Voices can be hoarse, raspy, loud, nasal, denasal, or breathy.  Sometimes we can lose our vocal production with gaps of phonation or lose it altogether.  Our voices can have glottal fry qualities or can be very low in volume.  Pitch control or suboptimal pitch levels may also affect the way our voice is heard. 

The voice is the “music” of our speech.  It provides our speech with a resonance and a rhythm of inflection that influences the subtleties of our language.  A change in our inflection can change the same sentence from being interpreted as a question, sarcasm, a command, or a simple declarative sentence.

A very basic description of the production of voice is that the air obtained by the lungs passes through the vibrating vocal cords creating sound.  Voice resonance is established from structural conditions of the oral structure such as the width and depth of the palate and the air supplied by the lungs.  It can be affected by hearing, conditions of the vocal cords, tonsils, and adenoids; as well as neurological conditions. Even the common cold can alter our voice production.

Basically, chronic vocal disorders should be first diagnosed by an otolaryngologist (Ear-Nose-Throat physician).  The physician would diagnose the vocal symptoms with objective measurement tools.

A speech language pathologist would get involved with treatment for voice therapy when a physician feels that the therapy would remediate the areas of concern.

Some conditions frequently referred to a speech pathologist include vocal polyps, nodules and ulceration of the vocal cords due to incorrect vocal usage or vocal abuse.  Usually a doctor will recommend voice therapy prior to surgery.  Sometimes surgery may even be contraindicated after receiving voice therapy.  Indications of the possibility of vocal anomalies benefiting from vocal therapy include, but are not limited to; vocal hoarseness, harshness and pitch breaks.

Another condition often remediated with voice therapy includes vocal paresis or vocal paralysis.  These conditions could be caused by structural, organic, or neurological reasons.  It is imperative that the correct medical doctor be utilized to identify the diagnosis first.  The physician will determine the etiology of the problem and recommend the appropriate treatment.  Sometimes symptoms could be vocal interruptions, tremors in the voice, difficulty producing louder volume and even control of vocal inflection and pitch.

Hypernasal (excessive air passes through the nose, ie. many deaf people speak with hypernasal voice) or hyponasal (insufficient voice passes through the nose, ie.  sounds like you have a cold) are other areas that a speech language pathologist may assist in treatment.  Sometimes insufficient velophygeal closure will also cause “air” sounds and those sounds “ploded” or pushed out with insufficient means to do so.  Again, the proper physician, usually an otolaryngologist, would make the diagnosis and recommend treatment. Cleft palate children are often seen with these kinds of difficulties, as well as many neurological conditions such as M.S. and cerebral palsy.

Voice therapy is helpful for people with dysphonia as well.  This is an interruption of phonation.  It can result from the over adduction of the vocal folds.  Sometimes dysphonia is psychogenic in nature, it can also be related to the cranial nerves as well as other structural conditions of the vocal cords.