Voice Therapy - An Overview

Introduction

Voice therapy involves vocal cord exercises to treat or prevent voice disorders such as laryngitis (inflammation of the larynx or voice box) and hoarseness. This therapy also makes the voice sound stronger than it was before the therapy. A voice disorder can also be prevented with the help of voice therapy. A type of voice therapy called gender-affirming voice therapy is beneficial for transgenders. Voice therapy encompasses many individually tailored exercises that are provided by a speech therapist, respiratory therapist, or voice coach.

How Are Sounds Produced?

Before learning about voice therapy, it is essential to understand the physiology of voice production. When one makes a sound, the air travels through the lungs into the windpipe (trachea) and larynx (voice box). There are two vocal cords or vocal folds that are present inside the larynx. The flexible muscles of the vocal cords vibrate as the air moves through them. As a result of these vibrations, sound waves or voice is produced.

A clear sound is produced when the vocal cords vibrate in unison. Vocal disorders occur when the vibration of the vocal folds is not in unison or if they do not open or close completely. Pitch refers to how low or how high one’s voice is. The size and length of the vocal folds influence pitch.

When Is Voice Therapy Required?

A consistent or inconsistent change in voice can happen due to certain disorders that affect the larynx (voice box). The vocal cords are confined in the larynx present in the throat. The larynx also contains muscles necessary for breathing, talking, and swallowing. Voice disorders can alter the pitch, quality, or loudness of the voice. The voice may sound husky, strained, or weak. Sometimes, the voice can sound like a whisper or disappear altogether. In these situations, voice therapy may be beneficial to correct the voice.

Who Requires Voice Therapy?

Voice therapy is the main treatment modality for lesions of the vocal folds like vocal polyps, cysts, and nodules. These lesions are common in people engaged in occupations that demand the need for frequent and high-pitched voices, like teachers, singers, clergy, or attorneys. Vocal overdoing can also be noticed in sports enthusiasts, aggressive or loud children, high-energy adults who talk loudly, and socially active individuals. Others who require voice therapy are as follows:

• Laryngitis (inflammation of the voice box).

• Vocal tremor or spasmodic dysphonia (a neurological disorder in which there is a spasm of the muscles of the voice box that results in periodic breaks in speech).

• Muscle tension dysphonia (a condition in which the muscles of the vocal cords can tighten due to excessive stress).

• Vocal cord dysfunction (in this condition, the vocal cords tend to shut when they are supposed to be open, which can result in difficulty breathing while exercising or when the throat is irritated).

• Vocal cord paralysis.

• Vocal cord paralysis (a scar or nerve damage can cause restricted or no movements in one or both vocal folds, which can result in difficulty swallowing, difficulty breathing, or can cause hoarseness).

What Are the Types of Voice Disorders?

There are two types of voice disorders, namely:

• Organic Voice Disorder: A change that affects the larynx can result in organic voice disorder. The physical changes that occur in the voice, like the paralysis of the vocal cords following thyroid surgery, may be due to a functional disorder.

• Psychogenic Voice Disorder: The voice becomes hoarse in individuals with a psychogenic voice disorder. For example, an individual may partially or completely lose their voice following a distressing event.

• Functional Voice Disorder: People who have the habit of speaking loudly can experience functional voice disorder.

Whom Should One Consult for Voice Therapy?

A laryngologist should be consulted if one has any issues with voice since a laryngologist treats problems that affect the larynx (voice box). They also perform surgeries in the larynx if required. Based on the problem, a laryngologist may refer an individual to a voice therapist. A voice therapist assists and teaches various voice therapy exercises to prevent or get rid of harmful vocal behaviors, teaches healthy vocal behaviors, and aids in the healing of vocal cords following injury or surgery.

What Are the Various Voice Therapy Exercises and What Is Transgender Voice Therapy?

There are various voice therapy exercises based on the cause of the vocal problem. These are as follows:

• Breathing Exercises: These exercises focus on controlling the diaphragm muscles involved in breathing and speaking.

