Voice Desorder and Treatment

Voice disorders may be caused by many different factors, events, physical alignment, and diseases. The vast majority of voice problems are caused by factors that are not life-threatening and that are easily treatable. Almost every disorder of the larynx may result in more than one symptom, and there is no single symptom associated with a specific disorder of the larynx. For example, hoarseness, limitations in pitch and loudness, shortness of breath, or increased vocal effort may be a sign of any number of disorders of the larynx. The severity of the voice symptoms does not necessarily correspond to the severity of the underlying disease. The only way to know what is causing your specific voice problem is to be evaluated by an otolaryngologist (ENT Specialist).

Voice Disorders

  • Nodules, Polyps, and Cysts
  • Granuloma
  • Muscle Tension Dysphonia (MTD)
  • Laryngitis
  • Reinke's Edema
  • Cancer of the Larynx and Vocal Folds
  • Scar and Sulcus Vocalis
  • Laryngopharyngeal Reflux Disease (LPR)
  • Custom Hearing Protection and Swim Molds
  • Assistive Listening Devices
  • Vestibular and Balance Evaluations
  • Virtual Care Appointments

 

Causes of Voice Disorders:

  • Upper respiratory infections
  • Inflammation or swelling
  • Acid Reflux.
  • Beings growths (e.g. Nodules, Polyps, cysts)
  • Neuromuscular Condition (Vocal Cord Paralysis, Spasmodic dysphonia)
  • Laryngeal Cancer
  • Habitual Coughing or throat clearing.

 

Symptoms of Voice Disorder:

  • Hoarseness
  • Breathiness
  • Pitch Change
  • Voice cracks
  • Loss Of vocal Range when singing
  • Frequent throat clearing
  • Vocal Fatigue –Pain

Comprehensive Voice Assessment (How is a voice disorder diagnosed?)

ENT Consultation

The diagnosis is in conjunction with an endoscopic and video stroboscopic examination of the vocal cords, done by an ENT Surgeon or Otolaryngologist.

  • A thorough history taking, to determine the exact nature and possible causes of the complaint
  • Direct video Laryngoscope
  • Flexible Laryngoscope – assessing the function of the vocal folds
  • Laryngostroboscopy – Examining the vocal cords using a specialized flickering light source, called digital Laryngostroboscopy. This allows an assessment of the movement and vibration of the vocal cords. This is the best & latest instrument for the early detection of vocal cord cancer.
  • Flexible fibreoptic nasopharyngoscope – Evaluation of the nasal cavity, palatal region, nasopharynx, and oropharynx.

Voice Therapist / Speech Language Pathologist Consultation:

The voice therapist plays an important role in the diagnosis and treatment of voice disorders. The voice therapist makes the diagnosis by the following means:

  • Perceptual assessment
  • Computerized voice analysis – Acoustic analysis or Analysis of the sound signal
  • Spectrographic analysis
  • Aerodynamic measurements – Analysis of airflow and air pressure during voice production
  • Electroglottography – Evaluation of vocal ford movement regularity.
  • Laryngeal Cancer
  • Habitual Coughing or throat clearing.

 

Voice Therapy (What is Voice Therapy?):

Voice Therapy is a mode of treatment for a patient with a voice disorder, which includes:

  • A vocal hygiene program
  • Relaxation and breathing techniques
  • Exercises for strengthening the vocal cords

 

What does a voice therapist do?

The voice therapist provides the behavioral mode of treatment. The voice therapy is conducted over several sessions, employing one-to-one interaction between the patient and the therapist. During these sessions, the various modes of the therapy are demonstrated and taught to the patient, so that he can follow the required regime independently and at home.

Special voice software programs are used to monitor the improvement in voice quality and provide feedback to the patient.

 

What is the scope of voice therapy?

Various voice problems can be successfully managed by voice therapy:

  • Vocal cord lesions due to vocal hyperfunction (voice misuse and abuse) such as vocal nodules, polyps, cysts, and vascular lesions can be treated by voice rest and an individually designed vocal hygiene program.
  • Vocal hypofunction disorders like bowing of cords and unilateral or bilateral vocal cord palsy can be treated by a regime of exercises for strengthening the vocal cords.
  • Functional aphonia and spasmodic dysphonia can also be managed successfully by relaxation and breathing exercises.
  • Voice therapy is a part of post-operative care for patients operated for vocal cord lesions and also following such procedures as thyroplasty, botulinum toxin injections and Teflon paste injections.
  • Post laryngectomy voice rehabilitation with the help of artificial larynges, voice prostheses, and oesophageal speech.

The success of voice therapy is dependent upon:

  • Correct medical diagnosis
  • Proper functional assessment of voice use
  • The therapist’s knowledge and skill
  • Patient compliance

 

CARE OF PROFESSIONAL VOICE

Nothing can surpass the ability of the voice to convey expression. Most professionals, who use their voice for a living, seek help for voice changes, vocal fatigue, anxiety, throat tension, or pain at some point of time in their life. These symptoms must be quickly diagnosed and effectively treated to restore the voice before further or permanent damage is done.

Many people in society with voice problems move desperately thinking that they have no solution for their problem. But, most of these problems can be prevented by Voice Hygiene techniques and can be treated by simple voice therapy.

Who needs professional voice care?
Actors, Teachers, Lecturers, Business executives, Entertainers, Lawyers, Coaches, Politicians, and Clergy need voice care as it is critical to their professional well-being.

