disorder, here are some of the symptoms to look for:

• Increased vocal effort when speaking
• Fatigue with prolonged voice use
• Running out of breath quickly
• Frequent coughing or throat clearing
• Throat or laryngeal tension, pain, or tenderness
• Variable vocal quality throughout the day
• Rough or raspy voice
• Breathy voice or bursts of breathiness
• Strained, tense, or harsh voice
• Strangled voice (as if talking with your breath held)
• Abnormal pitch (too high, too low, etc.)
• Abnormal volume (too high, too low, unsteady, etc.)
• Loss of voice
• Weak voice
• Wet sounding voice
• Pulsed voice (audible creaks or pulses in sound)
• Shrill voice (high, piercing sound)
• Shaky voice

If you have a voice disorder, you may experience many of these symptoms at once or just a few from time to time.

However, it’s hard to diagnose a voice disorder by just listening to people’s voices, so it’s recommended that you get a speech therapy assessment to determine the severity of the condition and any injuries.

What Causes Voice Disorders?

Our ability to make sounds and speak depends on the respiratory system, laryngeal muscle activation and other vocal mechanisms connected to internal structures such as the pharynx, the oral cavity, etc.

Any disturbance in these mechanisms can cause a voice disorder and as mentioned previously, the causes can be organic, functional, and/or psychogenic.

Structural causes include:

• Cleft lip and cleft palate
• Vocal fold nodules and polyps
• Cysts
• Edema
• Inflammation of the larynx
• Laryngitis
• Other trauma to the larynx
• Chemical exposure

Neurological cause include:

• Parkinson’s disease
• Multiple sclerosis
• Pseudobulbar palsy

Functional causes include:

• Frequent yelling or screaming
• Excessive throat clearing or coughing
• Speaking in too high or too low pitch
• Vocal fatigue due to overexertion

Psychogenic causes include:

• Chronic stress disorders
• Anxiety
• Depression

It’s not a good idea to try tending to your voice disorder by yourself.

You’ll need a professional, such as a speech therapist, to provide you with the appropriate interventions.

Even if an obvious cause is identified, your speech therapist may still examine your medical history to identify any comorbid conditions.

In these cases, voice disorders often remain even after the cause is identified.

A good example is when a voice disorder develops from an upper respiratory infection, which is fairly easy to treat, but the voice issues continue even after the infection is gone.

This can happen due to the improper use of speech techniques that only an experienced therapist can assist you with.

Screening For Voice Disorders

If you suspect that you may have a voice disorder, you might consider getting a speech therapy evaluation.

Some the vocal characteristics evaluated during a screening include:

• Respiration
• Phonation
• Resonance
• Vocal range
• Pitch
• Loudness
• Endurance

After the initial screening, your speech therapist might recommend a comprehensive assessment in order to identify or uncover impairments, medical conditions or medications contributing to your voice disorder.

A comprehensive assessment aims to identify:

• Impairments in body structure and function
• Comorbid conditions, such as health conditions and medications that could cause voice disorders
• Limitations in activity and participation, such as functional communication and interactions
• Environmental and personal factors
• Quality of life, communication impairment, and functional limitations

During a comprehensive assessment, your speech therapist might review your:

• Case history
• Self assessment
• Oral peripheral examination
• Assessment of respiration
• Auditory perceptual assessment
• Voice Quality:
• Resonance
• Phonation
• Rate of speech

Your speech therapist may also require an instrumental assessment for further testing.

Examples include:

• Laryngeal imaging
• Acoustic assessment
• Vocal amplitude

These tests work on both children and adults.

However, there are some voice disorders that are unique to the pediatric population.

This includes:

• Laryngomalacia, a congenital condition of the larynx characterized by immature laryngeal cartilage, floppy epiglottis, etc.
• Laryngeal webbing, a condition which forms membranous tissue that connects the two vocal folds and may cause airway blockage
• Laryngeal cleft, a rare condition which causes an opening between the larynx and the esophagus
• Puberphonia, a voice disorder diagnosed in male adolescents after a voice change during puberty, and causes a high pitched voice

Keep in mind that the kind of assessments and tests may vary depending on your speech therapist, and that this is not a complete list.

How Can A Speech Therapist Help With A Voice Disorder?