• Tension Release Exercises: These exercises involve stretching and massage to reduce the tension in the throat.

• Semi-occluded Vocal Tract Sounds: In this, the vibration of the vocal cords is enhanced through straw phonation, lip trills, humming, and so on.

• Voice-Building Exercises: Those with weak vocal cords are taught voice-building exercises to strengthen the vocal cords and enhance breath support.

Two common approaches in voice therapy are:

• Symptomatic Voice Therapy: In this therapy, the symptoms that lead to voice disorders are modified directly or indirectly. The rate, loudness, resonance, laryngeal muscle tension, respiration, and phonation are modified. One of the most preferred techniques in symptomatic voice therapy is chant-talk. This therapy aims to reduce the effort needed for talking. Another type of symptomatic voice therapy is resonant voice therapy. Actors and singers prefer this technique to enhance voice production.

• Physiologic Voice Therapy: This therapy is preferred when the vocal mechanism is affected by a voice disorder. The physiological activities that influence phonation, resonation, and respiration are modified in this therapy. One of the most preferred techniques in this therapy is the accent method. This is beneficial in the treatment of stuttering, dysphonia (possessing an abnormal voice or hoarseness), and dysprosody (a speech disorder characterized by changes in the timing, rhythm, intensity, or intonation of words). This technique aims to increase pulmonary output, reduce the glottis waste and muscle tension, and stabilize the vibration pattern.

Transgender individuals may undergo voice therapy either accompanied with or instead of voice masculinization or voice feminization surgery. Transgender voice therapy enables one to learn how to adjust the frequency or pitch of the voice, resonance, and nonverbal communication.

What Are the Benefits of Voice Therapy and How Can One Protect Their Voice?

Voice therapy aids one to learn the healthy methods of using one’s vocal cords as a preventive measure. It also helps prevent issues like laryngitis, hoarseness, and lesions that commonly affect individuals who are engaged in occupations that demand the need for frequent and high-pitched voices, like teachers, singers, and so on. By enhancing better vocal cord vibration, voice therapy aids in the healing of vocal cord swelling and small lesions in the vocal cords. Voice therapy can also heal the vocal cords after surgery. There are no known risks in undergoing voice therapy. One can take the following measures to protect one’s voice:

• Staying hydrated by drinking plenty of water.

• Providing sufficient rest to the vocal cords if one is engaged in activities like singing, teaching, and so on.

• Refraining from smoking and avoiding secondhand smoke.

• Limiting the consumption of alcohol and caffeine as these can dry out the vocal cords.

• Treating conditions like long-term coughs, allergies, and so on that could irritate the vocal cords.

How Does Voice Therapy Differ From Speech Therapy?

Voice therapy addresses issues that involve the vocal cords alone, while speech therapy covers a range of problems. Voice problems can accompany speech problems. Various speech problems include:

• Language disorders that influence one’s ability to express themselves or understand others.

• Speech disorders such as stuttering.

• Swallowing disorders that occur after an injury, stroke, or surgery.

• Cognitive-communication disorders that have an impact on thought processes. These disorders include traumatic brain injury, stroke, or dementia (a group of symptoms that affect thinking, memory, and social abilities).

• Social communication disorders linked with traumatic brain injury (TBI), and autism spectrum disorder (a developmental disability that affects the interaction, behavior, and learning ability of an individual).

Conclusion

Voice therapy aids in the recovery from a voice disorder or vocal cord surgery. A voice therapist can assist one with voice therapy by teaching exercises that strengthen the voice or aid in keeping the vocal cords healthy as a preventive measure. Gender-affirming voice therapy can benefit transgenders as they learn to attain a lower or higher pitch. The extent and time span of voice therapy depends on the cause. A majority of voice therapy sessions are scheduled once or twice a week for several months. To notice better results, one must adhere to the instructions of the voice therapist, practice the vocal exercises at home, and pursue these exercises even after the voice therapy sessions end.