Voice Therapy: Frequently Asked Questions

Why is voice therapy recommended for hoarseness?

Voice therapy

  • Is effective for hoarseness across the lifespan from children to older adults (Thomas & Stemple, 2007; Ramig & Verdolini, 1998).
  • Is the first line of treatment for vocal fold lesions like vocal nodules, polyps, or cysts (Johns, 2003; Anderson & Sataloff, 2002). These lesions often occur in people with vocally intense occupations like teachers, attorneys, or clergyman (Roy et al., 2001). Another possible cause of these lesions is vocal overdoing often seen in sports enthusiasts; in socially active, aggressive, or loud children; or in high-energy adults who often speak loudly (Trani et al., 2007; Rubin et al., 2006; Stemple et al., 2000; Boone et al., 2005).
  • Specifically the Lee Silverman Voice Therapy method, has been demonstrated to be the most effective method of treating the lower volume, lower energy, and rapid rate voice/speech of persons' with Parkinson's Disease (Fox et al., 2006; Dromey et al., 1995).
  • Has been used to treat hoarseness concurrently with other medical therapies, like botulinum toxin injections for spasmodic dysphonia and/or tremor (Pearson et al, 2003; Murry & Woodson, 1995).
  • Has been used alone in the treatment of unilateral vocal fold paralysis (Schindler et al, 2008; Miller, 2004) and has been used to improve the outcome of surgical procedures as in vocal fold augmentation (Rosen, 2000) or thyroplasty (Billiante et al, 2002).
  • Is an important component of any comprehensive surgical treatment for hoarseness (Branski & Murray, 2008).

What happens in voice therapy?

Voice therapy

  • Is a program to reduce hoarseness through guided change in vocal behaviors and lifestyle changes.
  • Consists of a tasks designed to eliminate harmful vocal behavior, shape healthy vocal behavior, and assist in vocal fold wound healing after surgery or injury.
  • For hoarseness, generally consists of 1–2 therapy sessions each week for 4–8 weeks (Hapner et al., 2009). The duration is determined by the origin of the hoarseness and severity of the problem, co-occurring medical therapy, and, importantly, to patient commitment to the practice and generalization of new vocal behaviors outside the therapy session (Behrman, 2006).

Who provides voice therapy?

Certified and licensed speech-language pathologists are the health-care professionals with the expertise needed to provide effective behavioral treatment for hoarseness (ASHA, 2005).

How do I find a qualified speech-language pathologist who has experience in voice?

Search on ASHA ProFind or contact the Action Center at actioncenter@asha.org or by phone Monday–Friday, 8:30 a.m.–5:30 p.m. at 800-638-8255.

Does insurance cover voice therapy?

Generally, Medicare, under the guidelines for coverage of speech therapy, will cover voice therapy if provided by a certified and licensed speech-language pathologist, ordered by a physician, and is deemed medically necessary for the diagnosis.

Medicaid varies from state to state, but generally covers voice therapy, under the rules for speech therapy, up to the age of 18 years old. Contact your local Medicaid office, as there are state differences and program differences.

Private insurance companies vary and the consumer is guided to contact their insurance company for specific guidelines for their purchased policies.

Are speech therapy and voice therapy the same?

Speech therapy is encompasses a variety of therapies, including voice therapy. Most insurance companies refer to voice therapy as speech therapy; they are the same if provided by a certified and licensed speech-language pathologist.

Where can I read more about it?

Sources for citations above and other resources include

American Academy of Otolaryngology-Head and Neck Surgery. (2005). Consensus statement voice therapy in the treatment of dysphonia (Guideline). Available from http://www.entnet.org/.

American Speech-Language-Hearing Association. (2005). The use of voice therapy in the treatment of dysphonia [Technical report]. Available from http://www.asha.org/policy.

Anderson, T., & Sataloff, R.T. (2002).The power of voice therapy. Ear Nose Throat Journal, 81 (7), 433–434.

