Voice Articles

Contemporary Voice Therapy

Like many areas in the field of speech language pathology, specific disorders that involve the voice continue to require some specialty training. With the development of videostroboscopy and its wider spread use, speech pathologists who are specialized in this area are able to work side by side with a laryngologist for accurate diagnosis and appropriate treatment. Obtaining a visualization of the larynx should be the first step toward generating a medical, surgical or therapeutic treatment plan.

For many voice disorders, direct voice therapy is an effective treatment approach. Therapy in this area has reached improved levels. Gone are the days when the only thing offered was a sheet with tips for good vocal hygiene. Gone too are the days in which we reprimanded patients for “abusing” the voice. Although good vocal hygiene is an important part of patient education, it provides only an indirect way of helping the patient. And while some patients need to be aware that some voice behaviors can be harmful, many simply have life styles and careers that are vocally demanding, regardless of how careful they are trying to be. For patients that have vocally demanding schedules, we are now able to offer more training for the actual manner in which a person uses the voice. This can be accomplished through various ways, and treatment plans should be individualized for each patient. Current research suggests that the most efficient voicing occurs when vocal folds are at a distance of approximately .6 mm (Berry et al. 2001). A distance of .6 - .7mm results in a glottal closure that is not overly closed or overly open. An overly closed phase results perceptually in a pressed or strained sounding voice while an overly open phase can result in a weak or breathy voice. The closure pattern was not seen with the naked eye, but with an intraglottal stress transducer in a laboratory experiment. This research data suggested that a voice type such as a “resonant voice” has strong clinical implications due to achieving a similar glottal configuration. This glottal configuration can facilitate a closure that is not too pressed or too breathy. By working with a patient on awareness of voice placement and taking them through a program step by step, reduced vocal fold contact stress can be achieved. Patients will report a greater ease of speaking and the feeling of improved airflow with speaking.

Another contemporary voice therapy technique involves vocal flexibility exercises. These exercises are very similar to singing warm ups. The exact type of flexibility exercise is patient dependent. What works well for one patient may cause increased stress and tension in another. The speech pathologist must carefully assess each exercise before sending a patient home for independent practice. The flexibility exercises can reduce tension, increase range, improve speaking voice quality, and improve breath support.

Additional therapy techniques are also effective, such as teaching a patient to produce voice without hard glottal attacks, teaching techniques to reduce amount of loudness, and direct work on breathing techniques. With many of the newer therapy techniques mentioned above, these other areas sometimes fall into place naturally. As with all therapy, generalization of techniques to real life takes time and commitment from the patient. The number of therapy sessions can range from as little as one session, to as many as ten sessions depending on the amount of direction a patient needs.
VOICE TRIVIA:

A soprano hitting a high C, is vibrating her vocal folds at a rate of 1046.5 times per second.

In the 19th century, Spanish singing teacher Dr. Manuel Garcia is credited with being the first to use a mirror exam to view the larynx.

Research shows that patients with significantly improved vocal quality after thyroplasty, botox injections, and traditional voice therapy, were also viewed as being younger, healthier and friendlier as judged by listeners compared to their pre-treatment voices.

95% of patients with squamous cell laryngeal cancer are smokers.

A research study revealed that vocal folds exposed to direct steam hydration vibrated with less phonatory effort supporting the recommendation to drink water to improve the voice!