Correcting voice problems with speech techniques

A hoarse voice that persists for many weeks or months is one of the most common voice complaints patients seek treatment for, according to Dr Ravi Seshadri, an ear, nose and throat (ENT) surgeon at Novena ENT – Head and Neck Specialist Centre. “There are two main causes of voice problems,” he says. “The most common one is vocal abuse – misuse of the voice – by shouting, singing in the wrong way, raising your voice everyday or talking to a large group of people without a microphone, and the other is smoking.”

The root cause of voice problems

A hoarse voice often indicates a problem in the larynx – also known as the voice box – and can only be properly diagnosed by looking at the larynx. “To do this we have to do an endoscopy, either a flexible endoscopy through the nose or a rigid laryngovideostroboscopy where we view the larynx with a strobe light,” Dr Seshadri says. “Doing this gives us an idea of the waveform and the vibratory potential of the vocal cord.”

Treatment for voice problems

Non-surgical treatment is the preferred option for voice problems, Dr Seshadri says. “If the bulk of patients have a voice problem because of misuse of their voice, then we need to change the way they talk and that will help them recover, it may even make the problem go away permanently.”

This is where speech therapy comes into its own as a treatment option. It is akin to physiotherapy for lousy limbs, as the vocal cords – other than the skin above it – is essentially all muscle. “People who are using their limbs the wrong way go for physiotherapy,” Dr Seshadri says. “And the same is true for patients with voice problems; you’re teaching them how to use their voice properly and efficiently.”

For some patients however, surgery may be required if there is a cyst or a polyp [a non-cancerous growth] on the vocal cord. “People who misuse their voice end up with nodules. These are like corns on your feet and it is due to improper use of the voice, so removing them surgically is not enough as the patient will go back to using their voice improperly again,” Dr Seshadri says.

Hence, Dr Seshadri stresses the importance of behaviour modification through speech therapy for this group of patients to ensure they learn to use their voices efficiently.

How to speak efficiently

The first step in learning to speak properly is understanding how speech is produced in the first place. When you speak, air that is pumped from the lungs travels through the windpipe and the voice box, where sound is made. The sound then travels through the upper aero-digestive tract, where its gets its resonance – its quality – and then to the lips and tongue where words are formed. “You do not speak at the level of your voice box, you speak at the level of your mouth, lips and tongue, despite sound being produced in the voice box,” Dr Seshadri explains. “A speech therapist trains you to breathe properly, to use your vocal cords properly, and to use your mouth and lips properly.”

It is also important to relieve any tension in the neck muscles, including the intrinsic muscles within the larynx, as any tension in the neck can affect the voice. It is not uncommon that people with vocal problems also have tension in their neck muscles, with stress and improper posture the main culprits. “A speech therapist will align everything back to its normal alignment to help improve speaking efficiency,” Dr Seshadri concludes.

Dr Ravi Seshadri is an Ear, Nose and Throat (ENT) surgeon with more than 20 years of experience, specialising in caring for patients with nasal allergy, snoring, and throat and voice problems. He also sees a wide variety of paediatric patients with ear, nose and throat problems.

Novena ENT – Head & Neck Surgery Specialist Centre

Main Clinic:
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #04-21/22/34
Singapore 329563
Tel: +65 6933 0451
Email: enquiry.mnh@novena-ent.com

Satellite Clinic:
Parkway East Medical Centre
319 Joo Chiat Place #03-07
Singapore 427989
Tel: +65 6346 7761
Email: enquiry_peh@novena-ent.com
www.novena-ent.com