Johns Hopkins Medicine recommends working with a speech therapist to help many types of voice disorders.

A speech therapist can help you to:

• Establish proper vocal hygiene practices
• Address weaknesses related to structural and functional issues that affect voice production
• Improve self awareness of voice quality
• Encourage you to acquire new communication skills and strategies
• Reduce barriers and enhance successful communication and participation
• Provide proper accommodations and training in how to use your voice

There are different approaches that a speech therapist can decide on, depending on your unique case.

For instance, some speech therapy sessions surround direct approaches, which focus on manipulating voice producing mechanisms such as respiration and musculoskeletal function to modify vocal behaviors.

Other aspects of speech therapy focus on indirect approaches, such as client education and counselling, to help raise awareness of the way voice disorders affect your everyday life.

Your speech therapist will put together a therapeutic plan, which is a unique plan designed for you to help manage your difficulties.

It will likely include a combination of direct and indirect approaches.

Speech therapists will also consider behaviors contributing to your voice difficulties, such as:

• Shouting
• Talking loudly over noise
• Coughing
• Throat clearing
• Poor hydration

Then, they will implement basic practices to reduce behaviors that can harm vocal health, such as voice conservation, drinking plenty of water, talking at a moderate volume, etc.

It’s important to mention that any plans designed by your speech therapist to treat voice disorders might vary depending on age.

For instance, speech therapy for adults often looks quite different than pediatric speech therapy.

RELATED: Dispelling The Myths Around Speech Therapy For Kids

Children have differences in anatomy, etiology, and developmental levels.

These differences can change the way a speech therapist approaches the management of voice disorders.

These anatomical differences include laryngeal size, size of the vocal tract, structure of the vocal folds, positioning of the larynx, etc.

RELATED: Getting To Know Your Larynx – Your Voice Box

The kinds of therapy included in a personal plan to manage voice disorders fall into one of two categories:

• Physiologic voice therapy: techniques that aim to modify the physiology of vocal mechanisms by balancing respiration, phonation, and resonance, instead of working directly on isolated voice symptoms
• Symptomatic voice therapy: techniques aimed at modifying perceptual voice components and vocal symptoms using facilitating techniques

Remember that your personalized management plan will depend on the type and severity of the voice disorder, as well as your communication needs.

Here is a brief description of some of the different physiologic voice therapy programs available:

• Accent method: designed to increase pulmonary output, reduce muscular tension and improve glottic efficiency
• Conversation training therapy: focuses on voice awareness and conversational narrative, which strives to guide the individual in achieving balanced phonation
• Expiratory muscle strength training: improves respiratory strength and expiratory pressure, thus improving the relationship between respiration, phonation, and resonance
• Lee Silverman voice treatment: an intensive treatment for people with Parkinson’s disease, designed to maximize phonatory and respiratory function
• Manual circumlaryngeal techniques: intended to reduce musculoskeletal tension by reposturing the larynx during phonation
• Resonant voice therapy: to achieve the strongest and cleanest possible voice with the least effort, to minimize injury and maximize vocal health
• Stretch and flow phonation: the focus on airflow management
• Flow phonation: facilitates increased airflow and ease of phonation, based on stretch and flow phonation but without the “stretch” component
• Vocal function exercises: a series of systematic voice manipulations that work together to strengthen and coordinate laryngeal musculature to recover healthy voice function

Some the different symptomatic voice therapy tools include:

• Amplification
• Auditory masking
• Chant speech
• Confidential voice
• Posture retraining
• Cup bubble
• Lip trills
• Yawn sigh

The different treatments for voice disorders can vary.

You may also modify them depending on your specific situation, so make sure to ask your speech therapist if modifications are required.

Book Your Appointment With District Speech and Language Therapy Today

Voice disorders are often hard to diagnose and manage, but if after reading this article you believe you have a voice disorder, don’t hesitate to contact our speech therapy clinic.

Our team of licensed speech therapists can answer all your questions and offer an assessment that meets your needs.

We can also provide you with the best care and attention, so you feel safe and encouraged to manage your symptoms.

If you’re interested in learning more about voice disorders and how we can help, we’re here to help.

Book your appointment with District Speech and Language Therapy today.