Current Otorhinolaryngology Reports

, Volume 4, Issue 3, pp 168–174 | Cite as

A Review of Voice Therapy Techniques Employed in Treatment of Dysphonia with and Without Vocal Fold Lesions

  • Karen Drake
  • Linda Bryans
  • Joshua S. Schindler
Professional Voice Disorders (G Garrett, Section Editor)
Part of the following topical collections:
  1. Professional Voice Disorders


Purpose of Review

The purpose of the review is to provide otolaryngologists a framework for understanding voice evaluation by speech-language pathologists and the voice therapy techniques they employ.

Recent Findings

Recent reports have demonstrated the efficacy of behavioral voice therapy in the management of a variety of types of dysphonia, including those associated with vocal fold lesions and those without.


Otolaryngologists can be experts in managing specific laryngeal lesions to improve voice. However, not all voice problems have lesions amenable to surgical or medical therapies. Many are associated with maladaptive voicing behaviors. Speech-language pathologists can be experts in both the evaluation of vocal function and technique. They may employ a variety of techniques to improve vocal quality and function in patients with and without structural or neurologic laryngeal pathology. Otolaryngologists can partner to manage a constellation of voice problems with directed voice evaluation and therapy. A basic review of these techniques and this partnership with voice therapists is presented.


Voice therapy Phonosurgery Muscle tension dysphonia Laryngeal pathology Laryngeal hyperfunction Dysphonia 


Compliance with Ethics Guidelines

Conflict of Interest

Dr. Karen Drake, Dr. Linda Bryans, and Dr. Joshua S. Schindler declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Lessac A. The use and training of the human voice: a practical approach to speech and voice dynamics. New York: Drama Book; 2012.Google Scholar
  2. 2.
    • Verdolini-Marston K, Burke MK, Lessac A, Glaze L, Caldwell E. Preliminary study of two methods of treatment for laryngeal nodules. J Voice. 1995;9(1):74–85. Resonant Voice Therapy is employed by most voice clinicians for many different types of conditions affecting the voice. This paper is the only controlled study that has provided some evidence that this approach may be beneficial in the treatment of vocal nodules. This is a seminal article on which subsequent research has been based. Google Scholar
  3. 3.
    Berry D, Montequin D, Tayama N. High-speed digital imaging of the medial surface of the vocal folds. J Acoust Soc Am. 2001;110:2539–47.CrossRefPubMedGoogle Scholar
  4. 4.
    • Stemple JC, Lee L, D’Amico B, Pickup B. Efficacy of vocal function exercises as a method of improving voice production. J Voice 1994;8(3):271–8. Stemple et al introduced a set of exercises based on a physiologic model of voice therapy which include a series of voice manipulations that were designed to strengthen and balance the laryngeal musculature as well as the coordinated interaction of respiration, phonation and resonance. This is a seminal article on which subsequent research has been based. These are exercises most voice clinicians use as a part of any voice therapy program. Google Scholar
  5. 5.
    Colton R, Casper J, Leonard R. Understanding voice problems: a physiological perspective for diagnosis and treatment. Baltimore: Lippincott, Williams & Wilkins; 2011.Google Scholar
  6. 6.
    Stone RS, Casteel RL. Restoration of voice in nonorganically based dysphonias. In: Filter M, editor. Phonatory voice disorders in children. Springfield: Charles C. Thomas; 1982.Google Scholar
  7. 7.
    Titze I, Story B. Acoustic interactions of the voice source with the lower vocal tract. J Acoust Soc Am. 1997;101:2234–43.CrossRefPubMedGoogle Scholar
  8. 8.
    Aronson AE. Clinical voice disorders: an interdisciplinary approach. New York: Brian C. Decker; 1985.Google Scholar
  9. 9.
    Roy N, Bless D. Manual circumlaryngeal techniques in the assessment and treatment of voice disorders. Curr Opin Otolaryngol Head Neck Surgery. 1998;6(3):151–5.CrossRefGoogle Scholar
  10. 10.
    Cohen SM, Garrett CG. Utility of voice therapy in the management of vocal fold polyps and cysts. Otolaryngol Head Neck Surg. 2007;136(5):742–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Murry T, Woodson G. Combined-modality treatment of adductor spasmodic dysphonia with botulinum toxin and voice therapy. J Voice. 1995;9(4):460–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Barkmeier-Kraemer J, Lato A, Wiley K. Development of a speech treatment program for a client with essential vocal tremor. In: Seminars in speech and language pathology 2011;32(1).Google Scholar
  13. 13.
    • Ramig LO, Countryman S, O’Brien C, Hoehn M, Thompson L. Intensive voice treatment (LSVT®) for patients with Parkinson’s disease: a 2 year follow up. J Neurol Neurosurg Psychiatry 2001;71(4): 493–8. LSVT is the most researched approach in all areas of voice therapy. This article demonstrates the efficacy of this treatment as well as the long term effectiveness in persons with Parkinson Disease. Google Scholar
  14. 14.
    Smith ME, Ramig LO, Dromey C, Perez KS, Samandari R. Intensive voice treatment in Parkinson disease: laryngostroboscopic findings. J Voice. 1995;9(4):453–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Spielman JL, Borod JC, Ramig LO. The effects of intensive voice treatment on facial expressiveness in Parkinson disease: preliminary data. Cognit Behav Neurol. 2003;16(3):177–88.CrossRefGoogle Scholar
  16. 16.
    Sapir S, Pawlas AA, Ramig LO, Seeley E, Fox C, Corboy J. Effects of intensive phonatory-respiratory treatment (LSVT) on voice in two individuals with multiple sclerosis. J Med Speech-Lang Pathol. 2001;9:141–51.Google Scholar
  17. 17.
    Sapir S, Ramig LO, Spielman JL, Fox C. Formant centralization ratio; a proposal for a new acoustic measure of dysarthric speech. J Speech Lang Hearing Res. 2010;53(1):114–25.CrossRefGoogle Scholar
  18. 18.
    Roy N, Stemple J, Merrill RM, Thomas L. Epidemiology of voice disorders in the elderly: preliminary findings. Laryngoscope. 2007;117(4):628–33.CrossRefPubMedGoogle Scholar
  19. 19.
    Kendall K. Presbyphonia: a review. Curr Opin Otolaryngol Head and Neck Surg. 2007;15(3):137–40.CrossRefGoogle Scholar
  20. 20.
    Gorman S, Weinrich B, Lee L, Stemple JC. Aerodynamic changes as a result of vocal function exercises in elderly men. Laryngoscope. 2008;118(10):1900–3.CrossRefPubMedGoogle Scholar
  21. 21.
    Berg EE, Hapner E, Klein A, Johns MM. Voice therapy improves quality of life in age-related dysphonia: a case-control study. J Voice. 2008;22(1):70–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Karen Drake
    • 1
  • Linda Bryans
    • 1
  • Joshua S. Schindler
    • 1
  1. 1.Department of Otolaryngology-Head and Neck SurgeryOregon Health and Science University Northwest Clinic for Voice and SwallowingPortlandUSA

Personalised recommendations