Voice and Dysphonia: A Complete Guide for Speech Therapists
The voice is the ultimate communication tool. Dysphonia refers to any alteration of the voice: hoarseness, vocal fatigue, breathy or forced voice. The speech therapist is the reference professional for the assessment and rehabilitation of voice disorders, in collaboration with the ENT doctor. This guide presents vocal physiology, types of dysphonias, and management approaches.
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Physiology of the Voice
Vocal production results from the interaction of three systems: the blower (lungs, diaphragm), the vibrator (vocal cords in the larynx), and the resonators (pharynx, mouth, nose). Understanding this mechanism is essential for rehabilitation.
The Blower
The air expelled from the lungs provides the energy necessary for the vibration of the vocal cords. Proper breath management (costal-diaphragmatic breathing) is the foundation of an effective and non-fatiguing voice. The subglottic pressure must be sufficient but not excessive.
The Laryngeal Vibrator
The vocal cords (or vocal folds) are two musculo-membranous structures located in the larynx. During phonation, they come together and vibrate under the effect of the airflow, producing a fundamental sound. The frequency of vibration determines the pitch of the voice.
The Resonators
The sound produced at the level of the larynx is amplified and modulated by the resonating cavities: pharynx, mouth, nasal cavities. These resonators give the voice its characteristic timbre and allow for the articulation of speech sounds.
What is Dysphonia?
Dysphonia is a disruption of the voice that can affect different parameters: pitch, intensity, timbre, vocal efficiency. It can be temporary or chronic, mild or severe, and can have a significant impact on quality of life, especially for voice professionals.
Vocal Parameters That Can Be Altered
- Pitch: voice too low, too high, or monotone
- Intensity: voice too weak, too loud, or difficulty modulating
- Timbre: hoarse, breathy, rough, muffled, tight voice
- Efficiency: vocal fatigue, forcing, effort to speak
Types of Dysphonias
🔹 Functional Dysphonias
Related to poor vocal use without initial organic lesion. Vocal forcing, muscle tension, poor breath management. Common among voice professionals (teachers, singers). Can evolve into organic lesions if untreated.
🔹 Organic Dysphonias
Related to a lesion of the vocal cords: nodules, polyps, edema, cyst, granuloma, paralysis, tumor. ENT diagnosis is essential. Some lesions (nodules, edema) may regress with rehabilitation, while others require medical or surgical treatment.
🔹 Neurological Dysphonias
Related to neurological impairment: laryngeal paralysis (unilateral or bilateral), dysarthria (Parkinson's, ALS, stroke), spasmodic dysphonia. Specific management according to etiology.
🔹 Psychogenic Dysphonias
Without identifiable organic cause, related to psychological factors: conversion aphonia, stress dysphonia. Often appears suddenly. Management combining vocal work and psychological support if necessary.
Warning Signs
- Persistent hoarseness lasting more than 2-3 weeks
- Vocal fatigue: voice "gives out" at the end of the day
- Effort to speak, sensation of forcing
- Pain or tension in the neck, throat
- Breathed voice: audible air leakage
- Recurrent voice loss (aphonia)
- Change in pitch or intensity
- Laryngeal whip: sudden break in the voice
⚠️ ENT Consultation Essential
Any hoarseness lasting more than 2-3 weeks requires an ENT consultation with examination of the vocal cords (laryngoscopy). Speech therapy can only begin after medical diagnosis and prescription.
Speech Therapy Assessment of the Voice
Anamnesis
- History of the disorder: onset, progression, circumstances
- Vocal use: profession, hobbies, environment
- Contributing factors: tobacco, GERD, allergies, stress
- Impact on daily and professional life
Perceptual Assessment
Auditory analysis of the voice according to standardized scales (GRBAS, CAPE-V): Grade, Roughness, Breathiness, Asthenia, Strain. Listening in conversational voice, projected voice, sung voice.
Functional Assessment
- Breathing: type, capacity, management of phonatory breath
- Posture and muscle tension
- Vocal behavior: onset, maintenance, end of sound
- Maximum phonation time (MPT)
- s/z ratio (laryngeal dysfunction index)
Acoustic Assessment
Instrumental analysis of acoustic parameters: fundamental frequency, jitter, shimmer, signal-to-noise ratio. Specialized software (Praat, etc.).
Speech Therapy Management
💡 Goals of Vocal Rehabilitation
- Become aware of vocal functioning
- Eliminate forcing behaviors
- Develop an effective and economical vocal technique
- Adapt vocal use to needs (especially professional)
- Prevent recurrences
Work Areas
Relaxation and Release: Reduce overall and local muscle tension (neck, shoulders, jaw, tongue). Relaxation techniques, massages, stretches. Relaxation is an essential prerequisite.
Breathing: Develop effective costal-diaphragmatic breathing. Work on managing phonatory breath, subglottic pressure. Breathing exercises, pneumo-phonetic coordination.
Posture: Adopt a posture that favors vocal production: alignment of head-neck-trunk, chest opening, grounding. Posture directly influences vocal quality.
Vocal Emission: Work on onset (gentle), sound maintenance, resonances. Seek a voice placed in the resonators, without laryngeal forcing. Exercises on vowels, glissandos, melodies.
Vocal Hygiene: Tips for preserving your voice daily: hydration, avoiding forcing, vocal rest, managing ambient noise, vocal warm-up.
Vocal Hygiene Tips
- Stay hydrated enough (at least 1.5L of water per day)
- Avoid speaking loudly or shouting
- Do not whisper (fatigues the vocal cords)
- Avoid clearing your throat
- Warm up your voice before intense use
- Take regular vocal breaks
- Avoid noisy, smoky, air-conditioned environments
Our Downloadable Voice Tools
🌬️ Breathing Exercises
Breathing exercises and management of phonatory breath. Different levels.
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Relaxation techniques to release tension. Suitable for vocal rehabilitation.
Download🌬️ Breathing Cards
Visual aids for breathing exercises. Coordination of breath and voice.
Download👅 Orofacial Praxies
Exercises for the mobility of articulatory organs. Complement to vocal work.
DownloadFrequently Asked Questions
Yes, often. Recent and small nodules can regress with well-conducted speech therapy, which aims to eliminate the forcing behaviors that caused the nodules. This is why rehabilitation is generally proposed as the first line of treatment. Surgery is only considered in cases of rehabilitation failure or for old and fibrous nodules.
Yes, teachers are among the professions most affected by dysphonias. Intensive vocal use (speaking several hours a day), often in noisy environments, without training in vocal technique, promotes forcing and lesions. Prevention (training, warm-up, amplification) and early management are essential.
The duration is variable depending on the pathology, the duration of the disorder, and the patient's involvement. On average, expect 15 to 30 sessions for functional dysphonia. The key is the automation of new vocal habits in daily life, which requires time and regular practice between sessions.
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