Voice Disorders: Management of Dysphonias
The voice is our sound signature. When it malfunctions, all communication is affected. Discover how to assess and rehabilitate voice disorders.
Voice disorders, or dysphonias, affect a significant portion of the population, particularly voice professionals (teachers, salespeople, artists). Beyond functional discomfort, they can have a major impact on professional and social life. The speech therapist is the specialist in voice rehabilitation, working closely with the ENT or phoniatrist.
🎵 Physiology of the Voice
Vocal production is a complex phenomenon involving three levels: the blower (lungs, respiratory muscles), the vibrator (larynx, vocal cords), and the resonators (pharynx, oral cavity, nasal cavities). The coordination of these three levels allows for the production of a quality voice.
The Blower
Lungs and respiratory muscles provide the breath necessary for the vibration of the vocal cords
The Vibrator
The vocal cords vibrate under the effect of air pressure, creating the fundamental sound
The Resonators
The resonance cavities amplify and color the sound, creating the characteristic timbre
The acoustic parameters of the voice are: fundamental frequency (pitch), intensity (volume), timbre (quality), and prosodic modulations. Each of these parameters can be altered in dysphonias.
📊 Types of Dysphonias
Dysphonias are classified according to their origin into two main categories, with different management approaches:
Organic Dysphonias
Visible lesions of the vocal cords: nodules, polyps, edema, paralysis, tumor
Functional Dysphonias
Poor vocal use without lesions, or forcing leading to secondary lesions
Psychogenic Dysphonias
Psychological origin, aphonia or conversion dysphonia, mutism
The Most Common Lesions
- Nodules: Bilateral thickening due to vocal forcing, common in teachers and children
- Polyps: Unilateral lesion, often after intense vocal effort
- Reinke's Edema: Swelling of the vocal cords, related to tobacco
- Laryngeal Paralysis: Immobility of one or both vocal cords, various causes
- Sulcus: Groove along the vocal cord, congenital or acquired
🔍 Voice Assessment
The vocal assessment is carried out after an ENT or phoniatric examination that visualizes the larynx. It includes a perceptual, acoustic, aerodynamic, and functional evaluation.
The Components of the Assessment
- Anamnesis: History of the disorder, professional and personal vocal use, lifestyle habits
- Perceptual Evaluation: Auditory analysis of the voice (GRBAS scale, CAPE-V)
- Acoustic Analysis: Objective measurements with specialized software (Praat, Vocalab)
- Aerodynamic Evaluation: Maximum phonation time, s/z ratio
- Self-Evaluation: VHI (Voice Handicap Index), impact on quality of life
- Observation of Vocal Gesture: Posture, breathing, tensions
💡 The Voice Handicap Index (VHI)
This standardized questionnaire assesses the impact of dysphonia on the patient's quality of life according to three dimensions: functional, physical, and emotional. It is a valuable tool for measuring progress and adapting management.
🎯 Voice Rehabilitation
Voice rehabilitation aims to restore optimal laryngeal function by modifying forcing behaviors and developing an effective and comfortable vocal gesture.
The Goals of Rehabilitation
Breathing
Develop effective costal-abdominal breathing, supporting the vocal gesture
Relaxation
Reduce laryngeal and peri-laryngeal tensions, relax forcing muscles
Phonation
Find an effective, economical vocal gesture, with good pneumo-phonic coordination
Principles of Rehabilitation
- Awareness of the inappropriate vocal gesture and its consequences
- Progressive work on breathing, posture, and relaxation
- Vocal exploration and search for the optimal gesture
- Automation of new behaviors
- Transfer to everyday and professional life situations
- Education on voice hygiene to prevent recurrences
🎓 Train in Voice Rehabilitation
DYNSEO offers training for speech therapists wishing to enrich their clinical practice.
Discover our training →🛠️ Techniques and Exercises
The speech therapist has a wide range of techniques to approach voice rehabilitation according to the patient's profile and the origin of the disorder.
The Main Approaches
- Manual Method (Le Huche): Global work on body-breath-voice, breath exercises and vocalizations
- LSVT (Lee Silverman Voice Treatment): Intensive approach for Parkinson's disease
- Tube Method: Phonation in a tube to promote pressure balance
- Vocal Function Exercises: Targeted vocalizations to strengthen and relax
- Postural Approach: Work on alignment and bodily tensions
⚠️ No Universal Recipe
Each patient is unique and requires a personalized approach. The speech therapist adapts their techniques to the patient's profile, pathology, profession, and goals. Voice rehabilitation is as much an art as it is a science.
🛡️ Voice Hygiene and Prevention
Preventing voice disorders involves good voice hygiene, particularly important for voice professionals.
Voice Hygiene Tips
- Sufficient hydration (1.5 to 2 liters of water per day)
- Avoid tobacco and limit alcohol
- Avoid forcing the voice in noise (bars, cafeterias...)
- Take regular vocal breaks
- Avoid throat clearing and prolonged whispering
- Treat gastroesophageal reflux if present
- Humidify the ambient air if necessary
🎯 Conclusion
Voice disorders are common and can have a major impact on professional and social life. Speech therapy rehabilitation, in collaboration with ENT specialists, allows for significant improvement in vocal quality and comfort of use in the vast majority of cases.
Prevention and education on voice hygiene are integral parts of management, particularly for voice professionals exposed to chronic vocal forcing.
Want to enrich your practice in voice rehabilitation?
DYNSEO supports you in your professional development.
