Voice Management

leading causes for non-adherence

• lack of insurance coverage

• acceptance of voice disorder

• distance to the clinic

• patient self-efficacy (clinician’s choice of words may influence)

• clinician’s rapport (use of blaming language when discussing dx)

• support and cultural norms

hygienic voice therapy (HVT) definition

concentrates on discovering the behavioral causes of the voice disorder and modification/elimination of the causes to improve vocal condition and quality

• organized and promoted in every voice test

• always a cause for a disorder; discover, modify/eliminate= improvement

• lacks adequate evidence to support use as the only VT approach

• used in tandem with other approaches

vocal hygiene counseling

• identifying abusive behaviors

• describing the physiologic effects of those behaviors on voice production mechanisms

• defining the specific occurances

• modifying or eliminating the behavior

identifying phonotrauma (HVT)

• determining through case history/interview/observation:

  • shouting

  • loud talking

  • vocal noises

  • throat clearing

describe effects of phonotraumatic behaviors (HVT)

utilize pictures, diagrams, drawings, and videos

• i.e. pictures of anatomy, hand example of VF patterns, biofeedback

define specific occurence (HVT)

• different with every individual → no management plan will be the same

• psychodynamics of the behavior must also be described

• behavioral triggers/psychodynamics of behavior

modifying the behavior (HVT)

• teaching how to shout

• modify/eliminate vocal noises

• eliminate non-play shouting

• eliminate throat clearing

alternatives to loud cheering, yellig, screaming

• use gestures, nonverbal sounds to attract attention

• use amplification

• setting up a system of nonvocal signals

in a noisy environment

• wait until quiet, then speak up

• face your conversation partner

• reduce the distance

• over articulate

• rest your voice during upper respiratory infection

• schedule days to include vocal rest

chronic cough/throat clearing substitutions

• silent cough technique

• forceful swallow

• sip water/let throat relax

• eat candy if needed

internal hydration

• critical to the health of VF tissue

• amount of liquid intake per day (8-10 glasses of decaffinated fluids)

• whole body _____ leads to secretory glands and musuc from the lungs to lubricate the VFs

phonation threshold pressure

increased _____ as a result of dehydration/increasing vocal endurance as a result of hydration

steam inhalation

virtually no evidence in literature of __________ having direct effect on vocal fold

• particles are too large

• particles cause cough if they reach the larynx

• most likely deposit in the oropharynx

• can have sensory effect making it feel like it is helping

topical hydration

• nebulized isotonic saline improves voice production

• prevents throat dryness and xerostomia

• reverses dryness symptoms

• improves aerodynamic, acoustic, and patient-based measures

• goes further than topical lubricants

• improves systemic dehydration by improving oropharyngeal dryness and mucus viscosity

dietary habits leading to voice pathologies

• smoking

• alcohol intake

• caffeine, tea, colas intake

• poor diet

• inadequate sleep (less than 7 hours)

• Pharmacology (NSAIDs, asprin, diuretics)

voice rest

• confidential voice therapy

• rationale: to promote healing of the vocal fold mucosa

  • post surgical, VF hemorrhage, acute laryngitis, severe phonotraumas

• 3-7 typical course

• start with easy, quiet, breathy voice NOT whisper (short term)

• too much rest not necessarily good for VF

• total: no VF vibration

• conservative: easy, breathy voice

symptomatic voice therapy

modification of deviant vocal symptoms such as breathiness, inappropriate pitch, loudness, hard glottal attacks, etc.

• limited research evidence for many of the facilitative techniques

• redirected phonation, chant talk, counseling, elimination of abuses, glottal fry, head positioning, hierarchy analysis, masking, etc.

• voice facilitative approaches

auditory feedback

• VFA1

• 5 modes:

  • real-time amplification

  • looping playback of what was said

  • delayed auditory feedback

  • speech-range masking (lumbar effect)

  • metronome pacing clicks

• need immediate feedback

• pt should self-assess after hearing themselves

• metronomes for increasing/decreasing pace are good for ataxic dysarthria

change of loudness

• VFA2

• three applications

  • decreasing loudness

  • increasing loudness

  • increasing loudness variability

• Key considerations

  • hearing abilities

  • physical limitations to modify loudness (breath support)

  • patient personality