Of course, the cause of the voice problem largely determines the management. Your doctor and SLP are in close collaboration regarding the best plan for improving your voice and will thoroughly explain the details of your management plan.
Essentially, management can fall under three categories: therapy, medical management and/or surgery. Often times, a combination of approaches is used to achieve the best outcome for your voice.
Taking care of your voice will always be important, even after your dysphonia has resolved. As such, all plans will include proper voice care or vocal hygiene. Following the guidelines of good vocal hygiene is especially important while you are actively under our care for your voice, but maintaining good vocal hygiene will always be important.
Essentially, management can fall under three categories: therapy, medical management and/or surgery. Often times, a combination of approaches is used to achieve the best outcome for your voice.
Taking care of your voice will always be important, even after your dysphonia has resolved. As such, all plans will include proper voice care or vocal hygiene. Following the guidelines of good vocal hygiene is especially important while you are actively under our care for your voice, but maintaining good vocal hygiene will always be important.
Vocal Hygiene Protocol
Regardless of the cause of your voice disorder or the management plan prescribed, good vocal hygiene is always advised. Taking care of your voice in the best way possible will ensure optimal outcomes and ensure that you maintain your quality voice over time. Click here for a Vocal Hygiene Protocol handout.
In doing so, it is important to remember the following guidelines:
- Drink plenty of non-caffeinated, non-alcoholic fluids - 64 oz per day.
- Avoid caffeine.
- Avoid alcohol.
- DO NOT SMOKE or use other tobacco products.
- Avoid smoky environments such as bars.
- Avoid shouting or yelling.
- DO NOT raise your voice louder than normal conversational loudness.
o Instead of yelling up or down the stairs, use your feet, and a normal voice loudness.
o Don’t try to compete with noise, turn the volume down on televisions and radios before you try to talk.
o Avoid talking on the phone in the car.
o Try not to talk over loud freeway or outdoor noise.
o Avoid noisy restaurants and bars.
- Give your voice a rest at the end of the day - after 5pm.
o Engage in activities that don’t involve talking: reading, watching tv, etc.
o Try to make all your phone calls before 5pm.
o Try not to answer the phone after 5pm, “let the machine get it.”
o Use emails or texting as much as possible after 5pm to assist with resting your voice.
- Avoid throat drops or anything with menthol or eucalyptus. These are very irritating to the larynx.
- Use hard candies - regular or sugar-free to keep your throat lubricated if desired. Avoid mint and sour candies.
- Don’t whisper if your voice is bad. Hoarseness can be a sign your voice needs a break! Limit talking and write instead.
Voice Therapy
For most functional voice disorders, as well as many organic disorders, voice therapy is indicated to improve phonatory production. The SLP staff is highly skilled in therapeutic techniques to evoke and maintain the best vocal quality possible.
Although voice therapy can be very effective in improving functional voice disorders, the key to success is patient consistency and participation. Because this type of therapy is aiming to change behavior patterns, consistent practice is required to “reset” those patterns.
The SLP staff will work with you during your office-based therapy sessions, teaching techniques aimed at improving your phonatory pattern. The office sessions, however, are only a portion of your therapy program. Following each session, you will be provided with a “Home Program.” This represents, in essence, your homework, or home practice that must be conducted. Effectively and consistently conducting your Home Program exercise is key to the success of your voice therapy.
How long you are enrolled in therapy depends on the nature and severity of your voice disorder, as well as how quickly your voice responds to therapy. In some cases, patients may require only one or two session while others may be enrolled in therapy for several months.
Your SLP can discuss plans for therapy, including an estimation of how long you will participate in therapy. It is important to remember that this is merely an estimation based on typical anticipated responses to treatment. Foreseeable changes in the length of your therapy course will be discussed with you as the need arises.
Medical Management
In some cases, a voice disorder may be caused or exacerbated (made worse), by a medical issue. Some common examples of this are sinus drainage and acid reflux, both of which may result in vocal cord inflammation. Smoking can also cause changes to the vocal cords that will result in a dysphonia. In such cases, therapy alone will not improve the quality of the voice as the overall health of the larynx will need to improve.
Changes in behaviors (such as quitting smoking) may be advised in such cases, although it is not uncommon for medications to also be prescribed. For example, allergy medicines may be prescribed if nasal drainage from allergies is suspected to be contributing to the dysphonia. Similarly, anti-reflux medications may also be prescribed if laryngopharyngeal reflux is thought to be contributing to your dysphonia.
Your doctor/SLP will discuss any appropriate medical management as it may contribute to the rehabilitation of your voice. Following their instructions in this regard will be very important in the overall rehabilitation of your voice.
Surgery
Depending on the nature of the voice disorder, your doctor and SLP may recommend surgery. Although there are many cases where surgery is not appropriate or advised (i.e., can make the voice disorder worse), there are other cases where surgical intervention will be required in order to improve your vocal quality.
Surgery is never indicated for functional voice disorders without an organic component. Not all organic voice disorders, however, require surgical intervention.
For example, vocal cord nodules are classified as an organic cause of a voice disorder, although the typical recommended treatment is always therapy. In contrast, however, a vocal cord cyst is also an organic cause of dysphonia but it will not typically resolve (go away) with therapy or medical management. For cysts, surgery is generally recommended.
In some cases, a combined approach using both therapy as well as surgery is necessary to restore the best vocal function.
For example, in addition to creating a dysphonia, continued voicing with a cyst on the vocal cord may cause a functional component to the dysphonia. In an effort to achieve closure and vocal cord vibrations, excessive muscle force may be used while trying to make a voice in the presence of the interfering cyst. Following removal, the excessive muscle force may continue during voicing, even when no longer necessary. In this case, the cyst would be surgically removed and a course of voice therapy would be advised in an effort to restore a normal voicing pattern.
In many cases, surgery is an effective treatment for removing masses/lesions that are causing or contributing to a voice disorder. There are cases, however, where surgical intervention is advised to help compensate for an organic disorder. This is the case, for example, with neurogenic disorders whereby full glottic closure (vocal cord closure) is not possible to due a partial or complete vocal cord paralysis. In this case, the affected vocal cord can be pushed over and/or made fuller to help achieve contact between the vocal cords.
Because surgery is an invasive procedure that may have the potential for scarring the vocal cords, it is only considered when other alternatives will not be effective in restoring the voice. Surgery will only be advised when it is believed to provide the best outcome potential, either alone or when combined with other management options.
Post-Operative Voice Care
In order to achieve the best possible outcomes from your voice surgery, it is important to take proper care of your voice post-operatively. The following guideline is used for most voice surgeries conducted in this practice. The closer this is followed, the more likely your voice will recover as planned. A printable version of these guidelines can be found here.
This plan will cover the first two weeks following your surgery. Depending on your work demands, it may be necessary to take this time away from work if you use your voice a lot throughout the day.
Be sure to schedule a post-operative appointment with the SLP department on or about day 14, before you resume normal voice use.
Day of Surgery:
- NO TALKING! NO WHISPERING!
After Surgery:
- Days 1-3: NO TALKING! NO WHISPERING!
- Days 4-6: Talking Begins, but do so no more than five minutes every half hour.
- Days 7-10: Talk no more than 10 minutes every half hour.
- Day 11-14: Talk no more than 15 minutes every 30 minutes.
Once you have been provided with clearance for the SLP staff to resume normal voice use, it is important to follow the guidelines set forth in the Vocal Hygiene Protocol.
