A voice problem (dysphonia) can result from a myriad of medical and non-medical issues. Benign vocal fold lesions such as nodules, cysts and polyps may lead to hoarseness. Faulty breath control and coordination from asthma and COPD can also undermine voice quality. Muscle atrophy due to nerve weakness or the natural aging process can leave a voice weak and unpredictable. Hormonal changes in body chemistry such as thyroid deficiencies and menstrual cycles can negatively impact the voice. And reflux can contribute to dysphonia in some cases. People with voice problems often complain of persistent hoarseness, frequent fatigue when speaking or singing, loss of range, running out of breath as they speak, even pain when speaking. Some voice problems require medical or surgical intervention, i.e., anti-fungal medication, mucolytics or antihistamines, or excision of a lesion. Usually, the most effective treatment of a voice problem is combined medical and behavioral therapy.
Vocology is a niche specialty in speech pathology dealing with habilitation and rehabilitation of the voice. Once a laryngologist recommends a patient for voice therapy it is the charge of the voice pathologist to help a person “get their voice back.” This is no small task given that our voice and our personality are so closely linked. Voice therapy is not about changing a person’s voice. It is more often about changing the biomechanics of voice production to facilitate vocal fold wound healing and/or allowing the vocal folds to vibrate without overpressure. Ultimately, we want the best sound possible with the least amount of effort without undue trauma to the vibrating edge of the vocal folds. Voice therapy is both a learning and an unlearning process. The voice is an effect—the result of coordinated motor activities in the body. The power source for the voice is the air we breathe. This air must be coordinated with laryngeal muscular activity and shaped by the structures above the vocal folds to produce what we know as the voice. People with vocal problems have often ‘forgotten’ how to use their bodies in this coordinated fashion to produce sound. One important element of voice therapy is to help someone stop doing things that hinder free, easy voice production. Once any underlying respiratory and laryngeal motor issues begin to improve, there are numerous exercises someone can do to regain vocal strength, flexibility and stamina. Generally, most vocal exercises for singers and non-singers alike are geared toward re-directing vocal tension away from the throat by developing or enhancing one’s proprioceptive awareness.
The vocal folds are the vibration source. That vibration travels upward through the pharynx and oral cavity and out into space, and we form words in the mouth on the way out. At its most basic level, the process of voice therapy teaches people to allow their voice to flow out on exhaled air and be shaped—and sensed—in the resonating cavities of the mouth, nose, facial and/or skull bones. There are certain bodily sensations that are associated with healthy vocal fold vibration. Recognizing and guiding these sensations in everyday speech and in singing is a major goal of voice therapy. Therefore, practicing awareness is as important as practicing any specific exercises. One of the keys to successful voice therapy is to bring patients more actively into their own bodies so they may use themselves better in speech and song. Overall, a better use of ‘self’ means a better voice.