Treatment of Voice Disorders

Most voice disorders are not life threatening. It is generally up to the individual whether to seek treatment for a voice disorder, depending on the extent of voice impairment or discomfort. However, though you will not die from non-treatment of a voice disorder, it is still considered medically necessary to seek treatment. A normal sounding voice, free from discomfort or fatigue, is considered a normal function. If it is disordered, restoring it is medically necessary. Sometimes insurance companies will argue that point, but if they challenge it, your voice care professional will help you negotiate with them.

Treatment of a voice disorder should start with an evaluation from a voice care specialty team.

 

Your Voice Specialty Team

The Evaluation Process

Types of Treatment

Medical Treatment involving prescription and nonprescription drugs.

Surgical Treatment using precision laser and microscopic techniques.

Functional Voice Therapy for re-teaching the mechanism to function properly through exercises.

 

Your Voice Specialty Team at the Lions Voice Clinic

Laryngologists: Dr. George S. Goding and Dr. Stephanie Misono

Laryngologists are otolaryngologists (also known as Ear, Nose, and Throat (ENT) physicians), who specialize in disorders and surgery of the larynx and upper airway. 

Speech-Language Pathologists: Dr. Deirdre D. Michael, Lisa Butcher, and Allison Alpers

Although Speech-Language Pathologists are trained to evaluate and treat a wide array of disorders of human communication, as well as the organs involved in communication, our SLPs specialize in the voice and airway.  All our Speech-Language Pathologists are singers and singing teachers, and have a special interest in treating disorders in singers.

We all treat:

  • Voice Disorders

  • Swallowing disorders

  • Chronic cough, throat-clearing, and irritable larynx

  • Breathing disorders of the upper airway

 

The Evaluation Process

At the Lions Voice Clinic, your voice evaluation is interdisciplinary, that is, the laryngologist and speech-language pathologist evaluate you together, at the same time. We discuss the problem thoroughly with you, gathering information about the history of the problem, and your complaints and needs.  This also includes a thorough examination of our ear, nose, and throat.

 

The Laryngeal Examination

The examination of the larynx is a fundamental part of the evaluation.  This may be done in a number of ways.  Most often, we video-record the examination of the larynx, in order to have a document of the results. Also, it is often desirable to have you view your own larynx in action, in order to better understand your voice disorder.

The examination may be done with either flexible or rigid endoscopy, or both. The flexible endoscope is passed through the nose and into the throat, allowing a full view of the larynx in action.  The rigid endoscope is inserted into the mouth and straight back, functioning like a submarine periscope to view the vocal folds. The rigid endoscope is larger, offering a larger, brighter view of the larynx. However, the flexible endoscope, being passed through the nose, allows you to talk and sing during the procedure. This is vital in assessing the function of the vocal mechanism.



An endoscope consists of a lens at the end of fiberoptic cables that carry light to the dark insides of the human body. The image is viewed through an eyepiece. In the Lions Voice Clinic, the endoscope is attached to a video camera. This allows the image to be projected onto a video monitor during the exam, and videorecorded for replay. We can make single still pictures from the examination for you, or dub the entire recording onto a DVD, or copy it to your flashdrive.

An additional feature of the endoscopic exam is called stroboscopy. In this case, the light carried through the fiberoptic cables is a strobe light, which shines intermittently on the vibrating vocal folds. The vocal folds vibrate anywhere from 80 to 1500 times per second; the faster the vibration, the higher the pitch of the voice (see Vocal Fold Vibration and Pitch in our page About the Voice). These vibrations are so fast, they can only be seen as a blur. But when the strobe light shines intermittently on the vibrating vocal folds, they look as if they're vibrating in slow motion. This allows an evaluation of the nature of the vibration, which is crucial to understanding many abnormalities of the vocal sound. In the Lions Voice Clinic, we use stroboscopy to assess voice disorders.

Regardless of who performs your endoscopic examination (a speech-language pathologist or a laryngologist), we always review your examination together, along with you.  Determining the cause of the problem and the treatment plan is a team event.  The nature of the disorder determines what kind of treatment is recommended. 

 

 

Medical Treatment

Treatment using medicines is one of the components of treatment for voice disorders. In some cases the laryngologist will prescribe a medication to make the larynx more healthy.  We may also suggest over-the-counter medications for certain vocal conditions.

