What is a Voice Disorder?
While some people make their living as professional speakers or singers, most people never think about their voices until they hear themselves on an answering machine. Or, until they wake up one morning so hoarse that they can't talk. It is at that moment that they realize how important the human voice is to communication.

Your voice should not call attention to itself, but rather be loud enough to be heard in the kinds of settings you frequent, be clear enough not to distract the listener, and be easy enough for you to produce that you experience little or no strain.

When any one of those characteristics of the normal voice becomes impaired, we call it a voice disorder.

An unusual voice disorder, referred to by otolaryngologists, pulmonologists or respiratory specialists as "Vocal Cord Dysfunction or VCD" has no effect on the voice itself. Instead, it appears to mimic the attacks associated with asthma, and can be misdiagnosed as asthma for many years. For more information on this disorder and how we treat it, click here.

How Does the Voice Work?
The larynx (sometimes called the "voice box") houses the mechanism responsible for voice sound production. The most important parts of this mechanism are the vocal folds (or cords), two muscles that open and close continuously during speech.

When we exhale, air from the lungs travels through the trachea ("windpipe") and passes between the vocal folds. When we want to talk, we bring the folds close together on the airstream, which causes them to vibrate like the strings of a violin to make sound.

What Causes a Voice Disorder?
The most common cause is vocal abuse and misuse resulting from chronic behaviors like smoking, drinking, shouting, throat clearing, and coughing, or using poor vocal technique or inappropriate pitch. These behaviors can inflame and injure the surface of the vocal folds, leading to changes in vibration, damage to tissue, and eventually to non-cancerous lesions (e.g. vocal nodules). The symptoms worsen as the behaviors persist. This is why some teachers complain of sounding worse at the end of the day, and children may be hoarse after an afternoon of play. Along with therapeutic intervention, the abusive behaviors must be eliminated.

Neuromuscular disorders are caused by damage to selected areas of the brain or to certain muscles. When the coordination between breathing and vocal fold vibration is disrupted, the capabilities of voice production may be significantly altered. Examples of neuromuscular disorders are spasmodic dysphonia and Parkinson's disease.

Cancer, malformation of structures in the mouth, throat, or nose, viral infections, asthma, and reflux disease are examples of disease and trauma which may affect the vocal structures. Medical intervention (e.g. surgery) often must be accompanied by voice therapy to restore and maintain vocal functioning.

Other common voice disorder symptoms include inability to speak loudly, monotone quality, strained-strangled quality, lowered pitch, an inappropriately high pitch, an inability to hit high notes (very common for singers), constant breathiness, pain in the throat, and tremor (a shaky voice).

Individuals often come to a voice clinic not reporting any specific symptoms, but they complain about trouble being heard, especially in restaurants, at work, or on the telephone, being unable to sing in church as they used to, and being asked if they have a cold.

What Can Voice Therapy Do?
The primary objective is to restore the voice to its prior level of functioning. This will frequently be possible when the cause of the disorder was vocal abuse. That is, the high profile politician can continue his rigorous speaking schedule, and the trial lawyer can return to the courtroom.

With neuromuscular cases and disease, on the other hand, complete restoration is not always possible. In such cases, therapy will help the patient learn coping strategies to maximize his or her vocal quality and to minimize the disruptions to communication.

What Kind of Treatment Will I Receive?
Your therapist at AFC will start by contacting your physician to ensure that your therapy is coordinated with your medical management. The therapist takes the time to help you assess your life style and find the least intrusive ways to change the behaviors which may have caused or contributed to the disorder.

To improve your voice, you need to establish control over your larynx and learn to better coordinate breathing with speech. You will learn to relax the muscles in your throat and neck, and to increase breath support and vocal strength. To help you learn more easily and quickly, AFC uses modern biofeedback instrumentation.

Your therapist will also select home exercises which are best suited to help you improve and maintain your voice.

The changes in your voice can impact on your self-image as well as on your communication. Your therapist will also help you address the social and emotional issues which may accompany a voice disorder. Other suggestions, such as joining a self-help group, may be appropriate for you as well.

How Long Will Voice Therapy Take?
In most cases, clients will be scheduled twice weekly for a total of six to twelve hour-long sessions. The vast majority of vocal disorders are resolved within this time period. Of course, each patient responds differently to treatment, and the outcome of your therapy depends largely on your level of motivation and your willingness to cooperate with the therapy regimen.