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Text of the page (random words):
f a voice that is most appropriate for the individual 6 symptomatic voice therapy can modify respiration phonation resonance voice loudness rate and laryngeal muscle tension and may assist in gender reassignment voice change 6 physiologic edit physiologic voice therapy may be adopted when the voice disorder is caused by a disturbance in the physiology of the vocal mechanism 5 6 therapy directly modifies the abnormal physiologic activity affecting respiration phonation and resonance 6 4 physiologic voice therapy aims to create a balance between the various subsystems 4 hygienic edit hygienic voice therapy involves modifying or eliminating inappropriate vocal behaviours that lead to voice dysfunction once behaviours are modified the voice may improve towards a normal state 5 6 the voice is improved without directly targeting physiological mechanisms 6 hygienic voice therapy uses different techniques which are used for both management and prevention for voice disorders for management of disorders hygienic voice therapy is usually used in conjunction with other voice therapy methods vocal hygiene programs can include many different components but usually includes speech and non speech aspects speech aspects include addressing loudness and amount of use whereas non speech components typically address components such as allergies or laryngopharyngeal reflux a vocal hygiene program also may include a component about learning about how the voice works e g anatomy and physiology 7 some vocal hygiene guidelines for better vocal health avoid phono traumatic behaviours i e throat clearing yelling cheering excessive crying talking over extensive background noise and increase use voice amplification when appropriate decrease or eliminate use of alcohol caffeine and drugs i e tobacco recreational drugs non steroidal anti inflammatories and aspirin increase humidification of the upper respiratory tract i e drink more water increase environmental humidity when possible and decrease time spent in dry or dusty environments decrease quantity of speech if you re an excessive voice user or post laryngeal surgery 5 8 psychogenic edit psychogenic voice therapy examines the psychological and emotional factors that cause and perpetuate disordered voice and focuses on modifying those factors to improve voice functioning 5 6 eclectic edit the various voice therapy orientations are not exclusive of each other any combination of orientations can be used in treatment this is known as eclectic voice therapy 5 6 procedures edit vocal surgeries edit while hormone replacement therapy and gender reassignment surgery can cause a more feminine physical appearance they do little to alter the pitch or sound of the voice a number of surgical procedures exist to alter the vocal structure these can be used in conjunction with voice therapy cricothyroid approximation cta is the most common laryngoplasty thyrohyoid approximation laryngeal reduction surgery surgical shortening of the vocal cords laser assisted voice adjustment lava voice prosthesis edit voice prosthesis is an artificial device usually made of silicone that is used to help laryngectomized patients to speak applications edit physiologic voice therapy edit accent method edit there are many different physiologic voice therapy approaches that can be used in treatment 9 an example of a holistic approach used in voice therapy is the smith accent method introduced as a method to improve both speech and voice production this technique can be used to treat stuttering breathing dysprosody dysphonia and to increase control of breathing phrasing and rhythm 10 the main targets of accent methods are to increase the pulmonary output to reduce tension in muscles to reduce glottis waste to stabilize the vibratory pattern of the vocal folds while speaking 11 12 the accent method is implemented two to three times a week in 20 minute sessions the procedure is two part diaphragmatic breathing and rhythmic vowel play during diaphragmatic breathing the patient is trained to elicit and monitor abdominal breathing and muscle relaxation rhythms are then introduced in two beats with an accent on the second sound the accented rhythm is then generalized to longer phonation at three speeds largo andante and allegro while maintaining proper breathing techniques the rhythms are then generalized to real speech through the use of repetition reading passages conversations and monologues 12 11 symptomatic voice therapy edit chant talk edit there is a wide variety of treatments that fall under symptomatic voice therapy 9 an example of a symptomatic voice treatment method is the chant talk approach the chant talk approach uses pre existing characteristics found in chanting styled music such as rhythm and prosodic patterns the therapy is used to reduce phonatory effort which causes vocal fatigue 9 chant therapy is used to minimize hyperfunctionality by affecting loudness and voice quality the technique employs the continuous tone quality found in music chanting more specifically it elevates the pitch of the voice during phonation prolongs the vowels de stresses syllables and lessens word initial glottal attacks 13 the goals of the chant talk approach are to use voice quality and pitch techniques to decrease the effort used while talking the technique is first demonstrated through the use of recordings with the patient subsequently asked to imitate the specified voicing patterns once the chant has been mastered the patient is asked to read aloud in chant and in normal register in 20 second alternation patients are asked to reduce chanting to a minimal while maintaining vowel prolongations and softened glottal word onsets sessions are recorded in order to provide auditory feedback 13 resonant voice therapy edit resonant voice is a technique often taught to actors and singers to improve voice production 8 resonant voice therapy teaches clients to use resonant voice in order to reduce vocal fold trauma resonant voice is produced with minimally adducted closed vocal folds this technique reduces the force of the vocal folds vibrating against each other which reduces trauma and allows healing 14 a variety of different programs including lessac masden resonant voice therapy lmrvt humming and y buzz have been studied and used to help teach resonant voice 14 each program uses slightly different strategies to teach resonant voice however they all have similar hierarchical structures and share the goal of producing a strong clear voice with minimal effort 14 in the aforementioned programs the client begins by trying to produce resonance during nasal consonants and vowels then progresses to using this technique in words sentences and conversations 14 during voice therapy clinicians often help patients conceptualize resonant voice by discussing where the patient feels their voice patients with dysphonia often describe their voices as vibrating in the throat 8 resonant voice is described as vibrating higher and further forward and being felt at the alveolar ridge and in the maxillary bones 14 range expansion and stabilization techniques rest and exercises range expansion and stabilization techniques rest and exercises target symptoms such as reduced pitch range reduced loudness and voice instability which are often related to a variety of different voice disorders 15 there are three main exercises that work to target these symptoms the first is called