What is a voice disorder?

While most of us have experienced changes with the tone of our voice; be it hoarseness after singing in the shower, a muffled tone during or after a cold or sore throat, or even an extremely soft or rough sounding voice that impacts other’s ability to hear or understand the words spoken; few have considered these changes in tone an actual voice disorder.

According to the American Speech and Hearing Association’s website (ASHA.org), “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.” The medical term for a voice disorder is “Dysphonia.”

Some signs and symptoms of Dysphonia include:

• Roughness (perception of aberrant vocal fold vibration)
• Breathiness (perception of audible air escape in the sound signal or bursts of breathiness)
• Strained Quality (as if talking while lifting heavy objects)
• Strangled Quality (as if talking while holding your breath)
• Abnormal Pitch (voice tone that’s too high, too low, breaks in pitch or decreases in range)
• Abnormal Loudness (tone volume that’s too high, too low, decreased in range, or an unsteady volume)
• Abnormal Resonance (hypernasal, hyponasal, cul de sac resonance)
• Aphonia (loss of voice)
• Phonation Breaks
• Asthenia (weak voice)
• Gurgled/Wet Sounding Voice
• Hoarse Voice (raspy, audible aperiodicity in sound)
• Pulsed Voice (fry register, audible creaks or pulses in sound)
• Shrill Voice (high, piercing sound, as if stifling a scream)
• Tremulous Voice (shaky voice; rhythmic pitch and loudness undulations)

Visit the website for The American Speech, Language, and Hearing Association (ASHA) for a complete list of signs and symptoms of Dysphonia.

If YOU express concern about having difficulty using your voice to meet daily needs, then a voice disorder is likely. You should discuss your voice concerns with your physician or a Speech-Language Pathologist (SLP).

Notes: Physicians often have little training in understanding how a SLP can help with voice disorders, so always advocate for yourself and call a local SLP if you need assistance.

How are voice disorders are diagnosed?

Voice disorders can affect anyone at any age. They can affect the 16-year-old cheerleader who spends too much time yelling! Maybe your voice sounds strangled when you speak, despite the fact that your spouse hasn’t strangled you…at least not yet! Voice disorders can even affect the older adult whose voice becomes “old sounding.”

There are three categories of voice disorders:

Organic

An organic voice disorder typically stems from a physiological change including trauma to the vocal cords (such as with intubation or chemical exposure), vocal nodules, aging, or certain diseases (Parkinson’s Disease, Multiple Sclerosis).

Functional

Functional voice disorders are a result of poor use of your voice including excessing screaming, excessive throat-clearing, overuse of your voice, and muscle tension in the throat.

Psychogenic

Psychogenic causes include depression, anxiety, chronic stress, and conversion disorders. You may find you fall into more than one category and that is typical because we don’t always fit into one box when it comes to signs and symptoms of a voice disorder.

How can Speech-Language Pathologists can help?

An SLP can absolutely help. They are medically trained and have no less than a master’s degree, and spend years learning about speech, language, and swallowing disorders. At times you will hear SLPs referred to as a Speech Therapists. The two names are interchangeable.

“One of my favorite populations to treat is those with a voice disorder. There are often so many aspects to the treatment, including teaching people how to improve their breath control, address good vocal hygiene, and work on vocal loudness,” offered Karen Ross, SLP, at Trio Rehabilitation & Wellness Solutions. “This is particularly fun when I work with clients who have Parkinson’s Disease because they improve drastically.”

A review of over 21 studies found moderate to strong evidence that vocal function exercises improved the aging voice. These results had an added caveat. Patient compliance is imperative! Patients who were monitored throughout their vocal treatment appeared to have better outcomes and greater success than those who were not monitored. Visit ASHA.org to learn more about these studies.

What happens in Speech Therapy?

During your first visit at Trio Rehab, our speech therapist will conduct an in-depth evaluation. Our assessment includes a description of each voice-related concern. During this process it is important to not get discouraged when assessing a long history of voice problems; no matter the phase, speech therapy can still help!

Next, your SLP will want to know about your medical history, including information about previous surgeries, medications you take, medical diagnoses, and daily habits related to vocal hygiene. Vocal hygiene refers to how well you care for your throat and your voice. Causes of poor vocal hygiene include reflux or GERD, allergies, poor nutrition, smoking, excessive coughing, excess throat clearing, and the use of inappropriate pitch levels such as screaming.

Finally, your speech therapist will want to know how your voice disorder is affecting your daily life. This includes your emotions, self-image, and ability to communicate in social and working settings.

Once the evaluation is complete, your speech therapist and you will establish a treatment plan that could include respiration exercises to support healthy voice production. Examples of this include LVST LOUD programs, Stretch and Flow Phonation, and Vocal Function Exercises. This is not an exhaustive list of voice production interventions, but it will guide your understanding of how respiration plays an important role in vocal quality.

If necessary, your SLP may also refer you to another healthcare professional as part of your overall treatment plan. This might include a gastroenterologist to manage reflux or to psychologist to assist with psychogenic evaluations. In both cases, the continuation of speech therapy will likely be warranted.

At Trio Rehab, your speech therapy will be conducted one-on-one for approximately 45 minutes. The length of your treatment plan will vary depending on performance of a home exercise program as well as the severity of the voice disorder.

Will my insurance pay for Voice Therapy?

YES! Insurance carriers pay for voice therapy. Typically, a referral to a speech therapist is requested, but not always required. Should you have questions about your coverage, call your HR representative or your insurance provider.

We can help!

Our team of speech therapists can help with voice disorder education, assess symptoms and explore treatment plans. Call Trio Rehab for more information!

Karen Ross, SLP
Trio Rehabilitation & Wellness Solutions
Boerne, Texas