There are few drugs specifically used to treat voice disorders. More commonly, the medications fall into several classes that have a secondary effect on the voice:

1. Medications to treat sinus drainage

Decongestants, antihistamines, or steroid nasal sprays may be prescribed if the individual is bothered by congestion or sinus drainage that may irritate the tissues in the larynx, or thicken secretions, making it hard for the vocal folds to vibrate.

2. Medications to treat acid reflux

Reflux is a common disorder that can cause acid from the stomach to reflux up the esophagus (the food pipe) and then spill over onto the larynx (see About the Voice). The acid is irritating to the larynx and may cause swelling or inflammation of the vocal folds. Medications such as Zantac or Prilosec may be prescribed to treat this condition, in order to improve the health of the larynx (see Related Disorders).

3. Medications to reduce inflammation of the vocal folds

On some occasions, vocal fold swelling warrants a prescription of oral steroids to reduce the inflammation. These are not used on a long-term basis.

4. Medications to thin secretions

Some individuals are helped by guaifenesin, a mucolytic/expectorant that thins secretions and may help reduce throat-clearing or the sense of congestion. This is available over the counter.

5. Over-the-counter medications

Conservative remedies are important at the Lions Voice Clinic. Maintaining good hydration of the mucosal tissues is extremely important to vocal health. We often recommend such strategies as saline nasal irrigation, personal steamers, and sucking on hard candies. Also, over-the-counter medications such as saline nasal sprays or guaifenesin (as in Mucinex) are helpful in keeping drainage minimal and secretions thinned.

 

Surgical Treatment

Certain voice disorders are best treated with surgical intervention. Some lesions (growths) need to be surgically removed. In the case of vocal fold paralysis, there are several surgical options that provide a better voice. Drs. Goding and Misono are known internationally for their skills as surgeons. At the Lions Voice Clinic, surgery is almost always accompanied by at least one session of functional voice therapy, to teach the individual about postoperative voice care, and to teach vocal techniques to optimize the surgical result. Surgical treatments for each voice disorder are described on the Voice Disorders page.

 

Functional Voice Therapy

  • Also known as voice therapy.
  • Much like physical therapy, progressive exercises are taught over a series of sessions.
  • Includes education about use and care of the voice and how the voice works.
  • Varies in length from a single session to many sessions over several months.
  • Should be done with a certified speech language pathologist with special expertise in voice disorders.
  • Often done in conjunction with other kinds of treatments. If voice treatment includes surgery, it should always include at least one session of functional treatment to learn techniques for optimal healing.

At the Lions Voice Clinic, functional therapy is done with Dr. Michael, Ms. Butcher, or Ms. Alpers.  After the voice evaluation, we discuss your treatment plan with you, and therapy sessions are scheduled. The plan for therapy varies from patient to patient, but in general, the first three to four sessions are an hour long, and a week or two weeks apart.  Sessions become gradually more spaced apart as you learn more advanced techniques and need more time to practice them and incorporate them into day to day speech.

 

The Therapeutic Process

In therapy for voice disorders, a typical process in the first few sessions would include:

  • a thorough discussion of the your vocal lifestyle: voice needs, activities, and habits.

  • education about how to keep your voice healthy, given our vocal activities

  • education about how your voice works, in order to understand the therapeutic process better.

  • exercises to keep your upper body relaxed while using the voice

  • exercises for optimal breathing technique

  • specific exercises to reduce the impact of the vocal folds to help reduce lesions, or to bring the muscles of the larynx into balance; these exercises often start with simple sounds; once the sounds are mastered, they are advanced to words, sentences, and finally conversational speech.

  • exercises and activities for specific vocal needs, such as singing, loud talking, prolonged talking, phone use, etc.

In the Lions Voice Clinic, we tailor the exercises specifically to your strengths, weaknesses, and needs. We record the exercises during the session so you can practice at home with recording. This ensures optimal practice.

 

 

Home | Who We Are | About The Voice | Voice Problems | Singers etc... | Related Problems | Research | Links | Index | Glossary

Deirdre D. Michael - micha008@umn.edu
To make an appointment, please call us at (612) 676-5717.