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Voice Disorders

How speech pathology treats voice disorders

Losing your voice can be a significant inconvenience. Day to day activities like ordering a coffee or talking to work colleagues are disrupted until your voice gets back into shape. Imagine the impact of having an ongoing voice problem that was actually a voice disorder? Imagine if you relied on your voice as your source of income?

What is a voice disorder?

A voice disorder is any change to the pitch, volume or quality of a person’s voice that impacts their ability to particulate and function in everyday life. Up to 6% of the population has a voice disorder. Concerningly, this increases to 21% for those who use their voice professionally such as teachers, ministers, actors and singers[1].

A voice loss is also known as dysphonia

How is your voice created?

The structure used to create voice is your voice box (larynx). Your larynx is located towards the front of your neck. It is surrounded by muscles in your neck, throat and shoulders. This sits on top of the trachea, which is the tube that leads to the lungs. Your larynx is made up of two sets of vocal cords/folds. These include the true vocal folds and the false vocal folds. The vocal folds are very tiny and delicate and have to be in optimum health.

When you speak, a number of physiological processes occur:

  1. You breathe in
  2. The true vocal folds come together (adduct)
  3. As you breathe out to speak, the air from your lungs travels up the trachea through the true vocal folds.
  4. Since the true vocal folds are in contact, the travelling air makes them vibrate.
  5. These vibrations travel upwards where the muscles in your mouth shape them into speech that we can understand.

How a voice problem begins

[1] Changes to your voice may be:

  • Momentary: such as having a wobbly voice when you’re feeling nervous.
  • Overnight or last a few days: such as experiencing a sore voice or voice loss after socialising where you have had to talk or yell over background noise.
  • Long term/ chronic: such as having a croaky or rough voice which continues to worsen after a cold/laryngitis.

Your voice may start to sound:

  • Rough and husky
  • Soft and high pitched
  • Strained and low pitched
  • Breathy and whispery
"Long term misuse of the voice can lead to muscle tension dysphonia and organic changes such as vocal nodules"

Types or voice problems

Voice Disorders are divided into two main categories: organic or functional[2]. The most commonly treated type of voice disorder is a muscle tension voice dysphonia, a functional voice disorder. This is caused by long term misuse of the voice which can lead to organic changes (e.g. vocal nodules). This is most common in those who use their voice professionally such as teachers, ministers, actors and singers.

Organic Voice Disorders are caused by damage to the vocal folds (e.g. cyst/acid reflux), structural changes to the larynx (e.g. tracheostomy) or neurological conditions (e.g. Parkinson’s Disease).

Every voice is unique and the way in which we use voice to articulate our thoughts and express emotion is unique. It is unsurprising then that in many cases there is a psychological component to a voice disorder, even if it is not the principal cause for it (psychogenic voice disorder).

Impacts of voice disorders

  • Voice Disorders can make it difficult to be heard or understood.
  • People may have to constantly repeat themselves, write things down, or use gestures to get a message across. This can be time-consuming, frustrating and embarrassing.
  • Voice Disorders can also cause pain and discomfort around the throat.

When to seek help for children

  • As soon as you notice your child has voice issues.
  • Your child’s voice issues are impacting his or her ability to be heard or understood by others.
  • Your child feels self-conscious or upset about his or her voice issues.
  • Your child is being teased by other children for his or her voice issues.
  • You are concerned about your child’s voice issues.

When to seek help for adolescents and adults

Voice Assessment

Your speech pathologist will have a discussion with you to clarify your concerns and gather information about health and voice use. This helps us understand the factors contributing to a voice disorder.

Your Speech Pathologist will perform a perceptual voice assessment and acoustic analysis to determine the type and severity of the voice disorder[2].

    1. The perceptual voice assessment describes and quantifies the characteristics of your voice (pitch, resonance, volume).
    2. The acoustic analysis objectively measures the vocal characteristics identified from the perceptual voice assessment.
    3. Your speech pathologist may recommend that you see an Ear Nose and Throat Specialist (ENT) to examine your vocal folds through a scope.

Voice Therapy

At Talkshop, our speech pathologists work on:

  • Introducing basic vocal care strategies into your daily life in order to take care of your vocal cords and reduce inflammation[3].
  • Removing patterns of vocal misuse and learning new ways to use your voice safely and efficiently[1][4]. We will target achieving a clear voice consistently. We also look to teach strategies to use voice effectively in your everyday voice.
  • A therapy block is typically for 6-10 sessions.

We may advise further assistance from other health professionals.

"In many cases there is a psychological component to a voice disorder, even if it is not the principal cause for it"
Book a Discovery Session

Our FREE Discovery Session is ideal for anyone with any questions relating to speech, stuttering, language, literacy, social skills, swallowing and voice.

This is an opportunity for us to give some information on how to monitor your concern and give you advice on how start self-managing any issues immediately.

Discovery Sessions can help you understand if an assessment or therapy is needed, how Speech Therapy would work and, if appropriate, help you book in.

References

1 Ma, E. P., Yiu, E. M., Abbott, K. V. (2007) Application of the ICF in voice disorders.Seminars in Speech and Language 2007 Nov;28(4):343-50. https://www.ncbi.nlm.nih.gov/pubmed/17935019. Accessed 11 Jan. 2019.

2 Baker, J. Ben-Torvin, D. Butcher, A. Esterman, A. & McLaughlin, K. (2007) Development of a modified diagnostic classification system for voice disorders with inter-rater reliability. Logopedics Phoniatrics Vocology, 2007;32(3):99-112. https://www.ncbi.nlm.nih.gov/pubmed/17885938. Accessed 14 Jan. 2019.

3 Obrien, J. O. (2014) Participation-focused Intervention among US Speech Language Pathologists. Masters Thesis, University of Washington. https://digital.lib.washington.edu/researchworks/bitstream/handle/1773/27230/OBrien_washington_0250O_13701.pdf?sequence=1. Accessed 14 Jan. 2019.

4 Voice: Person Centered Focus on Function. American Speech Language Hearing Association. https://www.asha.org/uploadedFiles/ICF-Voice-Disorders.pdf. Accessed 14 Jan. 2019.

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