What Are Voice Disorders?
Voice disorders are when the pitch (the notes going up and down), loudness (the volume; loud or quiet) or vocal quality (hoarseness, strained etc.) of someone’s speaking or singing voice are abnormal. This is due to a poorly functioning larynx (voice box), respiration system (breathing for phonation/voice) and vocal tract (the cavity and structures that allow voice; lips, tongue, palate, see diagram).
Difficulties and changes in voice can be due to a number of different causes including:
- Behaviour/habits-(e.g. talking too much, poor hydration)
- Physiological/neurological (e.g. damaged/altered vocal folds such as nodule or cysts, allergies, hormonal imbalance)
- Mental Health (e.g. stress, conversion disorder, puberphonia)
Often the cause is a combination of the factors listed above.
In our practice we see children, adults and elderly of both gender (female and male). Children will often be seen as a result of overuse, adults for various voice issues resulting from their occupation and elderly adults related to degenerative motor neuron diseases.
Adults are seen most often as they use their voice while parenting and/or as a key part of their employment or vocation and would benefit from voice therapy to learn how to protect their voice and prevent unnecessary time lost from parenting and/or vocational activities.
- Health Professionals
- Public Speakers
- Exercise Instructors
Individuals who are male can benefit from a combination of hormone therapy and vocal and social training to transition their voice to suit their identity.
- A sudden change in voice quality is noticeable by the client or family and friends.
- A chronic or inconsistent voice which “cuts out”
- A voice quality which makes it difficult to talk to friends, family and/or co-workers
– hoarse sounding
– feels/sounds strained “effortful”
– fatigue/pain (feeling tired when speaking)
– Voice “cracks”
– Loss/lack of vocal range when singing
– Frequent throat clearing
– change in pitch or abnormal for age/sex
– tremor “shaky” sounding voice
- complete “loss” of voice
Perceptual analysis by an experienced specialist such as Speech-Language Pathologist and/or an Otolaryngologist (Ear, Nose and Throat doctor) is still considered the most important aspect of a voice assessment.
However, it is also useful to conduct physical examination (oral and/or laryngeal scope) and acoustic measures to determine if a more serious condition (e.g. cancer or nodules) is present and to use data points from software to track progress.
Treatment is specific to each person so it can only be determined following a comprehensive assessment. Depending on the type of voice disorder the treatment could include:
- Voice therapy to teach vocal hygiene and remove bad habits
- Increase awareness of the problem through exercises and training on vocal tract anatomy
- Voice coaching to improve strength and clarity (some of the approaches used include Lessac Madsen, Resonant Voice, Stemples Vocal Function Exercises, Boone Program, Seth Riggs, Speech Mode Singing, Accent Method
- Articulation training
- Respiration training to extend vital capacity
Other professionals if referred to by the SLP may also treat with:
- Cognitive Behaviour Therapy
Step 1: 1.5 hour assessment session with an experienced Speech-Language Pathologist (SLP). A case history, oral exam and acoustic measures are conducted.
Step 2: SLP may refer to other professionals (otolaryngologist etc.) for further testing if needed
Step 3: A course of 8-12 weekly or fortnightly sessions of 45 minutes to 1 hour occur
Step 4: A short review of voice changes is conducted and acoustic measures are compared for progress
Step 5: The client may be discharged or recommended to continue using other techniques