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Voice Disorders

Lose your voice often? Feel pain while speaking or swallowing? Have a raspy or rough speaking voice?

An underlying pathology or speaking habit could be causing your voice to function less than optimally. A variety of factors can contribute to changes in vocal pitch, quality, loudness, or vocal effort. While some of these disorders may require medical intervention, many can be remediated or improved through voice therapy administered by a speech-language pathologist (SLP). Even in cases of surgical correction, voice therapy is recommended before and after a medical procedure to ensure healthy and efficient use of the voice. Common contributing factors to vocal issues include:

  • Vocal misuse/overuse
  • Vocal trauma (e.g. shouting)
  • Structural changes to the vocal mechanism
  • Neurogenic conditions
  • Psychological stressors (e.g. tension/anxiety)
  • Surgery
  • Acid reflux
  • Thyroid disturbances
  • Eating disorders
  • Cancer
  • Respiratory issues
  • Neurodegenerative diseases
  • Craniofacial anomalies
  • Smoking

Voice disorders can be caused by a number of issues and anomalies. This can range from serious conditions, such as Head and Neck cancer, to maladaptive speaking tendencies, such as poor posture that causes excess tension in vocal musculature. Causes of voice disorders are typically divided into organic (structural or neurologic), functional, and psychogenic classifications. Some voice disorders may be diagnosed exclusively by an SLP, while others require medical examination by an otolaryngologist (ENT) or other professional. We work with related professionals based on your needs to provide comprehensive evaluations and treatment.

The term “speech therapy” is used as an umbrella term for a myriad of domains within speech-language pathology, one of which is “voice therapy”. Voice therapy involves rehabilitation of the anatomical and physiologic integrity of the vocal mechanism. All voice therapists are licensed and certified speech-language pathologists, but not all SLPs have in-depth training in Voice Therapy. Our clinicians are speech-language pathologists with particular interest and experience in voice evaluation and therapy.

Part of vocal production is referred to as resonance. Resonance is understood as the way sound vibrates within a space and the acoustic quality that occurs as a result. In the context of voice, resonance is the tone or timbre of our voice created by sound vibrations within our speaking system. Vocal resonance can sometimes be confused with pitch, though they are actually distinct properties.

A helpful analogy would be to think of two different musical instruments, such as a trumpet and a piano. If these instruments play the exact same note, they will be producing the same pitch, yet we are still be able to distinguish which sound is coming from the trumpet versus the piano. Why do they still sound unique if they are playing the same note? They have a different type of sound because they resonate differently. Likewise, two humans may have drastically different sounding voices due to how the voice is resonating. Our resonance is affected by changing the size and shape of the different areas in our speaking system in which sound can vibrate. These include the oral, pharyngeal, and nasal cavities. Having the voice vibrate in these three cavities to different degrees is what causes distinct resonances. Sometimes this resonance or vocal tone can be atypical due to a resonance disorder.

Disorders of resonance may occur as a result of an inadequate velopharyngeal mechanism caused by structural abnormalities, such as cleft palate. This may result in hypernasality or hyponasality. Surgical intervention is required to repair the structures associated with these disorders. However, a speech-language pathologist is effective in treating errors regarding resonance that exist before and after surgery takes place, as well as providing facilitative strategies to improve resonant qualities.

Since the majority of us use our voices to communicate, a voice disorder can be unpleasant for anyone. However, voice disorders are especially debilitating for those classified as professional voice users; that is, a person whose voice is a large or primary tool used in their occupational or daily life. Professional voice users are those who rely on their voice to make a living. This includes individuals such as talk show hosts, actors/actresses, radio broadcasters, public speakers, etc. These professionals realize that the health of their voice is crucial to their success. Other professional voice users may not even recognize that they are classified as such! Professionals such as teachers, salespeople, consultants, waiters, counselors, bankers, and more, also rely on their voices to be effective in their field. In addition to depending on their voice for professional success, individuals in these fields are at an increased risk for voice disorders given heightened vocal demands. Many professional voice users simply try to “muscle through” their vocal difficulties instead of seeking help. This, however, is not necessary!

Voice therapy is an effective way to remediate most disorders caused by vocal misuse or overuse. The clinicians at New York Speech Pathology are trained to address the vocal concerns of professional voice users. Even after voice therapy is complete, the staff at New York Speech Coaching can assist professional voice users with further enhancing their speaking voices and public speaking skills.

For singers, nothing is considered more precious than the voice. Unfortunately, singers are not immune to voice disorders. Like other professional voice users, singers rely heavily on vocal functioning. Just like not all SLPs are voice therapists, not all voice therapists specialize in the singing voice. At New York Speech Pathology, we offer specialized singing voice rehabilitation with a dual certified speech-language pathologist and voice teacher. Even after rehabilitation is complete, the staff at New York Speech Coaching can assist singers with further enhancing their vocal technique.

Initial consultations involve a comprehensive assessment battery during which vocal functioning is assessed through quality of life measures, auditory-perceptual assessment, phonatory/respiratory efficiency, and acoustic analysis. All procedures are non-invasive and conducted on-site. If necessary, appropriate medical documentation or correspondence with other professionals (such as your otolaryngologist / ENT) will be gathered to inform our clinicians. A client and/or caregiver interview is included to gather relevant background information.

We also offer comprehensive evaluations for those who would like an extensive report beyond that of the initial consultation. In addition to the components of the initial consultation, each evaluation will include each evaluation will include assessment of related communication domains, an extended case-history, medical documentation, and communication with other professionals when appropriate. Prior to an evaluation, we will conduct a free 15-minute phone conversation to determine the assessment methodologies appropriate for you or your child’s concerns.

After the initial consultation or evaluation, the clinician will provide you with a treatment plan including a recommended frequency and total number of sessions. However, the frequency of sessions is at your discretion and amenable based on progress. Clients with vocal concerns are typically seen for voice therapy once per week for one hour. The number of sessions required is dependent on a variety of factors, including the etiology of the problem, the client’s diligence in performing the prescribed exercises, and implementation of necessary lifestyle and speaking adjustments outside of therapy. We are happy to work with you to determine how many sessions will fit your specific needs. This can be adjusted at any time.

Voice therapy will address how to properly care for your voice (vocal hygiene), provide counseling for the underlying problem, and prescribe specific rehabilitative exercises to return voice to optimal functioning.

Even if you have no known underlying impairment, but are not satisfied with the quality or sound of your voice, we would be happy to schedule a free phone consultation to address your concerns. If voice therapy is not appropriate for you, the instructors at New York Speech Coaching are specially trained in providing speaking voice enhancement for vocal concerns that are non-pathological in nature.