Speaker practices + Professional Practices

Identity, Training, and Functional Voice Use: Key Clinical Reflections

🔁 Voice Is Not Purely Biologically Determined

• Voice pitch and quality are not fixed after puberty based on biological sex alone.

• Trained voice users (e.g. countertenors, contraltos) show significant range flexibility far beyond typical pitch norms.

• Gender diverse speakers can learn effective vocal modulation through training and support.

⚠ Clinical implication: Avoid assumptions based solely on pitch or perceived voice-gender mismatches. Voice function must be understood as flexible and trainable.

 

🧬 Identity and Voice Use: Interactions and Examples

🎼 Countertenors (Male sopranos using falsetto)

• Use edge vibration of vocal folds to sing in the alto/soprano range.

• Defy gendered pitch norms—proof that biology does not rigidly determine voice pitch.

🎤 Contraltos (Low-pitched female voices)

• Challenge norms about "how women should sound".

• Reinforces that range and resonance can be expanded with training.

🌈 Gender Diverse Speakers (e.g., Rachel)

• Learn techniques to modify pitch, resonance, intonation, and speech style to align with gender identity.

• Example showed Rachel switching between a feminine and masculine voice range.

• Shows what’s possible with therapy, training, and personal intention.

 

⚖ Puberphonia (Mutational Falsetto): Clinical Caution

• A voice disorder, often seen in AMAB individuals post-puberty who maintain a childlike pitch.

• Not necessarily due to poor identity development—psychogenic labels can be inappropriate.

• Voice may be unstable, weak, high-pitched, with excess laryngeal tension.

• Treatment should focus on:

  • Functional voice use, not enforcing gender norms.

  • Client’s own goals and self-perception.

  • Teaching balanced laryngeal posture, breathing, resonance.

 

🧘‍♀ Key Treatment Principles: Functional, Not Normative

• The goal is not to normalise, but to support function and comfort.

• Whether for professional users (singers) or everyday speakers (e.g., a social worker), therapy focuses on:

  • Vocal flexibility

  • Efficient technique

  • Muscle balance and posture

  • Self-perception and identity

 

💡 SLP Role: Voice as an Expression of Self

• Recognise that voice:

  • Reflects identity, emotion, social context.

  • Is a tool that can be shaped, not just a fixed outcome of anatomy.

• SLPs must:

  • Use a client-centred, culturally responsive approach.

  • Avoid pathologising identity-linked variations.

  • Empower speakers to use their voice in the way they choose.

Voice, Lifestyle, and Health: Key Clinical Example and Insights

🎭 Example: German Actress with Chronic Smoking-Associated Voice

• Voice Profile: Actor uses smoking as part of her detective character, but smoking likely also affects her real-life voice.

• Auditory features:

  • Rough, irregular vocal quality

  • Low pitch

  • Noisy inhalation

• Diagnosis-related: Suggestive of Reinke's oedema, a condition commonly linked to long-term smoking.

 

🔬 Pathophysiology: Reinke’s Oedema

• Reinke’s space = layer just beneath the surface of the vocal fold (superficial lamina propria).

• Chronic irritation from smoking causes:

  • Swelling of this layer

  • Buldging or balloon-like vocal folds

  • Vocal fold vibration becomes irregular and sluggish

• Results in:

  • Hoarseness

  • Lowered pitch

  • Breathy or effortful breathing

  • Audible inhalatory stridor (if folds can’t abduct fully)

 

⚠ Lifestyle and Voice Health Risks

• Smoking:

  • Strongly linked to Reinke’s oedema

  • Increases risk of laryngeal cancer

  • Contributes to chronic laryngeal inflammation and poor vocal fold health

• Alcohol consumption:

  • Often synergistic with smoking in raising cancer risk

  • May lead to dehydration, affecting vocal fold pliability and voice control

 

🧘‍♀ Voice Care and SLP Role

🔧 Clinical focus:

• Encourage voice care behaviours:

  • Hydration

  • Vocal warm-ups/cool-downs

  • Smoke cessation

• Address voice use practises (e.g., habitual strain, shouting, overuse)

• Discuss self-care, sleep, diet, stress regulation as relevant to voice function

🧑‍⚕ Holistic support:

• Recognise that voice is influenced by:

  • Lifestyle choices

  • Mental and physical health

  • Environment

• SLPs promote sustainable voice use through education, behavioural change, and clinical intervention.

 Professional Practices and Functional Voice Production

Key Considerations in Professional Practice:

• Client-Centered Approach: Ensure that any professional practice, whether it's therapy, surgery, or medication, is beneficial and does not hinder the client’s functional voice production or overall well-being.

• Surgical Considerations:

  • Positive Impact: Some surgeries, like laryngectomy or vocal fold surgery, can be life-saving and restore function.

  • Negative Impact: Certain surgeries, such as vocal nodule removal or intubation injury, can leave scars or lead to long-term voice issues.

• Hormonal Treatment:

  • Facilitator: Hormone therapy, especially for gender-diverse people, can assist in voice changes (e.g., testosterone for a more masculine voice).

  • Barrier: Hormonal dysphonia can emerge in some individuals, leading to voice challenges related to hormone treatment.

 

Assessment Approach:

• Person-Centered and Culturally Responsive: Avoid pathologizing clients and instead focus on their strengths, needs, and personal identities.

• Diagnosis and Classification: While diagnosing voice disorders, it's crucial to explain the process, provide context, and avoid stigmatization.

 

Voice Training & Intervention:

• Goal: Support clients in achieving functional voice production, enabling communication of their sociocultural identity.

• Barrier: If the voice tasks used in therapy are irrelevant or disconnected from the client's real-world contexts, skill transfer becomes difficult.

• Cultural Sensitivity:

  • Gender Norms: Using binary gender norms in therapy may alienate non-binary individuals.

  • Inclusive Approach: Encourage expression that reflects the full spectrum of gender identities rather than pushing clients to fit into stereotypical norms.

 

Impact of Concealment of Diversity:

• Short-Term Relief: Concealing one's identity might feel protective in certain situations.

• Long-Term Stress: Constant vigilance about "passing" as a gender norm leads to:

  • Self-doubt and self-criticism.

  • Hypervigilance, worrying about how one’s voice and presentation are perceived.

 

Collaboration with Other Professionals:

• Interdisciplinary Approach: Collaboration with other healthcare providers (e.g., surgeons, endocrinologists) is essential to ensure that the voice care provided is in alignment with the client's medical and personal needs.

• Understanding Medical Impacts: Professionals must have knowledge of how surgeries or medications impact voice production and adapt treatment accordingly.

 

Multidisciplinary Practice:

• Voice care is complex and requires a broad understanding of medical, psychological, and sociocultural factors. Collaboration between professionals ensures the holistic care of the client.

 

💡 Key Takeaways:

• Voice treatment should be holistic, person-centered, and culturally responsive.

• Medical and hormonal treatments must be considered in the context of their potential impact on voice function.

• Collaboration with other professionals ensures that the voice care provided aligns with the client’s medical needs and identity.

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