a stretching exercise and targets pitch range the client is asked to find their comfortable pitch and then slowly go up 1 3 of an octave using a gliding technique and then gently go back to their comfortable pitch on one inhale this procedure is followed by an exhale and rest for 1 2 seconds then should be repeated 2 3 times as the client improves octave levels can be increased the second is called a resistance exercise and focuses on loudness the client is asked to use their comfortable pitch and go from a soft to loud voice for 3 4 seconds followed by an exhale it is important to train the client to do this without straining their voice the third is called an endurance exercise the client is instructed to hold a note as long as they can by controlling their exhale this should be done with 3 4 comfortable pitches 8 vocal pedagogy edit vocal pedagogy for singing particularly opera edit dialect training for actors who need to speak with a particular dialect or accent while many transgender women wish to sing like cisgender women it will require a lot of training for one to achieve a feminine sounding voice this is why most people who haven t gone through male puberty before beginning hormone replacement therapy have a higher chance of retaining this quality see castrato for more information debate public speaking voice therapy in transgender individuals edit main article voice therapy transgender voice therapy is sometimes undertaken by trans women and trans men to make their voices better match their gender 16 voice feminization is the desired outcome of surgical techniques speech therapy self help programs and a general litany of other techniques to acquire a female sounding voice from a perceived male sounding voice voice masculinization is the use of the same procedures and techniques to acquire a male sounding voice voice management after laryngectomy edit some laryngectomized patients may succeed in achieving communication through the use of esophageal speech in which air is swallowed then gradually released while producing speech 17 others may make use of an electrolarynx external vibrating device which produces vibrations in the patient s oral cavity that they can no longer produce themselves without air passing through their vocal folds 17 the current medical standard after a laryngectomy is a tracheoesophageal puncture which includes the insertion of a voice prosthesis voice prosthesis voice therapy with prostheses edit a voice prosthesis is an artificial device usually made of silicone that is used to help laryngectomized patients speak a tube is inserted into the neck below the vocal folds allowing air to go through the tube instead of through the mouth and nose 18 following a total laryngectomy air will no longer pass through the vocal folds significantly altering the person s ability to communicate orally 18 in some instances the person may be able to block the tube with their fingers and breathe as they did before the surgery or attach a valve to their tube which serves to allow air to enter while preventing food from passing into the windpipe in others this is not a viable option due to resistance infection and insufficient air 18 voice therapy may then be turned to as a means for a person to regain the ability to communicate orally voice prostheses and ventilators may affect the volume of the speaker and the overall quality of the speaker s voice 18 with the help of voice therapy as well as possible adjustments to ventilator settings the goal is to become accustomed to using the device functionally and to learn the techniques and skills needed to participate in daily communication 3 other types of speech and language therapy after laryngectomy communication strategies edit if the person is using a ventilator with their tube there are long pauses between cycles of the ventilator during these moments of silence someone else may begin to speak thus taking away the turn of the person with a ventilator the person who has undergone a laryngectomy can use tools and techniques such as those provided by a speech language pathologist slp to self advocate during conversations in order to ensure that they are given the space that they need to participate in conversation 3 an slp can also provide information to the person and to the people who interact with them frequently on communication strategies that would benefit them 3 pediatric voice therapy edit image of a vocal fold polyp as seen through endoscopic examination in children the voice disorders and dysphonia are quite common although the reported prevalence varies significantly depending on the type of data collection and the location from which it was drawn some estimates suggest a rate between 6 and 38 of school aged children 19 others indicate between 2 and 23 20 dysphonia is more common in male children than females during school age conversely as of 13 years and through to adulthood the disorder is more commonly seen in females 19 21 other voice disorders such as vocal nodules are also common in children particularly before the onset of puberty with an incidence of 17 30 22 the most common vocal pathologies occurring in children are nodules 55 68 of cases and damage caused by congenital lesions 27 41 of cases 19 23 other common pathologies in children include vocal fold cysts and polyps 20 the presence of dysphonia in children can impact psychological well being and social functioning both in academic and family life and can significantly influence a child s ability to perform daily functions 19 20 21 moreover pediatric voice disorders may progress into adulthood and consequently negatively affect personal and professional ambitions 21 as a result of these consequences the united states have implemented a federal mandate through the individuals with disabilities act which states that children with voice disorders that impact their academic performance are entitled to in school services 21 despite this the criteria for school based services is up to interpretation and children with voice disorders have inconsistent access to treatment 20 epidemiology there are various different types of dysphonia with distinct epidemiologies acute dysphonia usually triggered by an infectious onset juvenile recurrent respiratory papillomatosis rrp subglottic stenosis 23 24 endocrine pathology induced vt laryngeal conditions that lead to chronic childhood voice disorders 19 vocal fold nodules cysts velopharyngeal insufficiency vpi anterior glottic webs vocal fold paralysis 23 24 functional voice disorders i e no neurologic anatomical etiology 23 25 muscle tension dysphonia puberphonia mutational falsetto 23 pediatric voice team edit pediatric voice therapy involves the collaborative work of often multidisciplinary healthcare practitioners forming the voice care teams 20 in pediatric cases the speech language pathologist s lp is usually the primary treatment provider 20 his or her work may be facilitated by other team members depending on the issues involved these include a pediatric otolaryngologist pulmonologist allergist and nurses 20 additionally other members of the voice care team can include general practitioners surgeons social workers occupational therapists dieticians gastroenterologists and pharmacists 20 voice services can be provided in a number of settings including hospitals clinics schools and personal homes 20 assessment edit interview the first step of assessment in childhood dysphonia is the interview in the interview the clinician m...