If I had a nickel for every time I heard a new patient say, “My ENT said I needed speech therapy, but I have no idea why I’m here—my speech is absolutely fine,” I’d be one wealthy SLP. However, this is quite possibly one of my favorite statements, because it means I get to rock their world by telling them all about my specialized area of speech therapy that they had no idea even existed: Voice Therapy.
Yes, that’s right, speech therapists are trained to do a whole lot more than help kids pronounce their S’s and R’s! In fact—we work with people of all ages with all sorts of communication problems (check out my blog post, The Speech Umbrella, to learn more about what SLPs do!). So often my patients are amazed to learn about their voice in a relatable and functional way, including how we produce voice and all the factors that can impact it. Patient education happens to be one of my favorite parts of the job! So, this leads us to today’s big question: what is voice therapy, exactly?
“Voice therapy is like physical therapy for the voice.”
Voice therapy is a type of speech therapy that aims to improve the health, function, quality, and stamina of the voice by performing rehabilitative exercises and making adjustments to vocal behaviors and lifestyle choices. The term “voice therapy” includes therapy for upper airway disorders, such as chronic cough and vocal cord dysfunction (VCD/PVFM), as they involve the vocal cords and larynx, (a.k.a. your “voice box”). With voice therapy, a speech-language pathologist who is trained and experienced in voice and vocal injury works with you to evaluate your voice and provide individualized, evidence-based treatment tailored to your diagnosis.
The goal of rehabilitative voice therapy is to improve your voice quality and function so that you can return to normal daily activities, fulfill job responsibilities, and improve your quality of life. Essentially, voice therapy is like physical therapy for your voice. It is often the first step (and sometimes the only one necessary!) in resolving or improving chronic hoarseness, strain, and other voice disorders or aerodigestive disorders, and is often used alongside voice surgery to ensure a healthy recovery. For Gender Affirming Voice Therapy for transgender and gender diverse people, you can expect a similar overall structure and sentiment, however, the goal is of course different. It focuses on making healthy voice changes when modifying voice and communication to better align with a person’s gender identity.
What can I expect to do?
Now that you are well versed in what voice therapy is, here’s the break-down of what to expect. Sessions include a combination of:
Education for a complete understanding of vocal health practices and rationale of exercises
Instruction for therapeutic exercises and vocal technique designed to optimize voice production
Practice applying these new behaviors to speech and conversation (and singing if applicable)
Functional practice to promote generalization and carry-over into everyday activities
Unless you are participating in a program that requires a specific format or dosage for treatment sessions, most often voice therapy sessions are around 50 minutes long and ideally occur about once a week to allow time for home practice. As you gain confidence and independence with voice exercises and strategies, appointments may be spaced farther apart. Professional guidance is provided by the clinician to help retrain your voice and apply voice strategies to your daily life. The number of sessions vary per person and is based on each individual's diagnosis, physical progress, quality and consistency of home practice, independence with strategies, and self-satisfaction.
Areas addressed in therapy may include, but are not limited to:
Coordination of the voice with breathing, using sufficient breath support
Promoting oral/nasal resonance to reduce strain in the throat
Exploring and achieving the best vocal register, pitch, and loudness for speaking
Minimizing muscle tension within and surrounding the larynx
Reducing coughing episodes and chronic throat clearing with behavioral strategies
Respiratory retraining to reduce vocal cord dysfunction episodes or shortness of breath
When should I start?
Depending on your symptoms, a person can often get started with voice therapy even without a visit to the ENT or while waiting for your appointment date to arrive. For sudden loss of voice or hoarseness and other voice complaints lasting longer than 2 weeks, it is important to undergo an examination by an ENT physician (check out my blog post Laryngologist vs. Otolaryngologist: The Difference and Its Significance) to evaluate the health and function of the larynx and any underlying medical conditions that may be causing or contributing to your voice, cough, or breathing problem. If you have not already done so, your clinician will advise if it is necessary to have the larynx visualized in order to determine the most effective and ethical course of treatment.
What’s next?
If you need voice therapy, find an SLP in your state that specializes in the evaluation and treatment of voice disorders. Your ENT, health insurance directory, or ASHA ProFind are great resources to provide recommendations for specialists. Voice therapy can be provided both in person and online successfully. Research has shown that telehealth can provide similar outcomes, however, some people may benefit from in-person sessions with manual therapy. Speak to your health care provider to determine what plan works best for you. And lastly…
Go forth into your session with confidence and optimism! With your newfound understanding and insight into the world of voice therapy, I wish you all the best!
Jessica Schwartz Smith, MS, CCC-SLP is a licensed and certified speech-language pathologist in Pennsylvania and North Carolina. She is the owner of Resonate Voice and Speech Services, a speech therapy practice based in Philadelphia that specializes in voice disorders, chronic cough, VCD/PVFM, gender affirming voice therapy, and adult dysphagia.