Voice therapy

Voice therapy is a treatment method that involves performing vocal cord exercises to prevent or manage voice disorders such as hoarseness and laryngitis. Voice therapy is provided by speech-language pathologists, respiratory therapists, and voice coaches. Additionally, transgender individuals can benefit from voice therapy to regulate their pitch and achieve higher or lower voices. This type of therapy is commonly known as transgender voice therapy. (8)

Voice therapy Definition

Voice therapy is a form of treatment that assists individuals with voice disorders in modifying their vocal behaviors and aiding in the healing process of their vocal cords. This therapy can enhance the strength and quality of one’s voice, restoring it to its pre-disorder state. Voice therapy can also be used as a preventative measure against voice disorders. Furthermore, gender-affirming voice therapy, a specialized form of therapy, can help transgender individuals regulate their voices to align with their gender identity. (9, 10)

Voice disorders Definition

Voice disorders pertain to conditions that impact the voice box, also known as the larynx. These disorders can cause either a consistent or variable alteration in one’s voice. The larynx is responsible for housing the vocal cords and the muscles necessary for speaking, breathing, and swallowing. (11)

Voice disorders can lead to changes in the pitch, quality, or volume of one’s voice. An individual’s voice may sound strained, hoarse, or feeble. In certain instances, the voice may even be reduced to a whisper or silenced entirely.

How does voice works?

The process of voice production involves the movement of air through your lungs and into your windpipe (trachea) and voice box. Inside your larynx, two vocal cords (also known as vocal folds) are present. These elastic muscles vibrate when air passes through them, generating the sound waves that form your voice. (12)

Normally, the vocal cords vibrate in synchronization to produce a distinct sound. Voice disorders arise when the vocal cords vibrate out of sync or fail to fully open or close.

Pitch describes the highness or lowness of your voice. The size and tension of your vocal folds determine the pitch of your voice.

Who needs Voice Therapy?

Nearly 18 million Americans experience voice problems, but many do not pursue treatment. Voice therapy can assist both children and adults. If an individual has a voice disorder, their healthcare provider may recommend voice therapy. The following voice disorders are examples: (13)

• Laryngitis: The inflammation of the voice box caused by allergies or an upper respiratory infection, leading to swelling. Laryngitis typically resolves when the underlying condition clears up.
• Vocal nodules, which are callus-like growths that develop on the vocal cords due to vocal strain or misuse, are commonly seen in children who yell or scream frequently.
• Muscle tension dysphonia: Excessive stress on the vocal cords results in muscle tightening.
• Cleft palate, which can affect the resonance and quality of a child’s voice and may require speech therapy, including voice therapy
• Spasmodic dysphonia/vocal tremor: The muscles of the voice box spasm or shake, resulting in intermittent speech breaks. Spasmodic dysphonia is a neurological disorder.
• Congenital anomalies of the larynx or trachea, such as laryngomalacia or tracheomalacia, can cause noisy breathing and voice problems.
• Vocal cord dysfunction (VCD): The vocal cords close when they should be open. Vocal cord dysfunction may result in breathing difficulties during exercise or when the throat is irritated.
• Vocal cord lesions: Noncancerous growths, such as nodules, polyps, and cysts, develop on the vocal cords, affecting one’s voice. Vocal cord lesions are more prevalent in individuals who often speak, such as teachers, lawyers, and singers.
• Autism spectrum disorders can impact a child’s communication abilities and may require speech therapy, including voice therapy, to improve vocalization and verbal communication.
• Vocal cord paralysis: The lack of movement or reduced movement in one or both vocal cords, which an individual cannot control due to scar or nerve damage. Vocal cord paralysis can cause hoarseness, difficulty swallowing (dysphagia), and shortness of breath (dyspnea).

Gender-affirming voice therapy

Gender-affirming voice therapy is a type of therapy that can assist transgender individuals in achieving their desired voice. This therapy may be pursued prior to, after, or instead of surgical interventions aimed at changing the pitch and tone of the voice. (14)

Through various exercises and techniques, gender-affirming voice therapy can help individuals modify their intonation, pitch, and other vocal characteristics to achieve a more masculine or feminine-sounding voice that aligns with their gender identity.

