The document discusses advancements in voice therapy, including both direct and indirect techniques tailored to individual voice disorders and their severity, as well as the role of phonosurgery in treating vocal function. Key treatment methods include resonant voice therapy, vocal function exercises, and various surgical interventions, with emphasis on the importance of patient-specific approaches and outcomes. The document also references numerous studies highlighting the effectiveness of these therapies and surgical techniques in improving voice quality and function.

1. UNIT 4
B. VOICE DISORDERS:
(Recent advances in voice therapy including instrumentation, introduction to phono
surgical techniques. Treatment outcome in voice disorders)
SUBMITTED TO SUBMITTED BY
DR. ROHILA SHETTY HIMANI BANSAL
MVSCOSH MASLP 1ST YEAR

2. VOICE THERAPY
Voice therapy may be defined as an
effort to return the voice to a level of
adequacy that can be realistically
achieved and that will satisfy the
patient’s occupational, emotional, and
social needs (Aronson, 1990)
Indirect Voice Therapy
Direct Voice Therapy

3. Voice therapy program depends on both the type
and severity of a patient’s voice disorder
May be recommended before and/ or after surgical
treatment, depending on the patient’s needs
Helps to restore function so that the vocal profile
falls within the accepted normal range

4. TRAINING PRINCIPLES
Overload
Principle
Specificity
Principle
Reversibility
Principle
Individuality
Principle

5. INDIRECT VOICE THERAPY
Primarily educational
and includes an
overview of:
1. Normal vocal
anatomy and
physiology
2. Voice care/vocal
hygiene

6. DIRECT VOICE THERAPY
CONFIDENTIAL VOICE THERAPY
RESONANT VOICE THERAPY
VOCAL FUNCTION EXERCISES
ACCENT METHOD VOICE THERAPY
LEE SILVERMAN VOICE TREATMENT
RESPIRATORY TRAINING
DVT involves
alteration of a
patient's speaking
technique
It helps to increase
vocal efficiency and
improve voice quality

7. VOICE THERAPY ORIENTATION
Symptomatic
Voice Therapy
Etiological
Voice Therapy
Eclectic Voice
Therapy
Physiologic
Voice Therapy
Psychogenic
Voice Therapy

8. VOICE THERAPY APPROACHES FOR VARIOUS
VOICE DISORDERS
VOICE DISORDER VOICE THERAPY
Functional voice disorders: e.g., MTD Indirect and direct voice therapy
Organic voice disorders: e.g. vocal fold nodules,
cysts and polyps
Phono micro surgery and voice therapy
Neurological voice disorders: e.g., SD, EVT Lee Silverman voice treatment, behavioural
therapy used in combination with BOTOX injection
therapy
Vocal fold immobility: e.g., VF palsy Vocal function exercises, modified LSVT,
postural/positional alterations
Paradoxical Vocal Fold Movement Disorder
(PVFMD)
Combined modality treatment: respiratory
retraining and reflex therapy
Gastro Esophageal Reflux Disorder (GERD),
Laryngeal pharyngeal reflex (LPR)
Dietary and lifestyle changes, RVT

9. SOFTWARES USED FOR VOICE THERAPY
VAGHMI
MPD-
Pacman
MPD-
Baloo
F0
METER
F0 BIRD
DR.
SPEECH
VIDEO VOICE SPEECH
TRAINING SYSTEM
VISUAL VOICE
TOOL

10. STUDIES
AUTHOR SUMMARY
Spielman, Borod, Ramig (2003) Examined the effects of intensive voice therapy on facial
expression in Parkinson’s Disease and found that intensive
voice therapy may have a positive effect on facial
expressivity in PD
Speyer, Kempen, Wieneke (2002) Explored the digital laryngeals stroboscopic images to
demonstrate the changes in vocal fold vibration and found
that there were significant improvement in lesion size and
degree of maximal closure during vibration
Holmberg and Doyle (2001) Assessed the effects of voice therapy on vocal function
with vocal nodules and found that there were positive
effects of voice therapy on voice quality, vocal status and
vocal functions for majority of individuals with vocal
nodule

11. PHONOSURGERY
Any surgical procedure designed to
maintain, restore, or enhance the
human voice
Best possible restoration of laryngeal
function rather than the simple
removal of lesions to restore normal
laryngeal appearance
Based on: anatomy, physiology,
pathology, pathophysiology,
assessment of VF functioning and
patient history

12. AIMS OF PHONOSURGERY
1. Vocal fold lesions
with pathological tissue
impairing the vibratory
movement
2. Vocal fold movement
disorders with
inappropriate position
and/or tension of the
vocal folds

