Many people don’t give much thought to their voice, or the incredible vocal anatomy that makes speech production possible, until they experience a problem.

A complex series of muscles movements takes place every time we use our voice. Each of us have a larynx (commonly called a voice box) that is located at the bottom of our throat. Within the larynx are our vocal folds (or vocal cords). Everytime we use our voice, air travels from our lungs and through our vocal cords, which causes them to vibrate and create sound.

When this delicate balance of airflow and muscle movements is disturbed, we may develop a voice disorder. A voice disorder occurs when the pitch, volume, or quality of your voice is affected. The resulting symptoms can include hoarseness, discomfort, chronic cough, shortness of breath, or changes to your normal voice patterns.

Vocal disorders are a fairly broad category covering a number of conditions, but for the purposes of this article we’re going to focus on a few common examples. It’s also important to recognize that treatment for some voice disorders can involve a multidisciplinary team of specialists, including your doctor, an ENT, pulmonologist, psychologist, and speech-language pathologist. Treatment discussions in this article will focus on how voice therapy from a licensed speech-language pathologist can help individuals with a voice disorder.

Spasmodic dysphonia

Spasmodic dysphonia is a chronic voice disorder that is caused by nerve problems. Instead of your vocal cords vibrating normally, they may spasm or tighten when you speak. As a result, your voice may be very inconsistent: sometimes you may not be able to produce any sounds, while other times your voice could sound completely normal. People with spasmodic dysphonia commonly sound hoarse, jerky, or tight.

Voice Therapy for Spasmodic dysphonia

When it comes to voice therapy, your speech-language pathologists can help you work on strategies to articulate sounds in certain ways that make it easier to speak. They may instruct you on methods to improve your airflow, reduce excess tension and strain when uttering sounds, or compensate for your voice disorder in more efficient ways. These voice techniques can help you take back a sense of control with your voice and ultimately improve your quality of life.

Vocal Nodules and Polyps

Both vocal nodules and polyps are lesions that take place on your vocal cords.

Vocal nodules are benign growths and generally result from the repetitive overuse or misuse of your voice (for this reason they’re sometimes referred to as singer’s nodules). When your voice is pushed to the limit, swelling may occur. Overtime, this swelling can callous and become enlarged.

Vocal polyps are often bigger than nodules and can take the form of a swollen bump or blister. While nodules are generally caused over a period of time, polyps can happen after a single episode of vocal abuse (like screaming at a concert).

Both nodules and polyps can cause similar symptoms, including hoarseness, a rough or scratchy voice, trouble breathing, and more.

Voice Therapy for vocal Nodules and Polyps

Treatment often begins with voice therapy from a speech-language pathologist. Voice therapy may focus on taking care of your voice (also called voice hygiene) by helping you recognize the signs of abuse and modify your behavior. Your speech therapist will help you find ways to feel relaxed, relieve stress, and help change how your voice sounds. In some cases, depending on the size and severity of the nodules or polyps, medical or surgical intervention may also be necessary.

Vocal Fold Paralysis

Vocal fold paralysis can occur when one or both of your vocal cords are not able to vibrate or move. This can cause a variety of breathing and swallowing symptoms, including hoarseness, problems with voice pitch and volume, trouble with choking or coughing during eating, and more.

Voice Therapy for Vocal Fold Paralysis

Medical intervention, including surgery, may be necessary. While this is often required for individuals where both vocal folds are paralyzed, it may also be needed for those that have immobility in a single fold.

In many cases, doctors may recommend voice therapy prior to surgery or medical treatments. Your speech therapist will work with you to alter the pitch of your voice, and help increase airflow and breathing support to improve the volume of your voice.

Paradoxical Vocal Fold Movement (PVFM)

As mentioned, every time you breath your vocal folds open allowing air to travel through to your lung. When children or adults experience paradoxical vocal fold movement (PVFM), these vocal folds may close part-way or fully. This can cause a series of breathing and voice problems, including coughing, breathing difficulties, throat tightness, loss of voice, or changes to your voice.

It’s important to know that PVFM is often confused and misdiagnosed with asthma. While similar symptoms can present, these are in fact different conditions. Proper diagnosis is important when considering treatment.  

Voice Therapy for Paradoxical Vocal Fold Movement (PVFM)

Treatment for PVFM focuses on helping to ensure your vocal folds open normally, and continue to stay open, as you breathe. A speech therapist may help you practice different exercises and strategies to relax your throat during breathing. They may teach you methods for using your throat muscles to open your airways, suppress unnecessary coughing, and other ways to control and manage your PVFM. Additionally, they will help you become aware of certain triggers that can precipitate PVFM, and teach you strategies for avoiding these.

Chronic Coughing

While coughing occasionally is completely normal, and actually helps clear your throat and lungs to prevent infection, prolonged coughing can be highly disruptive and frustrating. Coughing is generally considered chronic if it lasts longer than 4 weeks in children and 8 weeks in adults. It can often interrupt your sleeping, day-to-day life, cause problems with your voice, and lead to headaches.

Voice Therapy for Chronic Coughing

Your speech therapist will teach you strategies for suppressing your urge to cough, techniques to keep your vocal folds healthy, and how to avoid triggers that can contribute to your cough. They may make recommendations, such as breathing through your nose rather than your mouth, or avoiding certain substances like alcohol or caffeine.