Adult Voice Services
Functional Voice Disorders
Muscle Tension Dysphonia
When a person exerts or carries excessive muscle tension in their vocal, throat, abdomen, and/or neck muscles, they may develop muscle tension dysphonia (MTD). This dysphonia can be characterized by hoarseness, breathiness, vocal fatigue, vocal strain, pain when speaking, loss of voice, a sensation that something is in the voice box or throat ('globus sensation'), pitch breaks, voice breaks, shortness of breath, reduced pitch range, and reduced vocal intensity. MTD can be associated with a medical condition that causes excessive muscle tension, by psychological stress (e.g., an anxiety disorder), exposure to an irritant, or maladaptive speaking behaviours (e.g., teachers who use their voices for prolonged periods of time each day). It may also develop after a respiratory illness (e.g., a cold or pneumonia) or reflux when an individual enters a cycle of frequent coughing, increased muscle tension, and over sensitivity in the larynx.
MTD can be classified as 'primary MTD' when there is no structural or neurologic abnormality causing the muscle tension. It is classified as 'secondary MTD' when the tension results from other conditions affecting the vocal mechanism (e.g., nodules).
MTD may also be known as hyperfunctional voice disorder, spastic dysphonia, functional dysphonia.
Treatment for MTD may include a combination of laryngeal massage, modifying maladaptive speaking behaviours, improving vocal hygiene, and vocal exercises.
People with MTD often also benefit from working with other professionals in conjunction with speech therapy. Physiotherapists with expertise in vocal physiotherapy can offer treatment to help decrease muscle tension and build strength in the extrinsic laryngeal muscles, and the muscles of the jaw, tongue, neck, shoulders, torso, and respiration that contribute to voice production. Cynthia Murphy, PT, of Scotia Physiotherapy in Halifax offers such treatment for persons with MTD. Learn more here: https://scotiaphysiotherapy.ca/service/vocal-physiotherapy/.
Video of Muscle Tension Dysphonia
Johns Hopkins Voice Center
University of Pittsburgh
Spasmodic Dysphonia
Spasmodic dysphonia is a type of dystonia. Dystonia is a movement disorder in which a person experiences forceful contractions of specific groups of muscles. In the case of spasmodic dysphonia, these muscle contractions occur in the intrinsic laryngeal muscles - the muscles inside your voice box.
There are different types of spasmodic dysphonia - adductor spasmodic dysphonia, abductor spasmodic dysphonia, and mixed dysphonia (a combination of adductor and abductor spasms). With adductor spasmodic dysphonia, the muscles that close the vocal folds are affected, resulting in abrupt closure of the vocal folds. The person's voice may sound tight, strained, and strangled and their vocal folds abruptly and unexpectedly close tightly when they are speaking. With abductor spasmodic dysphonia, the muscles that open the vocal folds are affected, resulting in a voice that is randomly breathy or sounds whispered.
Spasmodic dysphonia usually begins between the ages of 30 and 50 years. Its onset may be sudden or gradual - increasing in frequency over as long a period as 18 months, and then becoming more stable. There is no known cause, but the basal ganglia is thought to be involved.
The diagnosis of spasmodic dysphonia usually involves evaluation by an ENT doctor (ear, nose, and throat doctor; otolaryngologist) and speech-language pathologist. It may also require evaluation by other professionals such as a neurologist and psychologist to rule out other causes of the person's sudden voice difficulties.
Treatment usually involves medical intervention (e.g., botox injections). People may also benefit from voice therapy, although the response may be variable.
Resources:
'Spasmodic Dysphonia'
Dysphonia International
https://dysphonia.org/voice-conditions/spasmodic-dysphonia/
Gender-Affirming Voice Care
Achieving a feminine, masculine, or neutral voice involves consideration of pitch, resonance, vocal quality, prosodic patterns (e.g., intonation and rate), and nonverbal communication (e.g., gesture, posture, body position relative to others). While hormones frequently lower the pitch of trans men's voices over time, hormones for trans women do not have an effect on pitch. Each of these characteristics, however, can be modified through voice training.
Speech-language pathologists are among the voice professionals who work with trans men and women to help them achieve their goals for a gender congruent voice while preserving the health of their voice mechanism. It is recommended that trans men and women who are working toward achieving their ideal voice do so with the support of a psychologist or clinical therapist while working with an appropriate voice professional.
This process of voice modification requires time and practice, but is achievable. You can expect to visit with a speech-language pathologist weekly over a number of months. The process will also involve daily home practice.
