What is a Voice problem?

A voice problem may present itself as a chronic hoarse voice, or chronic cough with tiresome weak volume. The resonance of your voice may have changed and the quality may sound weak. It can be tiring to have a voice problem and if it goes on for a long time, it can have an effect on lifestyle and impact on communication. There are a number of factors which can cause a voice problem although frequently people who use their voice in their vocation can be more susceptible to voice difficulties such as teachers, lawyers, aerobics instructors.
Voice therapy aims to restore and maintain optimum voice quality and prevent the development of organic damage associated with vocal abuse, e.g. vocal nodules.

Prior to your appointment

All voice referrals require an ENT (ear, nose and throat) examination prior to starting therapy, in line with national recommendations. The patient is usually referred to ENT by their GP. Where voice therapy is the treatment of choice, the Consultant will write a detailed report on the workings of the larynx (voice box) to the Speech and Language Therapist, to enable her\him to draw up exactly the right treatment plan for each individual patient.

Where there has been a complete loss of voice, simultaneous referral by the GP to the Speech and Language Therapist is important and ensures early advice is given, though treatment itself cannot begin until the exact cause of the voice loss has been established by the ENT Consultant.

Assessment in a joint ENT / SALT clinic will be carried out where appropriate.

Initial assessment

During the initial assessment the Speech and Language Therapist will:

• Take a case history, including medical and social details – to try and establish the cause(s) of the problem
• Undertake an assessment of the patient’s voice quality and the way he\she uses their breathing to support the voice, which may include a digital recording
• Undertake an assessment of the face and neck muscles to ensure these are not being overused, creating unnecessary tension as the patient speaks
• Record any observations and assessment results in order to monitor progress and to evaluate effectiveness of intervention

The assessment results, including an explanation of the normal functioning of the vocal tract and an explanation of the causal and maintaining factors that make up the voice disorder, will be discussed with the patient and a report will be written and sent to the ENT Consultant, GP and if required, other members of the multi-disciplinary team.

Ongoing therapy

Following assessment and in consultation with the patient, a decision will be made with regards the most appropriate management. This may include:
• An explanation of voice care plus conservation (one session).
• A period of direct therapy (on average four to six sessions).
• Review appointments for monitoring progress if required

Discharge
Discharge will be at the discretion of the therapist and in full consultation with the patient and where appropriate, the ENT Consultant
Patients will be discharged when one of the following conditions apply:
• The voice disorder has resolved to the patient’s and therapist’s satisfaction.
• The voice disorder has improved to full potential and the patient has reached a plateau.
• The patient refuses intervention
• The patient failed to attend an appointment, without giving notice.

A discharge report will be sent to the GP and other members of the MDT.