How can I improve dysphonia?

How to Improve Dysphonia

Voice therapy delivered by a certified speech-language pathologist should be your first-line treatment for dysphonia, but only after laryngoscopy has been performed to visualize the vocal folds and establish the underlying diagnosis. 1

Mandatory First Step: Laryngoscopy Before Treatment

• Perform diagnostic laryngoscopy (or refer for it) before prescribing any treatment, including voice therapy, to identify the underlying cause and rule out malignancy or other serious pathology. 1, 2
• Do not prescribe antibiotics, corticosteroids, or antireflux medications empirically without laryngoscopic visualization. 1
• Document and communicate laryngoscopy findings to the speech-language pathologist before initiating voice therapy. 1

Voice Therapy: The Primary Treatment

Voice therapy is effective across all age groups and should be advocated for dysphonia from causes amenable to behavioral intervention. 1, 3

Core Voice Therapy Techniques

Voice therapy addresses the underlying mechanism through several evidence-based approaches:

For Functional Dysphonia (Muscle Tension Dysphonia)

• Circumlaryngeal massage with manual repositioning of the larynx reduces excessive musculoskeletal tension—explain to the patient this tension is reversible, not structural damage. 1
• Semi-occluded vocal tract exercises including humming, lip trills, tongue trills, and straw phonation facilitate easier voice production. 1
• Vocal function exercises and resonant voice exercises help consolidate normal phonation patterns. 1
• Playful vocal exercises such as sirening down the scale on nasal sounds, gentle sighing, blowing raspberries while voicing, and producing glottal fry at the bottom of the vocal range redirect attention away from effortful phonation. 1

For Specific Conditions

• Parkinson's disease dysphonia: Lee Silverman Voice Therapy (LSVT LOUD) is the most effective method for treating low-volume, low-energy voice. 1
• Spasmodic dysphonia/laryngeal dystonia: Botulinum toxin injections are the treatment of choice, with voice therapy as an essential adjunct to address compensatory behaviors and maximize outcomes. 2
• Benign vocal fold lesions (nodules, polyps, cysts): Voice therapy is first-line treatment and often eliminates the need for surgery entirely. 4

Psychological Component

• Provide clear explanation that the voice disorder results from reversible habitual patterns, not irreversible structural abnormality—patients often misunderstand medical reports describing "abnormal movements." 1
• Address predisposing and perpetuating psychosocial factors through communication counseling, identifying patterns of avoidance or excessive dependence on communication aids. 1
• Refer to mental health professionals when there is evidence of long-standing anxiety, comorbid depression, or ongoing medicolegal issues that impede recovery. 1

Vocal Hygiene and Preventive Measures

Educate all patients about behavioral and environmental modifications that reduce dysphonia risk. 1

Things to DO:

• Drink adequate water daily to maintain hydration—absence of water intake increases dysphonia risk by 60%. 1
• Use amplification in large noisy spaces to reduce vocal strain and sustain voice quality during heavy use. 1
• Rest your voice periodically to prevent fatigue, straining, and overuse. 1
• Provide indoor humidification in dry, arid environments. 1
• Engage in regular physical exercise (≥3 times weekly), which is associated with lower dysphonia prevalence. 1

Things to AVOID:

• Smoking and secondhand smoke from all tobacco products. 1
• Yelling, shouting, speaking over loud noise, and whispering—all strain the vocal mechanism. 1
• Excessive throat clearing and coughing—these are traumatic to vocal folds. 1
• Alcohol and caffeine consumption—these dry the throat and thicken mucus. 1
• Drying medications when possible. 1

Surgical Intervention

Surgery is reserved for conditions that do not respond to conservative management or when malignancy is suspected. 1, 4

• Advocate for surgery when there is suspected malignancy, symptomatic benign vocal fold lesions refractory to voice therapy, or glottic insufficiency requiring medialization. 1
• Surgery can improve voice-related quality of life and objective vocal parameters when appropriately selected. 4
• In children, vocal polyps and nodules typically resolve with development—surgery has a limited role and is reserved only for severe cases refractory to conservative treatment. 4

Follow-Up and Documentation

• Document resolution, improvement, or worsening of dysphonia symptoms and quality of life changes after treatment. 1
• If dysphonia persists beyond 4 weeks without improvement, perform or refer for laryngoscopy. 1
• Prepare patients for possible relapse with strategies for self-management using techniques learned during therapy—make future support available if needed. 1

Common Pitfalls to Avoid

• Never prescribe empiric medications (antibiotics, steroids, proton pump inhibitors) for isolated dysphonia without laryngoscopic diagnosis. 1
• Do not delay laryngoscopy in patients with dysphonia lasting >4 weeks, risk factors for malignancy (smoking, alcohol use), or concerning features. 1
• Avoid assuming functional dysphonia is purely psychological—always search for micro-organic causes including reflux, infection, allergy, or environmental irritants. 5
• Do not underestimate the impact on quality of life—dysphonia significantly affects communication, mental health, social functioning, and vocational performance. 3, 6