Evaluation and Treatment for Voice and Upper Airway Disorders

If you’re experiencing a change in voice quality or difficulty speaking, you may have a voice disorder. With most voice disorders, the best treatment results come from a combination of behavioral, medical and sometimes surgical approaches. Often a voice condition starts or gets worse with excessive or inefficient voice use. Without correcting the behavioral aspect, symptoms may recur even if medical or surgical treatments provide temporary improvement.

Voice and swallow programs address many different voice and throat symptoms, including:

• Hoarse or gravelly voice quality.
• Unpleasant or changed voice tone.
• Weak voice.
• Throat pain with voice use.
• Change in voice stamina; voice tires quickly.
• Tight voice or throat.
• Pitch changes or voice limitations.

Conditions we treat include:

• Benign vocal fold lesions such as nodules, polyps and cysts. These can cause a raspy, rough or breathy voice.
• Vocal fold thinning (atrophy). You may notice that your voice gets softer and softer, and talking becomes very effortful.
• Scarring and tissue loss in the vocal cords (sulcus vocalis). This condition is usually related to vocal abuse or trauma and is sometimes congenital. Sulcus vocalis leads to a soft, breathy and rough voice.
• Vocal fold weakness (paresis). This may be caused by damage to the vocal fold nerve or physical damage. It may cause a very soft voice because the vocal folds cannot close completely.
• Precancerous or early cancer vocal fold lesions. This is diagnosed by biopsy.
• Spasmodic dysphonia and vocal tremor. These voice disturbances are neurological conditions and cause the voice to be strained or shaky.
• Recurrent respiratory papillomatosis. These are benign vocal fold lesions related to the human papilloma virus (HPV).
• Inflammatory and infectious vocal fold lesions. These vocal fold disorders can create acute or chronic inflammation of the vocal folds.

Certain Sutter sites offer multidisciplinary voice and swallow care in local clinics. We also offer therapy services via telehealth, ideally after an initial evaluation in a multidisciplinary clinic.

Voice Evaluation

A multidisciplinary voice evaluation, a joint visit with the laryngologist and dedicated speech language pathologists, helps determine your current voice quality and possible physical changes that can explain your symptoms.

The evaluation starts with a voice recording. Next, an examination provides a high-definition, detailed look at the vocal folds and how they’re moving. During this exam, the voice team also listens to your voice quality to hear the impact your symptoms are having on the way you sound.

Using all the gathered information, the team works with you to design the best treatment course. This may combine both medical and behavioral aspects, such as medications, in-office procedures, surgical procedures, voice therapy or a short term of voice rest.

Voice Therapy Services

Often, voice symptoms are caused by unintended behavioral changes related to injuries to the vocal folds, or changes in the way the vocal folds function. Addressing how you use your voice is an essential part of recovery.

Voice therapy allows you to work directly with a speech language pathologist (SLP) to retrain the throat and adjust your vocal technique to optimize healing and restore function. Dedicated SLPs are specially trained to evaluate and treat voice, swallowing and dynamic upper airway disorders.

Pre- and Post-Surgery Voice Therapy

Voice therapy is an essential part of recovery for most laryngeal surgeries. One or two therapy sessions before surgery combined with short-term post-op therapy can significantly improve voice recovery and reduce the chance of reinjury or legion regrowth.

Professional or Singing Voice Therapy

Professional voice users (actors, teachers, public speakers) and singers place unique and extreme demands on their voices. While traditional voice therapy focuses on enabling the voice to work well in all applications, applying these skills to the extreme voice use of professional vocalists requires special attention. SLPs will work with you to address issues such as:

• Vocal fatigue.
• Difficulty projecting.
• Range limitations.
• Change in voice tone.
• Pain during or after long periods of voice use.

Gender-Affirming Voice and Communication Training

Our voice and swallow programs strive to provide a comfortable environment for people across the gender spectrum. With this training, you’ll work one-on-one with a speech language pathologist to achieve your goals in finding a comfortable, sustainable voice that authentically represents you.

Therapy for Voice Changes Related to Parkinson’s Disease

Parkinson’s disease can have a considerable effect on the voice. We offer two common therapy protocols:

• Lee Silverman Voice Therapy (LSVT).
• SPEAK OUT!(R) Patients who complete SPEAK OUT! are eligible for weekly group maintenance sessions, called LOUD Crowd(R), for no charge.

Therapy for Upper Airway and Breathing Disorders

The larynx (voice box) sits near the top of the airway. The vocal folds act as gatekeepers to help protect the lungs. Occasionally, this gatekeeping function becomes disordered. SLPs provide evaluation and training to help reduce the impact of:

• Troubled, Noisy Breathing When Inhaling — This condition is called vocal cord dysfunction (VCD), exercise-induced laryngeal obstruction (EILO) or paradoxical vocal fold movement disorder (PVFMD). Symptoms come and go and usually have a clearly defined trigger (often exercising or strong odors). Evaluation looks for closing of the vocal folds, which impedes airflow. Working one-on-one with SLPs can help you retrain your breathing, keeping the airway open.
• Coughing and Throat Clearing — Your body uses coughing and throat clearing to clear or protect the lungs. Occasionally, coughing or throat clearing in the absence of a significant need can become chronic and disruptive. Working with an SLP can provide strategies for managing the response to sensations that cause you to unnecessarily cough or clear your throat.