Condition: Voice Disorders

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From the American Speech-Language Hearing Association: 

voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual’s age, gender, cultural background, or geographic location (Aronson & Bless, 2009; Boone, McFarlane, Von Berg, & Zraik, 2010; Lee, Stemple, Glaze, & Kelchner, 2004). A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant (American Speech-Language-Hearing Association [ASHA], 1993; Colton & Casper, 1996; Stemple, Glaze, & Klaben, 2010; Verdolini & Ramig, 2001).

A number of different systems are used for classifying voice disorders. For the purposes of this document, voice disorders are categorized as follows:

  • Organic — voice disorders that are physiological in nature and result from alterations in respiratory, laryngeal, or vocal tract mechanisms
    • Structural — organic voice disorders that result from physical changes in the voice mechanism (e.g., alterations in vocal fold tissues such as edema or vocal nodules; structural changes in the larynx due to aging)
    • Neurogenic — organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds)
  • Functional — voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation)

Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia. The resulting voice disorders are referred to as psychogenic voice disorders or psychogenic conversion aphonia/dysphonia (Stemple, Glaze, & Klaben, 2010). These voice disorders are rare. SLPs refer individuals suspected of having a psychogenic voice disorder to other appropriate professionals (e.g., psychologist or psychiatrist) for diagnosis and may collaborate in subsequent treatment.


Developmental Norms:

Issues with voice quality are not considered developmental.  If children have any of the following red flags, voice concerns should be investigated: 

  •  Hoarseness or abnormal cry in babies
  • Harsh or hoarse voice in older children
  • Noisy breathing (stridor)
  • Voice that sounds too low or too high
  • Voice that sounds too loud or too quiet
  • Weak or breathy voice
  • Increased effort to speak
  • Vocal fatigue
  • Losing the voice (unable to phonate)


Guidance from the American Speech-Language Hearing Association on assessment for voice disorders: 

A comprehensive assessment for voice disorders typically includes the following components: 

  • Case History
  • Self-assessment of how the voice problem affects their emotions and daily living
  • Oral-peripheral examination
  • Assessment of respiration
  • Auditory-Perceptual Assessment: Subjective assessment based on clinical impressions of the speech-language pathologist
  • Instrumental assessment: Such as laryngeal imaging, acoustic assessments, and aerodynamic assessments

Suggested Goals:

The results of the assessment process should help guide what you will target in therapy for a child with feeding and/or swallowing disorders.  Here are some goals that you may be addressing with this population.  You can click on one of the goals below to learn more.  Or, scroll down to the therapy section for more in-depth resources and support for treating this condition.


Start at the ENT:

Therapy for voice disorders should always begin with a referral to an Ear Nose Throat (ENT) doctor who can evaluate the physical structures and provide clearance for speech therapy to begin.  Some clients will require surgical or prosthetic management before speech therapy can begin.

What We Can Target: 

According to the American Speech-Language Hearing Association, approaches for treating voice disorders include:

  • Direct approaches focus on manipulating the voice-producing mechanisms (e.g., phonation, respiration, and musculoskeletal function) in order to modify vocal behaviors and establishing healthy voice production (Colton & Casper, 1996; Stemple, 2000).
  • Indirect approaches modify the cognitive, behavioral, psychological, and physical environments in which voicing occurs (Roy, et al., 2001; Thomas & Stemple, 2007). Indirect approaches include the following two components:
    • Patient education—discussing normal physiology of voice production and the impact of voice disorders on function; providing information about the impact of vocal misuse and strategies for maintaining vocal health (vocal hygiene)
    • Counseling—identifying and implementing strategies such as stress management to modify psychosocial factors that negatively affect vocal health (Van Stan, Roy, Awan, Stemple, & Hillman, 2015)


Additional Resources for Treatment of Voice Disorders:

How to Teach Frontal Focus Resonance Instead of Laryngeal Resonance

This resonance strategy is helpful for clients who are using laryngeal tension or glottal fry instead of achieving proper resonance in the front of the face. 

Belly Breathing for Voice Disorders

Learn how to teach clients to use proper belly breathing to address voice issues.

Client Education about the Voice/Speech Mechanism

Laura walks you through how she educates clients about how their voice works.

Sample Goals for Voice

Sample goals for addressing voice disorders for both the medical setting and the school setting.

Treating Voice in the Schools – Webinar Recording

A full, hour-long webinar recording about treating voice disorders in the schools.

Overview of Voice Therapy – Webinar Recording

A full, hour-long webinar recording with a general overview of treating voice disorders.

High, Low, and Normal Pitch Activity

Simple one-page visual for helping younger clients become aware of if they’re using a high, low, or “normal” pitch.

Treating Hypophonia (Quiet Voice)

Quick training video on treating clients with a diagnosis of hypophonia (voice is too quiet)

Vocal Hygiene for Teachers

Great handout you can give to teachers and educators about how to preserve their own voices through good vocal hygiene

Yawn-Sigh Technique Worksheet

Activity to teach the yawn-sight technique that can be used to reduce laryngeal tension and teach easy onset

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Resources, Tools, and Training for Speech-Language Professionals

*** The SLP Solution is for informational and educational purposes only and does not provide medical or psychological advice.  We provide general resources but cannot tell you exactly what should be done for a specific client.  Every client is different and your clinical judgement should be used when making decisions about specific individuals.


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