13. PHONOSURGICAL TECHNIQUES
Nerve muscle innervations techniques, Vocal fold injection techniques
Phono surgery over the
VFs for voice generation
• Laryngoplastic Phono surgery (Thyroplasty) for correcting position of vocal fold as in vocal cord paralysis
and also for correcting the tension of the vocal fold
Correction of cleft palate, cleft lip, orthodontic surgery pharyngoplasty
and endoscopic sino-nasal surgeries
Phono surgery for voice
resonance
• Highly specialized surgery to improve voice (phonosurgery) using microsurgical techniques and highly
magnified views (microsurgery) in order to provide microscopic details
Microsurgery of benign lesions: LASER or Instrumental
Benign lesions
• Pathological lesions like: Vocal nodules, polyps, vocal cord cysts, papillomas, angiomatous lesions and
Reinke's oedema; lesions like sulcus vocalis, Leukoplakia and intramucosal cysts

14. STUDIES
AUTHOR SUMMARY
Billante, Clary, Childs and Netterville
(2002)
Examined vocal improvements in persons
before thyroplasty at 3 months and one
year after surgery found the voice
improved after 3 months and 1 year post
thyroplasty surgery
Sommer and Schultz-Coulon (2007) Explored the long term results of micro
laryngoscopy after the removal of
Reinke’s oedema and found that its
necessary to select patients carefully for
surgical treatment as the long term
results vary from person to person

15. TREATMENT OUTCOMES IN VOICE
DISORDERS
John. A, Enderby. P, Hughes. A (2005) aimed studying the outcomes in speech and
language therapy (SLT) using the therapy outcome measure (TOM) for patients
with voice disorder (dysphonia) comparing outcomes of seven separate speech
and language therapy service and concluded that there were significant
differences in the number of treatment contacts provided by the different services
Smith, Kempster and Sims (2010) studied to determine whether patient-related
factors could be identified which distinguished patients who attended voice therapy
and had positive voice change from those who did not and concluded that patients
with more complex laryngeal diagnoses, more perceived vocal severity, occupational
issues, more health issues, and higher VHI scores at the time of the initial voice
evaluation may be at greater risk for failing to attend voice therapy sessions
Mathieson, Hirani, Epstein, Wood and Rubi (2009) studied the appropriate
acoustic and outcome measures of laryngeal manual therapy (LMT) used in the
treatment of patients with muscle tension dysphonia (MTD) and concluded that
there were positive evidence for LMT as a method of therapy in the treatment of
hyperfunctional voice disorders

16. REFERENCES
1.Moya. L. Andrews, (1999). Manual of voice treatment: Pediatrics through geriatrics. (2nd edtion), Cengage Learning.
2.Charles N. Ford, and Diane M. Bless (1991) Phonosurgery: Assessment and surgical management of voice disorders. (1st edition), Raven
Pr.
3.Marc Remacle, and Eckel Hans Edmund, (2000). Surgery of larynx and trachea. (1st Edition), Berlin: Springer, 2010.Brittanica
encyclopaedia.
4.Sheng Hwa Chen, Tzu-Yu Hsiao, Li-Chun Hsiao, Yu-Mei Chung, and Shu-Chiung Chiang, (2007). Outcome of resonant voice therapy for
female teachers with voice disorders: perceptual, physiological, acoustic, aerodynamic, and functional measurements. Journal of Voice,
21(4), https://doi.org/10.1016/j.jvoice.2006.02.001.
5.http://www.speech ville.com/speechtherapy/software-sips.html.
6.http://www.dr speech.com/speechtherapy5.html.
7.Bonnie E. Smith, Gail B. Kempster and H. Steven Sims, (2010). Patient factors related to voice therapy attendance and outcomes. Journal
of Voice, 24(6), https://doi.org/10.1016/j.jvoice.2009.03.004.
8.L. Mathieson, S. P. Hirani, R. Epstein, R. J. Baken, G. Wood, and J. S. Rubin. (2009). Laryngeal manual therapy: a preliminary study to
examine its treatment effects in the management of muscle tension dysphonia. Journal of Voice, 23(3),
https://doi.org/10.1016/j.jvoice.2007.10.002.

17. QUESTIONS ASKED IN PREVIOUS YEARS
1. What are the recent advances in the management of voice disorders in adults? (16 marks, 2011)
2. Short note on resonant voice therapy. (4 marks, 2013)
3. Short note on vocal hygiene. (4 marks, 2015)
4. Management of voice problems in Parkinson’s disease. (4 marks, 2012, 2015)
5. What is phono surgery? Explain its implications in voice management. (8 marks, 2015)
6. Explain vocal function exercises with rationale and procedure. (8 marks, 2017)
7. Compare and contrast between physiological therapy methods versus behavioural voice therapy
methods. (16 marks, 2019)
8. Describe RVT and VFE. (16 marks, 2018)
9. Explain RVT with rationale and procedure. (8 marks, 2016)