Voice Therapy

Voice therapy helps people with voice disorders heal their vocal cords or change vocal behaviors that can harm their voice. Voice disorders affect your larynx, or voice box. This is the part of your throat that contains your vocal cords. Your voice box also has the muscles you need to talk, breathe and swallow.

When you use your voice, air flows from your lungs to your voice box. It causes your vocal cords (also called vocal folds) to vibrate together as air passes through them. The vibrations produce the sound that you and others recognize as your voice.

But if you have a voice disorder, your vocal cords vibrate out of sync or don’t fully open or close. This can make it hard to vocalize (use your voice). It can lead to hoarseness and problems with pitch (how high or low your voice is). Sometimes, you can lose your voice altogether.

Voice therapy can help with these issues. You may need it on its own or alongside other procedures that treat vocal cord issues.

What does voice therapy treat?

You may need therapy if you have a voice disorder, such as:

• Laryngitis: With this condition, allergies or an upper respiratory infection irritate your voice box, causing your vocal cords to swell.
• Muscle tension dysphonia: Excess muscle tension in your throat causes strain on your vocal cords.
• Spasmodic dysphonia/vocal tremor: Voice box muscles spasm or shake, causing periodic breaks in your voice.
• Inducible laryngeal obstruction (ILO): Vocal cords want to shut when they should be open. It can lead to trouble breathing during exercise or when your throat is irritated.
• Vocal cord lesions: These are noncancerous growths on your vocal cords. They include nodules, polyps and cysts. They’re more common in people who use their voices a lot, like singers.
• Vocal cord paralysis: With this condition, scar tissue or nerve damage leads to reduced or no movement in one or both vocal folds. It can cause hoarseness, trouble swallowing and shortness of breath.

Often, voice therapy is part of rehabilitation after surgery on your vocal cords.

But you don’t have to have health issues to benefit from voice therapy. If you’re a singer or someone who uses their voice for a living, for instance, voice therapy may improve the quality of your voice. And it can reduce your risk of vocal injury.

What happens during this treatment?

If you’re having voice problems, you may first see a laryngologist. This doctor treats conditions that affect your voice box. Depending on the problem, they may refer you to a speech-language pathologist (SLP) who specializes in voice disorders.

There isn’t a one-size-fits-all treatment. Instead, your SLP will:

• Ask about behaviors that may have led to your vocal injury
• Assess your voice to pinpoint problem areas
• Tailor a treatment plan for you based on what they find

There is a range of vocal exercises and voice therapy techniques they may use. The following are just a few of the most common ones.

Vocal hygiene education

Your SLP will teach you good vocal hygiene. These are everyday things you can do to keep your vocal folds in good shape. They may advise you to:

• Drink plenty of water to stay hydrated.
• Limit substances that dry out your vocal cords, like caffeine and alcohol.
• Manage conditions that irritate your vocal cords, like allergies, chronic coughs and acid reflux.
• Rest your vocal cords as needed if you do a lot of talking or singing.
• Quit smoking (if you do) and avoid secondhand smoke.
• Practice stress reduction techniques.

If you’re recovering from an injury, good vocal hygiene may mean using your voice as little as possible. You may need to communicate in writing or via text-to-speech apps.

Breathing and relaxation exercises

Your provider may work with you to breathe from your diaphragm instead of your chest. This muscle enables you to breathe and speak. Practicing diaphragmatic, or “belly,” breathing helps you breathe more naturally and with less strain. Breath from your diaphragm is a more powerful vocal engine than breath that doesn’t fully engage this muscle.

As part of this work, you may work on relaxation techniques and proper posture. Muscle tension and the position of your shoulders, neck and jaw all play a role in how much effort it takes to vocalize.

Tension release exercises

Your SLP may ease tension in your throat by stretching or massaging your muscles. They’ll use their hands to release tight muscles in your neck and jaw. Using their fingertips, they may make circular motions or apply gentle downward pressure to lower your larynx to a relaxed position.

Semi-occluded vocal tract (SOVT) exercises

These exercises promote healthy vocal cord vibration. You’ll learn different methods that help you direct vocal energy within the upper part of your vocal tract. This is the part that’s closer to your mouth and farther away from your vocal cords. You’ll direct sound forward, toward your lips. This helps reduce stress on your vocal folds.

Examples of SOVT exercises include:

• Humming
• Lip trills (a technique that involves making a buzzing sound with your lips)
• Tongue trills (a technique where you use your tongue to make rolling R’s)
• Straw phonation (a technique that requires vocalizing through a straw)

Variations of these exercises are a part of what’s called resonant voice therapy. It helps you vocalize clearly and with more power, without straining your vocal cords.

Vocal function exercises

These exercises build your voice by helping you strengthen the muscles in your voice box, coordinate vocal cord movements and use airflow more efficiently. Exercises may involve:

• Sustaining certain sounds
• Vocalizing safely across your range (from the lowest pitch to the highest and vice versa)
• Powering your voice more efficiently without straining your vocal cords

How long does it take for voice therapy to work?

Most people need voice therapy a few times per month for several months. But it depends on the issue you’re having.

Your timeline depends on you, too. For success, it’s important to follow your SLP’s instructions about how to care for your voice at home. Make sure you’re practicing the exercises they teach you on the schedule they give you.

Is there anything I can do to make this treatment easier on me?

Be sure to ask your SLP questions if you’re unsure if you’re doing an exercise correctly. And take care not to overdo it. You’ll have better results when you train correctly, at a pace that doesn’t put you at risk of an overuse injury.

In some cases, there may be tech devices you can use at home to monitor your progress. Ask your SLP if you might benefit from apps that can monitor your performance, like your pitch or how steady your voice is.

When should I call my healthcare provider?

Reach out to your primary care provider if you have:

• Chronic hoarseness or wheezing
• Loss of voice or a raspy voice for several weeks
• Neck pain or a lump in your throat
• Shortness of breath
• Speech or swallowing problems

They may decide to connect you with a laryngologist or SLP, who can evaluate your voice and provide voice therapy, if needed.

What’s the difference between voice therapy and speech therapy?

Voice therapy is a type of speech therapy. Speech therapy can address a range of problems, not just those that affect vocal cords. Voice problems may occur along with other speech problems. Other types of speech issues include:

• Cognitive-communication disorders due to stroke, traumatic brain injury (TBI) or dementia that affect thought processes
• Language disorders that affect your ability to express yourself or understand others
• Social communication disorders associated with autism spectrum disorder and TBI
• Speech disorders, like stuttering
• Swallowing disorders after a stroke, injury or surgery