Behrman, A. (2006). Facilitating behavioral change in voice therapy: the relevance of motivational interviewing. American Journal of Speech-Language Pathology. 15 (3), 215–225.

Billiante, C.R., Clary, J., Sullivan, C., & Netterville, J. (2002). Voice therapy following thyroplasty with long standing vocal fold immobility. Aurus, Narus, Larynx, 29 (4), 341–345.

Boone, D.R., McFarlane, S.C., & Von Berg, S. (2005). The voice and voice therapy (7th ed.). Boston: Allyn and Bacon.

Branski, R.C., & Murray, T. (2008). Voice therapy. WebMD. Accessed May 18, 2009, from http://emedicine.medscape.com/article/866712-overview.

Carding, P.N., Horsley, I.A., & Docherty, G.J. (1999). A study of the effectiveness of voice therapy in the treatment of 45 patients with nonorganic dysphonia. Journal of Voice, 13 (1), 72–104.

Dromey, C., Ramig, L.O., & Johnson, A.B. (1995). Phonatory and articulatory changes associated with increased vocal intensity in Parkinson disease: A case study. Journal of Speech and Hearing Research, 38 (4), 751–64.

Fox, C.M., Ramig, L.O., Ciucci, M.R., Sapir, S., McFarland, D.H., & Farley, B.G. (2006). The science and practice of LSVT/LOUD: Neural plasticity-principled approach to treating individuals with Parkinson disease and other neurological disorders. Seminars in Speech and Language, 27 (4), 283–299.

Hapner, E.R., Portone-Maira, C., & Johns, M.M. (2009). A study of voice therapy dropout. Journal of Voice, 23 (3), 337–340.

Johns, M.M. (2003). Update on the etiology, diagnosis, and treatment, of vocal fold nodules, polyps, and cyts. Current Opinion in Otolaryngology & Head and Neck Surgery, 11 (6), 456–461.

Miller S. (2004). Voice therapy for vocal fold paralysis. Otolaryngology Clinics of North America, 37(1), 105–19.

Murry T, & Woodson, G.E. (1995) . Combined-modality treatment of adductor spasmodic dysphonia with botulinum toxin and voice therapy. Journal of Voice, 9(4), 460–465.

Pearson, E.J., & Sapienza, C.M. (2003). Historical approaches to the treatment of Adductor-Type Spasmodic Dysphonia (ADSD): Review and tutorial. NeuroRehabilitation.18(4), 325–338.

Ramig, L.O., & Verdolini, K. (1998). Treatment efficacy: Voice disorders. Journal of Speech, Language, and Hearing Research, 41, S101–S116.

Rosen, C. (2000). Phonosurgical vocal fold injection: Procedures and materials. Otolaryngologic Clinics of North America, 33(5), 1087–1096.

Roy, N., Gray, S., Simon, M., Dove, H., Corbin-Lewis, K., & Stemple, J. (2001). An evaluation of the effects of two treatment approaches for teachers with voice disorders: A prospective randomized clinical trial. Journal of Speech, Language, and Hearing Research, 44, 286–296.

Rubin, J.S., Sataloff, R.T., & Korovin, G.S. (Eds.). (2006). Diagnosis and treatment of voice disorders. San Diego, CA: Plural Publishing.

Schindler, A., Bottero, A., Capaccio, P., Ginocchio, D., Adorni, F., Ottaviani, F. (2008), Vocal improvement after voice therapy in unilateral vocal fold paralysis. Journal of Voice, 22(1), 113–118.

Stemple, J., Glaze, L., & Klaben, B. (2000). Clinical voice pathology: Theory and management (3rd ed.). San Diego, CA: Singular.

Thomas, L.B., & Stemple, J.C. (2007). Voice therapy: Does science support the art? Communicative Disorders Review, 1(1), 51–79.

Trani, M., Ghidini, A., Bergamini, G., & Presutti, L. (2007). Voice therapy in pediatric functional dysphonia: a prospective study. International Journal of Pediatric Otorhinolaryngology, 71(3), 379–384.

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