If you have a voice problem related to how, or how much, you use your voice, or if other medical conditions have caused changes in your voice that muscle retraining can help resolve, your laryngologist may refer you to a speech pathologist (less formally called a speech therapist). Think of this as physical therapy for your throat.
Just as not all ENTs are true laryngologists, not all speech pathologists have a thorough, up to date understanding of the voice and voice therapy. It is a small subspecialty within the profession. As with your efforts to find a voice-knowledgeable doctor, finding a voice-rehabilitation specialist may mean traveling farther or looking out of one’s normal network. If your voice is a primary tool of your trade, or otherwise central to your personal identity, these efforts may spare you time, work, and frustration in the long run.
In true voice clinics staffed by a multidisciplinary team, the speech pathologist may perform an initial videostroboscopic exam and review the results with the laryngologist. Or they may both be present from the outset. Whereas a doctor examines your vocal cords to look for specific cell changes (lesions) such as nodules, swelling, or inflammation, the speech pathologist focuses on how the cords are working: how they move in and out of vibratory position; whether the vibration is complete and fluid or is irregular, interrupted in some small area; and how the surrounding muscles behave.
The speech pathologist will also talk with you about the demands on your voice, your general health, and your vocal habits, and will record and analyze your vocal sound. Some speech pathologists also measure airflow using a special mask while you sing or talk. The review of your personal and medical history may uncover contributing factors that you thought were unrelated to the throat.
Goals of Speech Therapy
The goals of speech therapy are to help resolve the current problem and to protect you from future trouble using behavioral, educational, and counseling approaches alongside the doctor’s tools of medication and so on. The speech pathologist may suggest lifestyle adjustments, including many issues addressed in this manual, and will develop an individualized plan of exercises to retrain your voice. He or she will work with you to rehabilitate weaknesses; train efficient, effective voice technique for your needs; troubleshoot specific voice situations; and establish healthy vocal habits for the long term.
Voice-rehabilitation services are typically offered in a 4- to 12- week timeframe. They may be covered by medical insurance, depending on your individual plan and situation. When the therapy program is complete, you may “graduate” from care and be referred back to your singing teachers, to another voice specialist, or to a class or community group.
Some aspects of speech therapy can be similar to working with a singing or speech coach. However, there are important differences. A speech pathologist is formally licensed, meeting certain standards of medical and scientific knowledge. Speech pathologists are required to stay up to date through continuing education at conferences and seminars, and are held accountable for the quality of care we provide with multiple levels of review.
Artistic voice teachers are often very skilled and insightful, but at present they are not legally qualified to work with damaged voices, except in collaboration with a medical team. An official statement on such collaboration follows:
The Role of The Speech-Language Pathologist, the Teacher of Singing, and the Speaking Voice Trainer in Voice Rehabilitation
— Excerpted from the American Speech-Language-Hearing Association Technical Report
Since the founding of the American Speech-Language-Hearing Association (ASHA) in 1925, the founding of the National Association of Teachers of Singing (NATS) in 1944, and the founding of the Voice and Speech Trainers Association (VASTA) in 1986, there has been increasing awareness of (a) the importance of having healthy laryngeal function in all styles of speech and singing and (b) the existence of a connection between optimal vocal usage in speech and optimal vocal usage in singing.
All three organizations acknowledge that the most effective path to vocal recovery often will include an integrated approach to optimal voice care and production that addresses both speech and singing tasks. ASHA, NATS, and VASTA therefore collectively affirm the importance of interdisciplinary management of speakers and singers with voice problems and disorders, with the management team ideally consisting of some or all of the following individuals: an otolaryngologist, a speech-language pathologist, and a singing teacher and/or speaking voice and speech trainer …
ASHA, NATS, and VASTA encourage their members to cooperate in the development and delivery of interdisciplinary program and services for singers and other professional voice users with voice disorders.