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Key points

  • Voice disorders are a range of conditions which affect the voice box (larynx). They may cause changes to the voice or complete loss of voice. Voice problems can affect adults or children, and may be short-term or long-term. 
  • People with voice disorders often experience difficulties in day-to-day life, such as trouble talking on the telephone, in social situations and with work, school or hobbies. 
  • Speech and language therapists (SLTs) have an important role in assessing, treating, managing and preventing voice disorders. In many cases, voice therapy delivered by an SLT can help to improve or eliminate a voice problem. 
  • SLTs work closely with Ear, Nose and Throat (ENT) Doctors, GPs and other professionals to help improve voice disorders. 
  • If you have had a hoarse voice for more than three weeks, it is important to see your GP, who may refer you to an ENT Doctor.

What are voice disorders?

Voice disorders are a range of conditions which affect the larynx. They can cause changes to the voice called dysphonia or loss of voice aphonia. These changes can affect the way the voice sounds, for example, making it sound hoarse, croaky, strained, breathy or weak. Voice disorders can also make the throat feel different, for example it might feel sore, achey or dry. 

Voice disorders can cause difficulties in day-to-day life for some people. For example, it may be difficult to be heard by other people, or it may affect your work, school or hobbies. Voice disorders can also cause frustration, low mood or isolation in some cases. 

Voice disorders have many different causes, including how you use your voice, lifestyle factors, medical conditions and many more. In some cases, a hoarse voice can be a sign of cancer or another medical condition, so if you have had a hoarse voice for more than three weeks, it is important to see your General Practitioner (GP). Most voice problems are not due to cancer, but it’s important to rule this out (Cancer Research UK, 2018).

Before you are referred to speech and language therapy for voice therapy, you will need to be seen by an Ear Nose and Throat (ENT) Doctor, who will look into your throat using a camera to establish what is causing your voice problem. This procedure is called an endoscopy, laryngoscopy or nasendoscopy. 

You may be asked to attend a multidisciplinary voice clinic or joint voice clinic. This is a specialist clinic where an ENT Doctor and a speech and language therapist (SLT), and sometimes other professionals, will look into your throat with a camera and work together to agree the best management plan. 

How can speech and language therapy help with my voice condition?

SLTs have an important role in helping people with voice disorders. After seeing an Ear, Nose and Throat (ENT) Doctor, you may be referred to speech and language therapy for voice therapy.

Input by an SLT may include:

  • Helping you to understand what factors have contributed to your voice problem.
  • Giving you information and advice about your voice.
  • Suggesting things that you can do to improve your voice or reduce the impact that it is having.
  • Teaching you some therapy techniques and exercises to improve your voice. You will usually be asked to practice these regularly at home, a bit like physiotherapy for your voice.
  • Helping educate those around you (for example, your family, work or school, with your permission) about your voice condition and things that they can do to help.
  • Teaching you how to keep your voice healthy in the long-term.

Some voice conditions may improve by themselves, and many others respond well to voice therapy. In some cases, a voice problem may be long-term. In this case, your ENT Doctor and SLT will try to work with you to find ways to reduce the impact of the problem on your everyday life. 

There are several simple things that you can do to look after your voice. Read about them here.

What to expect from speech and language therapy

Your first appointment

On your first appointment, your SLT will usually want to gather as much information about you and your voice as possible, in order to determine a suitable treatment plan. Your SLT will ask you a number of questions about your health, your lifestyle, your well-being and how you use your voice. 

Following this:

  • Your SLT will likely assess your voice in detail. 
  • They may ask you to make some sounds and use your voice in different ways. 
  • Your SLT may also wish to make a recording of your voice, with your permission, or analyse your voice using some software.
  • They may also ask you to complete some questionnaires about your voice problem and/or symptoms. 

After this, your SLT will usually give you some information about how the voice works and about the nature of your voice problem. They will discuss with you whether they think voice therapy will be suitable for you, and talk about what that will involve. They may also suggest some strategies, such as lifestyle changes, that you can implement to help improve your voice. 

If you are having another type of intervention, such as surgery on your voice, your SLT may give you information about the surgery, advise you about recovery and after-care and take recordings before and after your surgery. You may also be offered voice therapy after your surgery has been carried out.

Voice therapy

If voice therapy is thought to be appropriate, you will likely be offered some therapy sessions. In these sessions, you will be shown some voice exercises and you will usually be asked to practice these at home, perhaps several times per day. 

When you return for your next session, your SLT will review your voice and your exercises, and may make adjustments to the exercises, such as making them more challenging or adding new ones. As well as therapy exercises, your SLT may want to discuss with you things that are affecting your voice, such as lifestyle factors or your mental well-being. 

If voice therapy is not thought to be suitable for you, your SLT may discuss some ways to lessen the impact of your voice problem, for example by changing aspects of your environment, or by using strategies to reduce the demand on your voice. 

Usually, SLTs will expect you to take an active role in your voice therapy. This may include carrying out the exercises regularly, implementing the advice or strategies that you have been given. Without this active engagement, your progress may be limited. 

Review

During your speech and language therapy input, your SLT may suggest that you are reviewed by the ENT Doctor or that you attend the multidisciplinary voice clinic for a review. This gives your SLT an opportunity to gain an up-to-date visual picture of your larynx in order to guide further management. 

Discharge

You are likely to be discharged from speech and language therapy when one of the following outcomes has been reached: 

  • Your voice has improved to a level that you feel you can manage.
  • Your voice has improved as much as it is likely to, given the nature of your voice condition.
  • Your voice has not responded to voice therapy and another type of intervention is required.
  • Voice therapy has not been possible and is unlikely to be possible due to other factors.

Public health and voice disorders

The Faculty of Public Health defines public health as: "The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.”

Public health in relation to voice disorders:

  • A number of lifestyle factors and medical conditions can increase the risk of voice disorders. These include smoking, reflux, dehydration and air quality. 
  • Some groups of people may be at higher risk of voice disorders due to their occupation or hobbies. These include teachers, performers, call centre workers and bar staff. 
  • SLTs have an important role in both treating voice disorders and in providing education and training to high-risk groups to help prevent voice problems from occurring. 

Further information:

For more information see the RCSLT’s information on Public health.

Resources

Factsheets and leaflets

RCSLT

Position statement: speech and language therapists working with individuals with voice disorders 

Voice care factsheet

Public health factsheet

British Voice Association

A variety of leaflets and factsheets for both children and adults have also been produced by the British Voice Association

Dystonia Society

Voice dystonia leaflet

Some hospitals also provide online and downloadable resources, for example Great Ormond Street Hospital

Videos

Many videos are available online which explain and/or demonstrate voice conditions. Unless specifically stated, the RCSLT does not endorse these videos or the companies who have made them:

Nodules
Muscle tension dysphonia 
Spasmodic dysphonia
Vocal cord palsy 

Contacts and websites

British Voice Association 
British Laryngological Association
National Spasmodic Dysphonia Association 
The Lary Project  
The Dystonia Society 

Related topics

For related topics please see: [LINK to public page for each]