What Happens to Transgender voice therapy?

Transgender voice therapy involves working with a voice therapist to create healthier, more efficient vocal folds, increase pitch, and change resonance. This therapy can be done in conjunction with or instead of voice feminization or voice masculinization surgery. Regardless of whether surgery is chosen, transgender voice therapy helps individuals adjust their voice’s pitch, nonverbal communication, and resonance to meet their gender identity goals. (15)

Professionals doing Voice Therapy

In case of voice-related issues, a visit to a laryngologist may be the first step, as they are medical doctors specialized in treating conditions affecting the voice box and can also perform surgeries if needed. 

The laryngologist may recommend voice therapy and refer you to a specialist if necessary. Various professionals can provide voice therapy, including speech-language pathologists, respiratory therapists, and voice coaches. (16)

What does a speech-language pathologist do?

A speech-language pathologist specializing in voice therapy (also known as a speech therapist) will work with you to perform voice exercises aimed at achieving the following objectives: (17)

• Eliminating or preventing harmful vocal behaviors
• Assisting in the recovery of vocal cords after surgery or injury
• Encouraging healthy vocal behaviors.

Types of Voice Therapy Techniques

Voice therapy techniques are exercises that aim to improve vocal function and vary depending on the underlying cause of the vocal problem. These exercises are taught during voice therapy and may involve the following:

• Breathing exercises control the diaphragm muscle that enables breathing and speaking. (1)
• Tension release exercises to reduce the tension in the throat, such as stretching and massage. (2)
• Semi-occluded vocal tract sounds, including straw phonation, lip trills, and humming, promote healthy vocal cord vibration. (3)
• Voice-building exercises to strengthen the vocal cords and breath support for people with weak vocal cords.
• Resonant voice therapy aims to improve your voice’s resonance or sound quality. The therapy involves exercises that help you focus on vibrations in specific areas of your head and neck, such as the nose, mouth, or chest. The therapist may use tools such as a vibrator or visual feedback to help you achieve proper resonance. Resonant voice therapy is often used to treat conditions such as muscle tension dysphonia or vocal nodules. (4)
• Lee Silverman Voice Treatment (LSVT) is designed to improve voice loudness and clarity for individuals with Parkinson’s disease or other neurological conditions. (5)
• Vocal function exercises target specific voice production aspects, such as pitch range, volume, and quality, to improve overall vocal function. (6)
• Cough suppression therapy aims to reduce the frequency and intensity of coughing episodes by teaching strategies to manage cough triggers and sensations in the throat. (7)

Advantages of voice therapy

Voice therapy has several advantages. It can be used as a preventive measure to teach healthy vocal habits and avoid problems like hoarseness, laryngitis, and vocal cord lesions that are common among people who use their voices a lot. Additionally, voice therapy can help promote better vocal cord vibration, which can heal vocal cord swelling and small lesions. Voice therapy is also used to aid in postsurgical recovery. There are no risks or downsides associated with undergoing voice therapy. (18)

Duration of voice therapy

The duration and effectiveness of voice therapy vary depending on the specific issue being treated. Typically, voice therapy involves sessions once or twice a week for a few months, and it’s essential to follow the therapist’s instructions and practice exercises at home for optimal results. It is recommended to continue the exercises even after the therapy sessions have ended to maintain healthy vocal cords. (20)

Voice Protective Measures

To protect your voice, you can practice good vocal hygiene by following these steps: (20)

• Stay hydrated by drinking plenty of water.
• Limit your intake of caffeine and alcohol, which can dry out your vocal cords.
• Manage conditions like allergies, chronic coughs, and GERD (chronic acid reflux), which can irritate your vocal cords.
• Rest your voice when possible if you do a lot of talking or singing.
• Quit smoking and avoid exposure to second hand smoke.

When to call a Physician?

