Voice disorders can significantly affect quality of life and place an unnecessary financial burden on health services if unidentified or misdiagnosed. Speech and language therapists have an important role in supporting people with Voice disorders by contributing to differential diagnosis and the management of these disorders.
What Is Voice Disorders?
A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual’s age, gender,
cultural background, or geographic location. A voice disorder is present when an individual expresses concern about
having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant.
Voice disorders occur with a change in the voice, often described as hoarseness, roughness, or a raspy quality. People
with voice disorders often complain about or notice changes in pitch, loss of voice, loss of endurance, and sometimes a
sharp or dull pain associated with voice use.
Voice disorders affect the co-ordination of muscles in the throat (larynx). They can occur independently, or co-exist with
lower respiratory disease – for example, asthma, bronchiectasis (a long-term condition where the airways of the lungs
become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to
infection).
Voice disorders are thought to result from heightened sensitivity in the throat and hyperactivity of throat muscles, which
can result in the vocal cords shutting unnecessarily. They include:
• Inducible laryngeal obstruction (ILO, previously known as vocal cord dysfunction): A choking
sensation/wheeze (typically when breathing in) caused by throat muscles squeezing together and obstructing
airflow in the throat.
• Chronic cough: Dry coughing bouts which persist for longer than eight weeks and do not respond to medication.
• Throat clearing: Often in response to an irritation in the throat that will not clear.
• Globus pharyngeous: Lump sensation in the throat in the absence of a physical lump.
• Voice difficulties (dysphonia): Typically, due to muscle tightness, inflammation, structural lesions or
neurological disorders.
• Swallowing difficulties (dysphagia): Dysphagia or pseudo dysphagia, often associated with altered laryngeal
sensitivity.
What Is The Role Of Speech And Language Therapists (SLTs)?
• Speech and language therapists (SLTs) have a key role to play in the assessment, differential diagnosis and
treatment of voice disorders. Timely and appropriate input from SLTs can reduce the frequency and severity of
symptoms and reduce health costs.
• SLTs work within a multidisciplinary team of respiratory experts, including doctors, nurses, and clinical
psychologists.
• SLTs perform videolaryngeal examinations, to observe laryngeal pathology and assess function and sensation,
which is essential for the differential diagnosis of voice disorders.
• SLTs support people with respiratory conditions through teaching them rescue breathing strategies, throat and
upper body relaxation exercises, giving advice on how to maintain a healthy larynx including throat care advice,
behavior change techniques and offering psychological support.
Voice Care.
Tips On Voice Care And Projection
Our voices are a key part of our identity. We use them to communicate with our families, friends, work colleagues and wider society. They convey our thoughts and feelings, and enable us to make an impact, whether we are speaking, shouting, cheering or singing. It is important that we take care of our voices to avoid long-term problems, particularly if public speaking is part of our everyday life. Here are some tips from expert speech and language therapists on how you can care for and project your voice.
Caring For Your Voice
General Advice
• Aim for good hydration; drinking 8-10 glasses of water a day is recommended as dehydration, caused by alcohol or
caffeine in drinks, can lead to vocal cord irritation.
• If you are hoarse, don’t whisper - use your voice gently to avoid strain.
• Try to ‘warm up’ your voice, through gentle humming or speaking, before a lot of public speaking.
• Ensure adequate sleep and exercise, because your voice reflects your general health and wellbeing.
Avoid The Following
• Avoid long periods of overuse, especially speaking over background noise.
• Heartburn/reflux can lead to vocal cord irritation so avoid foods that cause indigestion and avoid eating late at
night.
• Reduce/avoid smoking. Smoke irritates the vocal cords and causes them to swell.
• Avoid lots of dairy produce as this can cause thick secretions and throat clearing.
• Throat clearing leads to vocal cord irritation, so try to avoid this by coughing gently or sipping water.
Projecting Your Voice
General Advice
• Aim for an open and relaxed stance with weight evenly distributed and balanced posture.
• Wear comfortable shoes and clothes.
• Try to develop a relaxed voice production technique with controlled breathing.
• Clear articulation and a good range of intonation facilitate voice projection.
• Emphasis, energy and variety project the voice better than a loud and strained voice.
Avoid The Following
• Poor posture affects vocal delivery, so locked knees, weight on one leg, raised shoulders and forward thrust of the
head and neck should be avoided.
• Pushing the vocal volume leads to a constricted and often harsh vocal pitch.
• A monotonous vocal range may encourage the listener to ‘switch off’.
• Disconnection with the material may lead to an ‘automatic’ delivery, so listeners feel disengaged
Pay Attention To The Environment
• Be aware of the acoustics of the space to determine the amount of reverberation (vibrations and/or echo from your
voice).
• When speaking outdoors, if possible, stand on a platform or with a wall behind you.
• When possible, use amplification to avoid voice strain.
• Have a sense of ownership of the space.
• Create a positive attitude to and connection with your audience