Speech Therapy Treatments For Voice Disorders

We use our voices to communicate with those around us.

Communication is important to express our thoughts and feelings, and even though speech usually happens naturally as we grow up, there are times when people develop voice disorders.

Some voice disorders can be considered speech disorders, which can affect the way people form words and this can 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.

Please keep reading to find out more about voice disorders and how speech therapy 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.

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

• Organic:
  This means that the cause of the voice disorder is physiological because it’s the result of abnormalities in respiratory, laryngeal, or vocal tract mechanisms.

• Structural:
  A kind of organic voice disorder that results from structural changes, such as the alteration of vocal fold tissues caused by inflammation or vocal nodules for example.

• Neurogenic:
  A kind of organic voice disorder that results from issues with the central or peripheral nervous system in the larynx that affects the vocal mechanism, causing vocal tremors and vocal fold paralysis.

• Functional:
  This kind of voice disorder happens when the vocal mechanism is not used properly, so while there are no physical problems, people can still experience vocal fatigue, ventricular phonation, and muscle tension dysphonia or aphonia.

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

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.

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

A person with a voice disorder can 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 to get a medical 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.

Here is a list of the most common causes for voice disorders:

• Structural:
  Vocal nodules, cysts, polyps, edema, inflammation of the larynx, laryngitis, trauma to the larynx, chemical exposure, etc.

• Neurologic:
  Parkinson’s disease, multiple sclerosis, pseudobulbar palsy, etc.

• Functional:
  Yelling, screaming, excessive throat clearing/coughing, speaking in too high or too low pitch, vocal fatigue due to effort, etc.

• Psychogenic:
  Chronic stress disorders, anxiety, depression, etc.

Keep in mind that trying to tend to voice disorders on your own is not recommended and that you will need a professional, such as a speech therapist to provide you with the appropriate help.

Also, medical history is often required for an assessment, because even when an obvious cause is found, the problem could persist.

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

People who suspect having a voice disorder should get a proper examination from a doctor, but it’s also recommended to get an evaluation from a speech therapist.

This is important because every specialist have their unique tests and instrumentation that can help in providing a more comprehensive diagnosis.

These are some the vocal characteristics evaluated during a screening:

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

After the initial screening, a comprehensive assessment might be needed in order to identify or uncover impairments, medical conditions or medications that could be triggering certain voice disorders.

Here is what a comprehensive assessment aims to identify:

• Impairments in body structure and function:
  Strengths and weaknesses in speech and communication.

• Comorbid deficits:
  Health conditions and medications that could cause voice disorders.

• Limitations in activity and participation:
  Functional communication and interactions.

• Environmental and personal factors:
  Factors that affect communication and life participation.

• Quality of life:
  Communication impairment and functional limitations

A comprehensive assessment typically requires to review the following:

• Case History:
  The individual will get asked to describe their symptoms and talk about their medical history including surgeries, chronic disorders, and medications.

• Self-Assessment:
  The individual will get asked about their own perception of their voice disorder and how it’s affecting their lives.

• Oral-Peripheral Examination:
  Assessment of structural or motor-based abnormalities, that may be affecting communication and voice, including oral muscles and strength.

• Assessment of Respiration:
  Respiratory patterns and coordination of respiration with phonation.

• Auditory-Perceptual Assessment:
  The speech therapist will take notes on their own clinical impressions while running speech tests.

• Voice Quality:
  Roughness, breathiness, strain, pitch, loudness, tremor, vocal fry, wet/gurgly quality, etc.

• Resonance:
  Hyponasal, hypernasal, pharyngeal/laryngeal, nasal, etc.

• Phonation:
  Delayed voice onset and quality of voice at onset.

• Rate of Speech:
  Changes in rate of speech can be an indirect result of a voice disorder when an individual decides to modify it, in an attempt to compensate for their condition and sound more clear.

An instrumental assessment may also be needed for further testing, and this includes:

• Laryngeal Imaging:
  Measures structure and gross function using video endoscopy.

• Acoustic Assessment:
  Measures vocal loudness, pitch, and quality.

• Vocal amplitude:
  Measures the typical sound level of voice during speech.

Some of the tests described above can also apply for children, but there are some voice disorders that are unique to the pediatric population, such as:

• Laryngomalacia:
  A congenital condition of the larynx characterized by immature laryngeal cartilage, floppy epiglottis, etc.

• Laryngeal webbing:
  Characterized by membranous tissue that connects the two vocal folds and may cause airway blockage.

• Laryngeal cleft:
  A rare condition characterized by having an opening between the larynx and the esophagus.

• Puberphonia:
  A voice disorder that can happen to male adolescents after a voice change during puberty, that causes a high-pitched voice.

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

How Can A Speech Therapist For Voice Disorders Help?

Early intervention when it comes to voice disorders is very important and speech therapy can help 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 the individual to acquire new communication skills and strategies
• Reduce barriers and enhance successful communication and participation
• Provide proper accommodations and training in how to use them.

There are different approaches that a speech therapist can decide on, depending on your unique case, but these are the most common:

• Direct Approaches:
  These focus on manipulating voice-producing mechanisms such as respiration and musculoskeletal function to modify vocal behaviors.
• Indirect Approaches:
  These are based on education and counselling, so the individual becomes aware of the way voice disorders work and can identify strategies to manage them.

• Therapeutic Plan:
  A speech therapist can design a unique plan to help manage voice disorders, which includes a combination of direct and indirect approaches.

Speech therapists will also consider behaviours that are causing voice problems, while designing a management plan, 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, can vary depending on age.

When it comes to children the differences in anatomy, etiology, and developmental level 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.

The kinds of therapy included in a personal plan to manage voice disorders fall into these 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. It also improves respiratory support, laryngeal muscle activity, articulation, etc.

• Manual circumlaryngeal techniques:
  These are intended to reduce musculoskeletal tension by re-posturing the larynx during phonation.

• Resonant voice therapy:
  The purpose of resonant voice therapy is to achieve the strongest and cleanest possible voice with the least effort, to minimize injury and maximize vocal health.

• Stretch and flow phonation:
  Focuses on airflow management and is used to produce a breathy voice quality and a slowed speaking rate.

• Flow phonation:
  Designed to facilitate 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.

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

• Amplification:
  Amplification devices (like microphones for example) can be used as a supportive tool to increase voice loudness and prevent vocal hyper function.
• Auditory Masking:
  Individuals read passages aloud while wearing headphones and using a loud noise background, to produce voice at increased volume.
• Chant speech:
  Uses a rhythmic pattern to help reduce vocal fatigue and encourage the coordination of respiratory, phonatory, and resonance subsystems.
• Confidential voice:
  Designed to facilitate relaxation in the muscles of the larynx and increase airflow.
• Posture:
  Sitting with an upright posture can facilitate voice production, however collaboration with a physical therapist may be necessary.
• Cup bubble:
  It is done by having an individual blow air into a cup of water without voice. These exercises can widen the vocal tract and reduce tension in the vocal folds.

• Lip trills:
  The focus is to improve breath support to produce voice without tension
• Yawn-Sigh:
  Uses the natural functions of yawning and sighing to ease the symptoms of vocal hyper function and produce a more relaxed voice and natural pitch.

The different treatments for voice disorders can vary or be modified depending on your specific situation, so make sure to ask your speech therapist what would be best for you.

Book Your Appointment With District Speech Today

Voice disorders can be hard to diagnose and manage, but if after reading this article you believe you have a voice disorder, don’t hesitate to contact District Speech.

Our team of licensed speech pathologist 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, book an appointment with us today.