Voice Difficulties (Dysphonia)

Voice difficulties (Dysphonia) can arise for a variety of reasons including:

  • Muscle tension
  • Laryngopharyngeal reflux (LPR)
  • Lesions (e.g. polyps, cysts and nodules)
  • Other organic or structural changes
  • Following surgery
  • Neurological conditions
  • Emotional and psychological factors
  • Usually a combination of some of the above

An Ear, Nose & Throat (ENT) doctor can help to determine which of these factors has caused a change in your voice, and may want to look inside your larynx (voice box) with a small camera (laryngoscopy). Speech and Language Therapy may then be required to address these changes, through advice on how to look after your voice to prevent further difficulties, and exercises to get the best out of your voice.

Certain muscles were designed to be the primary movers in voicing and can stand up to the workload we give them. These include the muscles of the vocal folds themselves as well as the muscles that control vocal fold closure, pitch change and resonance balance in the upper airway above the larynx. If these muscles become overly tight, or alternatively are underused, other, less effective muscles around the larynx are recruited to ‘help out’. These recruited muscles were not usually designed to be primarily involved in voicing so over time, the system tires and the voice begins to produce audible symptoms.

By Sara Harris, Voice Specialist Speech and Language Therapist, Team Member, Lewisham Voice Clinic, London and Sara Caldwell, Voice Specialist Speech and Language Therapist, Cheshire.

LPR is the backflow of stomach juices up the gullet (oesophagus) and into the throat and voice box (pharynx / larynx).

Stomach juices are made up of strong acid and the digestive enzyme, pepsin. Both are harmful to the delicate lining of the throat.

LPR can occur during the day or night, even if you haven’t eaten anything.  It is referred to as ‘Silent Reflux’ as many people don’t experience heartburn or indigestion.

The British Voice Association (BVA)
The BVA is a registered charity that runs courses for professional voice users, e.g. teachers, singers, actors and for healthcare professionals.

The LARYproject
An organisation representing and supporting people with voice problems by providing information and advice, e.g. online discussions, self-help groups, funding equipment.

Voice Care Network (VCN) UK
VCN is a teaching organisation that focuses on sharing knowledge amongst voice care professionals and people who use their voice as part of their job. 

NHS choices: Moodzone
Cognitive Behaviour Therapy audio guides (pod casts) narrated by Dr. Chris Williams on topics such as low mood and depression, anxiety, assertiveness, trouble sleeping, unhelpful thoughts and mood self-assessment.:https://www.nhs.uk/Tools/Pages/Mood-self-assessment.aspx

Collated resources including managing your emotions and downloadable relaxation exercises including deep breathing, visualisation, progressive muscle relaxation and guided imagery. 

Live Life to the Full
Free online courses covering low mood, stress and resiliency. 

The Wheel of Life
A tool to help you consider each area of your life in turn and identify areas that need more attention.

Includes 8 week mindfulness for stress and health courses available. 

Carer Advice
Helpline on 03001231053 (Mo-Fr: 9am-8pm, weekends 11am -4pm) 
Information regarding practical support, mental health support, transport and care needs, carer rights and end of life issues.

Coping with bereavement
National Cruse Helpline 08444779400 (talk to a counsellor)
Local Cruse Centres: free UK wide bereavement counselling 

Talking Mental Health Derbyshire
Self-referral form for talking therapies including CBT(available online). Alternatively call 0300 123 0542.

British Association for Counselling and Psychotherapy (BACP) or call 01455883300 
The BACP is a register of therapists which members of the public can use to find a psychotherapist or a counsellor.

Psychology tools
Includes a self-help section with free downloadable CBT tools & resources. 

Sod it! The depression ‘Virus’ and how to deal with it by Martin Davies
Available on Amazon

Sod it all! How to deal with the stress virus in your life by Martin Davies

The Acid Watcher Diet by Jonathan Aviv 
Written by an American ENT consultant, this book includes advice for lifestyle changes and a detailed diet plan to reduce reflux. 

Mindfulness: Finding peace in a frantic world by Mark Williams 
A mindfulness-based cognitive therapy approach, it includes an audio cd

Buddhify (Available on Apple and Android devices) 
A meditation and mindfulness app with guided meditations from between 4 to 30 minutes. Select mindfulness meditations relevant to everyday life situations. One off fee. 

Headspace (Available on Apple and Android devices)
Clear and concise introduction to mindfulness practice. 
Free download, optional subscription

Voice Exercises

Patient Information Leaflets

Title Filename Date Posted Size
Airflow EXERCISES modified Jan 2022 alt.pdf Airflow_EXERCISES_modified_Jan_2022_alt.pdf 11/01/23 117.58 KB
LPR 2018 revision.pdf LPR_2018_revision.pdf 11/01/23 424.44 KB
Coping with Colds.pdf Coping_with_Colds.pdf 11/01/23 1,143.49 KB
Muscle Tension Dysphonia.pdf Muscle_Tension_Dysphonia.pdf 11/01/23 511.85 KB
Reflux and your Voice.pdf Reflux_and_your_Voice.pdf 11/01/23 308.83 KB
Useful information about voice Nov21.pdf Useful_information_about_voice_Nov21.pdf 11/01/23 172.73 KB
The Effects of Stress and Emotion on the Voice.pdf The_Effects_of_Stress_and_Emotion_on_the_Voice.pdf 11/01/23 469.38 KB
Voice Warm Up.pdf Voice_Warm_Up.pdf 11/01/23 46.89 KB