Voice Therapy

1) Definition

Voice therapy is a medical process of eliminating or improving the problems associated with the production of vocal sounds (phonation) that occur in the voice box or larynx. Voice therapy is used to treat most types of voice disorders through individually tailored exercises taught by a speech or voice therapist. Voice therapy can strengthen a weak voice and make one speak more clearly and confidently.

2) Voice Disorders

Voice disorders, also known as dysphonia, are medical conditions characterised by abnormal pitch, quality or loudness of sound created from the larynx, thus affecting speech production. Voice disorders are often examined based on the person’s age, gender, geographic location or cultural background.

3) Causes

Voice is produced when the vocal cords vibrate on the movement of air through the larynx. When there is damage caused to these vocal cords, such as due to inflammation, extra growths or paralysis, they fail to vibrate, and hence cause difficulties in the production of sound. There can be various causes of voice disorders, which include –

  • Vocal fold nodules or polyps
  • Vocal fold cysts
  • Vocal fold paralysis
  • Paradoxical Vocal Fold Movement (PVFM)
  • Neurological voice disorders, like Spasmodic dysphonia
  • Laryngitis
  • Lesions (precancerous or cancerous)
  • White patches or leukoplakia
  • Phonatory Gap
  • Unilateral vocal cord paresis
  • viral attack
  • Thyroidectomy
  • Surgical trauma
  • Progressive neurological disorders
  • Parkinson’s disease
  • Atrophy due to ageing
  • Tuberculosis
  • Phonatory gap due to surgery
  • Muscle tension Dysphonia
  • spasmodic Dysphonia
  • False vocal cord over adduction
  • Intubation during ventilatory support
  • Sudden vocal trauma TBI or Traumatic Brain Injury

Among the risk factors that can contribute to voice problems, include –

  • Allergies
  • Ageing
  • Alcohol consumption
  • Smoking
  • Screaming
  • Psychological stress
  • Neurological disorders
  • Voice misuse or overuse
  • Improper throat-clearing over a prolonged period of time
  • GERD (Gastroesophageal reflux disease)
  • Trauma caused to the front of the neck
  • Throat cancer
  • Thyroid problems
  • Throat dehydration
  • Pollution
  • Wrong pitch selection for singing
  • overuse/ abuse/ misuse
  • Poor Breath support
  • COPD
  • Excessive use of voice on higher notes
  • Continuous Throat clearing
  • Use of nicotine
  • Lack of vocal rest
  • Long use of steroids
  • Unhealthy lifestyle
  • Mental stress

4) Signs and Symptoms

Dysphonia refers to the auditory-perceptual signs and symptoms associated with voice disorders. Some of them are –

  • Roughness
  • Breathiness
  • Strangled or strained quality of sound
  • Unusual loudness or volume
  • Abnormal resonance
  • Phonation breaks
  • Hoarseness
  • Aphonia or loss of voice
  • Increased vocal effort while speaking or the onset of fatigue due to prolonged voice use
  • Decreased vocal endurance
  • Excessive laryngeal tension or pain
  • Frequent coughing and/or throat clearing
  • Variable quality of voice throughout the day during speech
  • There may be bleeding in severe cases
  • Problem in singing particularly in higher notes
  • consistent hoarseness
  • Lack of power in voice ( mono loudness )
  • Dryness of throat and mouth
  • Burning sensation in throat

5) Treatment Protocol

Treatment of voice disorders may include voice therapy, medication or even surgery. Voice therapy, being the safest and often the most effective solution for a majority of voice problems, is also given in the form of online voice therapy sessions. The treatment approaches may be either –

  • Direct – in which the speech or voice therapist would focus on improving the voice-producing mechanisms like respiration, phonation, musculoskeletal functions.
  • Indirect – in which the therapist will work on modifying the behavioural, cognitive and psychological aspects of the candidate along with change of vocal behaviours

The general treatment options for voice disorders include –

  • Physiologic Voice Therapy
  • Symptomatic Voice Therapy
  • Novel voice therapy Approach
  • voice conservation programmes
  • Ear training and vocal cord relaxation techniques
  • Self-correction method
  • Counseling
  • Compensatory Mechanism
  • Esophageal speech

6) Preventive Measures

The good news is, most of the voice disorders can be prevented. To maintain good vocal health, you need to follow these vocal hygiene approaches –

  • Healthy diet and lifestyle
  • Voice exercise for improving endurance
  • Voice training on how to use our vocal cords appropriately
  • Frequent vocal breaks in between prolonged usage
  • Avoid screaming or voice misuse
  • Quit smoking
  • Avoid alcohol intake
  • Drink plenty of water every day to avoid vocal cord dehydration
  • Take proper voice rest
  • Do regular preventive vocal exercises
  • Do breathing exercises
  • Avoid mental stress
  • Enjoy your singing at a proper scale
  • Take breaks from regular routine
  • Meditation
  • Use compensatory Mechanism

7) Role of a Voice Therapist

A licensed voice therapist would offer voice therapy sessions that involve exercises or other such activities to improve the quality of sound produced. A voice therapist also works on improving your breath control strategies during speech, and would help prevent unusual tension in the muscles around paralysed vocal folds, thus protecting one’s airway while swallowing food. He/she basically tries to improve the vocal structure through therapy in such a way as to enable a person with dysphonia to speak normally or in a near-to-normal manner.

A voice therapist would go through an assessment of your voice a first, and then try to determine the underlying cause. Accordingly, the voice therapist will conduct online voice therapy at home in one-on-one sessions.

8) Voice Disorder and Depression

As per research studies, a link has been found between voice disorders and the onset of depression. This further suggests that there is a strong connection between dysphonia and psychological distress, especially in adults. Not being able to convey oneself properly is a primary reason for concern, and this is what leads to anxiety and gradually pushes a person towards depression. The situation gets worse for vocal professionals like singers, RJs, wrappers and others, for whom it comes to the question of earning a living.

9) Self-check Questionnaire

Here is a short questionnaire for you to self-assess your vocal health –

  1. Do you have a breathy or rough voice?
  2. Are you suffering from hoarseness?
  3. Do you feel pain in your vocal cords?
  4. Do you have an inconsistent pitch, volume or sound quality?
  5. Do you put in a lot of effort while speaking?
  6. Are you suffering from depression recently?
  7. Do you face difficulties in communication in your day-to-day lives?
  8. Are you losing self-confidence or self-image in almost every walk of life?
  9. Do you have hyperacidity
  10. Do you have a problem in a higher pitch
  11. Do you have a lack of power in your voice
  12. Do you feel dryness of mouth as well as throat
  13. Do you feel irritation in the throat or burning sensation
  14. Do u face voice breaks in day to day communication
  15. Do you feel vocal fatigue?

If you answered ‘Yes’ to five or more of the above, then you need to seek help immediately. You can opt for an online voice therapy session given by a certified voice therapist for effective results and positive outcomes.

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