VOICE

 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 (Aronson & Bless, 2009; Boone, McFarlane, Von Berg, & Zraik, 2010; Lee, Stemple, Glaze, & Kelchner, 2004). 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 (American Speech-Language-Hearing Association [ASHA], 1993; Colton & Casper, 1996; Stemple, Glaze, & Klaben, 2010; Verdolini & Ramig, 2001).

Several different systems are used for classifying voice disorders. For the purposes of this document, voice disorders are categorized as follows:

· Organic — voice disorders that are physiological in nature and result from alterations in respiratory, laryngeal, or vocal tract mechanisms

· Structural — organic voice disorders that result from physical changes in the voice mechanism (e.g., alterations in vocal fold tissues such as edema or vocal nodules; structural changes in the larynx due to aging)

· Neurogenic — organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds)

· Functional — voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation)

Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia. The resulting voice disorders are referred to as psychogenic voice disorders or psychogenic conversion aphonia/dysphonia (Stemple, Glaze, & Klaben, 2010). These voice disorders are rare. SLPs refer individuals suspected of having a psychogenic voice disorder to other appropriate professionals (e.g., psychologist or psychiatrist) for diagnosis and may collaborate in subsequent treatment. We can help anyone with voice issues, including:

· Roughness

· Breathiness

· Strained quality

· Strangles quality

· Abnormal pitch

· Abnormal loudness

· Abnormal resonance

· Aphonia (loss of voice)

· Phonation breaks

· Asthenia (weak voice)

· Gurgly/wet voice

· Hoarse voice

· Increased vocal effort associated with speaker

· Decreased vocal endurance or onset of fatigue with prolongued voice use

· Running out of breath

· Frequent coughing or throat clearing

· Any professional voice user who requires vocal coaching for them to satisfy their career needs. 

· Anyone with voice or speech issues caused by Parkinson’s disease or any other neurodegenerative diseases like Motor Neurone Disease (MND) OR Multiple Sclerosis 

· Singers, Actors, or other performers who are having difficulties with voice projection, pitch range or maintaining vocal quality/care. 

Start at the ENT:

Therapy for voice disorders should always begin with a referral to an Ear Nose Throat (ENT) doctor who can evaluate the physical structures and provide clearance for speech therapy to begin.  Some clients will require surgical or prosthetic management before speech therapy can begin.

What We Can Target: 

Our approaches for treating voice disorder follow the American Speech-Language Hearing Association and include:

· Direct approaches focus on manipulating the voice-producing mechanisms (e.g., phonation, respiration, and musculoskeletal function) in order to modify vocal behaviors and establishing healthy voice production (Colton & Casper, 1996; Stemple, 2000).

· Indirect approaches modify the cognitive, behavioral, psychological, and physical environments in which voicing occurs (Roy, et al., 2001; Thomas & Stemple, 2007). Indirect approaches include the following two components:

· Patient education—discussing normal physiology of voice production and the impact of voice disorders on function; providing information about the impact of vocal misuse and strategies for maintaining vocal health (vocal hygiene)

· Counselling—identifying and implementing strategies such as stress management to modify psychosocial factors that negatively affect vocal health (Van Stan, Roy, Awan, Stemple, & Hillman, 2015)

Source: https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942600&section=Treatment