Resources:
"Voice and Communication Change for Transgender People", American Speech-Language-Hearing Association
by Matthew Mills & Gillie Stoneham
(This book is part of Shoreline's collection and can be borrowed by clients of any of the health professionals at Paddlers Cove Professional Centre.)
Videos
"5 Year Voice Transition Timeline: The Evolution of My Voice"
TransVoiceLessons
https://www.youtube.com/watch?v=2txYhkmhVts
Neurogenic Voice Disorders
Please see our pages on Parkinson's disease and stroke.
Voice Problems After COVID-19
After recovering from a COVID-19 infection, people may experience persistent voice difficulties. These difficulties may be a result of the cough associated with COVID. Coughing brings your vocal folds forcefully together, causing irritation and inflammation. This irritation can then result in more coughing and/or throat clearing as the person attempts to relieve the irritation.
If a person has more long term respiratory effects from COVID, this can also potentially affect their voice. We require adequate breath support and air pressure from our lungs to power the voice. When a person's respiratory system is affected, they may have reduced breath support and thus decreased air pressure when trying to voice. Their body may try to compensate for this by squeezing the muscles around their larynx. This combination of reduced breath support and overuse of the muscles can result in voice difficulties.
If a person required intubation while in the hospital for a serious COVID infection, this may also affect their voice as the tube must be passed through the vocal folds. If damage was caused to the vocal folds during intubation and/or when the tube was removed, these effects are usually short term and the vocal folds will recover naturally.
Support and treatment for voice difficulties post-COVID may involve various health professionals including your family doctor, an ear, nose, and throat doctor, respiratory specialist, speech-language pathologist, or physiotherapist (with specialty treating voice disorders).
Resources:
Voice Problems Post COVID-19
Royal College of Speech-Language Therapists
https://www.youtube.com/watch?v=Y9QqYuHhSkI&list=PLwPFCsiLex6vNMCTjCfvxuBhSkCPk0Yn9&index=55&t=213s
Performers and Singers
Those who use their voice professionally for performance may require specialized support to prevent and/or recover from a voice disorder. The nature of their profession places greater demand on the voice mechanism (e.g., projecting for theatre performance, singing), they rely on optimal voice functioning to engage in their profession, and they require an SLP with knowledge of both voice disorders and performance voice use.
Shoreline does not currently have an SLP with this expertise on their team. You may wish to consult the following directory of private SLPs in Nova Scotia: https://www.novascotiaslp.com/adult-services.
You may also wish to consult with the SLP below who has experience in this area of voice practice:
J. Heather MacLean, M.Sc., SLP-Reg, SLP(C)
Fall River, NS (mobile service)
(902) 456-5594
Assessment
A clinical voice evaluation typically includes the following:
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analysis of your voice (e.g., loudness, quality, and pitch range)
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evaluation of the impact of voice changes on your daily life and your family
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discussion of your goals for intervention
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identification lifestyle factors contributing to voice issues
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case history
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oral mechanism exam (examination of oral structures required for speech)
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evaluation of candidacy for treatment
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prognosis for improvement with treatment
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review of reports from other professionals (ENT, audiologist, family doctor, neurologist)
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hearing screening
Please bring the following to your appointment or send them ahead of time. If you do not have access to these reports, please just bring the name/contact information of the health professional who provided the service. With your consent I will be able to request these reports on your behalf.
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results of any recent hearing test
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copy of relevant reports (e.g., ENT)
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list of medications
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medical history (if you have a history of cardiac disease or surgery, medical clearance may be required before starting voice treatment)
Part of a voice evaluation includes completion of a laryngeal exam by an Ear Nose and Throat (ENT) doctor ('otolaryngologist'). Your doctor can make this referral. For a laryngeal exam, the ENT (or specially trained SLP) will place a scope in your mouth so that they can look down your throat to your vocal folds. This scope only goes to the back of your mouth. In some cases, a flexible scope may need to be passed through your nose to your throat. Topical anesthetic will be used to make this more comfortable. From this position, your vocal folds can also be viewed. The ENT/SLP will discuss this with your before starting the procedure. The laryngeal exam is important in order to identify or rule out any structural reason for the voice changes you are experiencing (e.g., nodules).
Laryngoscopy and Stroboscopy to Examine the Vocal Cords (video)
University of California, Irvine
Department of Otolaryngology
Fiberoptic Laryngoscopy with Dr. Hermsen (video)
McFarland Clinic
Dr. Derek Hewitt: What is Videostroboscopy? (video)
Yavapai Regional Medical Center
Rigid Videostroboscopy Procedure (video)
Swallowing and Neurological Rehabilitation, LLC
On This Page
Gender Affirming Care
Neurogenic Voice Disorders
Performers and Singers
Assessment