If you have experienced any of the following symptoms, it’s important to contact your healthcare provider:

• Sudden or severe voice changes, such as a complete loss of voice, hoarseness, or difficulty speaking
• Chronic hoarseness or wheezing
• Persistent sore throat or throat clearing
• Loss of voice (laryngitis) or a raspy voice that lasts for several weeks
• Neck pain or a lump in your throat
• Coughing up blood
• Difficulty breathing or noisy breathing
• Difficulty with speech or swallowing

Voice therapy vs. Speech therapy

Voice therapy is focused specifically on the vocal cords and how they produce sound, while speech therapy addresses a broader range of communication problems, including cognitive-communication disorders due to stroke, traumatic brain injury (TBI) or dementia, language disorders, social communication disorders associated with autism spectrum disorder (ASD) and TBI, speech disorders like stuttering, and swallowing disorders after a stroke, injury or surgery. (19)

References

1. https://umc.edu/Healthcare/ENT/Patient-Handouts/Adult/Speech-Language-Pathology/Voice/Diaphragmatic-Breathing.html#:~:text=For%20example%3A%20Inhale%20to%20a,an%20easy%20%E2%80%9CS%E2%80%9D%20sound.
2. RELEASE OF EXCESS TENSION IN THE VOCAL TRACT, https://www.worcsacute.nhs.uk/patient-information-and-leaflets/documents/patient-information-leaflets-a-z/2669-release-of-excess-tension-in-the-vocal-tract/file#:~:text=Drop%20your%20jaw%20and%20protrude,neck%20to%20feel%20for%20tension.
3. Ceilo et al., SEMIOCCLUDED VOCAL TRACT EXERCISES: LITERATURE REVIEW, https://www.scielo.br/j/rcefac/a/SppybSqtSsnk9KpwJwMhVFk/?format=pdf&lang=en
4. Salturk et al., Assessment of Resonant Voice Therapy in the Treatment of Vocal Fold Nodules, https://pubmed.ncbi.nlm.nih.gov/30017429/,2019
5. Lee Silverman voice treatment (LSVT) mitigates voice difficulties in mild Parkinson’s disease, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504915/, 2019
6. Leeps, Vocal Function Exercises, https://uad-lab.slhs.phhp.ufl.edu/2021/03/26/vocal-function-exercises/, 2021
7. Chamberlain et al., Cough suppression therapy: does it work? https://pubmed.ncbi.nlm.nih.gov/23524013/, 2013
8. https://www.ncbi.nlm.nih.gov/books/NBK534632/
9. Voice Therapy, https://my.clevelandclinic.org/health/treatments/22339-voice-therapy, 2022
10. Cates et al., Voice Therapy, https://www.sciencedirect.com/topics/medicine-and-dentistry/voice-therapy, 2018
11. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=134&contentid=239#:~:text=Voice%20disorders%20affect%20the%20ability,in%20your%20throat%20when%20speaking.
12. How your voice works, https://myhealth.alberta.ca/speech-language-hearing/voice-and-resonance/learn-more/how-your-voice-works#:~:text=Your%20vocal%20cords%20vibrate%20to,is%20what%20makes%20the%20sound., 2021
13. Rehabilitation for Your Singing and Speaking Voice, https://www.jeffersonhealth.org/conditions-and-treatments/voice-therapy
14. Transgender voice therapy and surgery, https://www.mayoclinic.org/tests-procedures/transgender-voice-therapy-and-surgery/about/pac-20470545
15. Transgender Voice Therapy, https://my.clevelandclinic.org/health/treatments/24510-transgender-voice-therapy
16. Schneider et al., Voice therapy for the professional voice, https://pubmed.ncbi.nlm.nih.gov/17765699/, 2007
17. What Is a Speech-Language Pathologist, https://www.webmd.com/a-to-z-guides/what-is-a-speech-language-pathologist, 2022
18. Reena Gupta, The Benefits of Voice Therapy, https://www.ohniww.org/voice-therapist-los-angeles/
19. Chang, Voice therapy versus Speech therapy, https://www.fauquierent.net/voicetx.htm, 2021
20. Taking Care of Your Voice, https://www.nidcd.nih.gov/health/taking-care-your-voice