Effective oral expression is of paramount importance in our communications-based world.

One of the most damaging vocal behaviors I know is speaking at the incorrect optimal pitch, usually too low. (Vocal Fry) More women than men have this problem.

Causes of vocal problem in singers and professional voice users

Lack of discipline and self-motivation.

Lack of self-restraint: Overuse and abuse.

  • Speaking too long, too loud, too low, over too loud noises - particularly when voice is tired or “ill.” Voice rest is not an excuse for not practicing. It is the reason to eliminate or severely restrict social talking.
  • Inability to say ‘no’ socially and professionally when you and your voice are tired, sick, and overworked.

Incorrect vocal technique - To develop good technique and maintain a healthy voice:

  • Warm up the voice every day before speaking and singing.
  • Practice efficiently and carefully.
  • Correct technical problems when pointed out and work diligently to correct them as soon as possible.
  • Correct specific vocal habits that hamper good technique:
  • The mouth/jaw does not open enough.
  • Vowels — example: E too stretched, restricting mouth opening.
  • Tongue retracted, humped, etc., causing muscular tension, particularly the jaw.

Singer’s vocal technique problems that result from vocal dysfunction (laryngitis, hoarseness, nodules, etc.)

  • Inability to bridge easily between registers.
  • A voice quality that is breathy, hoarse, raspy, and gravelly.
  • The inability to sing loudly and/or softly, particularly in the bridge from middle to low register (a “break”).
  • The double whammy: It takes longer to warm up a damaged voice. But, to minimize further damage, it is imperative that one thoroughly warms up the voice. This is unfortunate because a “sick” voice tires quickly.

Singers and professional voice users with vocal dysfunction may have some of the following problems:

  • Raised shoulders, one shoulder higher than the other.
  • Congenital conditions such as a short leg may result in one shoulder being held higher than the other. The longer leg is habitually in front of the other with the weight on one foot. Do not try to artificially level the shoulders. It will only cause more tension. A lift or small molded appliance in the shoe is needed. This is also one cause or exacerbator of Temporomandibular Joint Dysfunction (TMJD).
  • TMJD – mouth/jaw does not open symmetrically.
  • Incorrect head position (ex. chin up).
  • The tension of neck muscles, shoulders, arms, hands.

Symptoms that should alert one to the possibility of asthma, bronchitis, and allergies:

  • A feeling of tightness in the chest
  • Wheezing and/or shortness of breath
  • Problems with breath — inability to complete a relatively short musical phrase
  • Frequent episodes of vocal and physical fatigue. The appearance of the stress of being tired without sufficient cause
  • A frequent dry or wet cough with the feeling of mucus on the vocal folds
  • Excessive tension of the extrinsic neck muscles, jaw, and face
  • Persistent throat clearing
  • Tickle in the throat
  • The appearance of restlessness or nervousness
  • A wrinkled forehead
  • Loss of voice

For singers, this means careful attention to the following recommendations for good laryngeal health and the prevention of serious vocal problems:

  • General rules of good health for the entire body
  • Voice training and exercise
  • Proper speaking techniques
  • Good vocal habits (avoidance of yelling, throat clearing, etc.)
  • Attention to allergies and hormone balance
  • Prompt and professional care for respiratory infection and laryngitis

What is involved in voice care?

We at Apple speech and hearing clinic diagnose and treat voice disorders that affect the voice box. Utilizing current state-of-art equipment and technology, individualized treatment plans are designed to keep your voice strong, healthy, and sound beautiful.

What symptoms indicate a need for voice care?
  • Hoarseness
  • Change of voice/ loss of range
  • Vocal spasms
  • Pain with talking or singing
  • Chronic sore throat
  • Heartburn or chronic cough
  • Breathing difficulties of noisy breathing

Voice Care Tips

How the Voice problems can be prevented?

Voice hygiene techniques play a greater role. Some simple tips to improve your vocal health

  • Drink plenty of water- take sips of water the whole day to keep your throat wet, water acts as a lubricant to your vocal cords
  • Avoid reflux triggers like spicy foods, alcohol
  • Avoid airborne irritants like smoking
  • Avoid abuse or misuse of voice like yelling
  • Avoid throat clearing
  • Avoid drugs that cause throat dryings like aspirin or anti-allergic drugs

Tips for Singers

  • Do some easy physical warm-ups before vocalizing
  • Begin with five minutes of humming
  • Begin vocalizing only in the middle voice and gradually and cautiously extend the range up and down
  • Always “warm-down” after singing or performing, particularly after strenuous singing using easy humming exercises, etc
  • Never whisper! Use a quiet, well-supported head voice

High-Performance Voice Training

Voice clinics for voice problems

At our clinic, we provide High-Performance Voice Training. High-Performance Voice Training is a unique service for singers, actors, dubbing artists, broadcast journalists, and other professionals whose careers demand the most of their voice. Anyone who needs to do public speaking, whether it’s on the air at a trade show, must have their voice tuned to its optimum performance.

We Apple speech and hearing clinic will perform an initial assessment of a patient’s voice and/or singing technique. An individualized plan is prepared based on the assessment.

Singers especially can benefit from High-Performance Voice Training. Our expert voice therapist will provide services specifically tailored to your needs including:

  • Optimization of support
  • Efficient phonation
  • Increase in vocal range and flexibility
  • Reducing strain to vocal cords from challenging vocal material
  • Strengthening exercises improve vocal stamina and decrease vocal fatigue.

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