Voice therapy is seen as a kind of ‘‘behavioral medicine’’.

Inherent in most behavioral treatments are these primary issues: (1) vocal hygiene—how to keep the vocal
folds in healthy condition; (2) voice production exercises—how to use the laryngeal and respiratory muscles to produce the best voice efficiently without injury; (3)
psychological stress management.

Therapy Description Recommended Population (based Purpose/Rationale How it works Power/Source/Fil

Name on literature) (Physiologically)

Vocal 4 vocal exercises practised twice a day for 6-8 weeks Elderly presbyphonia (Saudier et To improve voice Closed vowel All!
Function al., 2010) quality and exercises form a low
Exercises increase flexibility, resistance SOVT
strength and exercise; SOVT
endurance of the exercises narrow the
voice. vocal tract and
redirect some air
back toward the
vocal folds, causing a
backpressure and
'unpressing' of vocal
folds (Rosenberg,
2014). This results in
improved subglottic
airflow coordination
and improved glottic
competence.

Pitch glide exercises

target all laryngeal
muscles; stretching
the cricothyroid
muscles on ascent
and contracting the
vocalis on descent.
(increases flexibility
 and strength of VFs:
SOURCE)

Sustained phonation
improves respiratory
efficiency. (Increases
endurance of the
voice: POWER)

Semi- • Elderly To decrease vocal SOVT exercises Primary focus is

occluded presbyphonia fold oedema, narrow the vocal source
vocal (Kapsner-Smith et improve subglottic tract and redirect
tract al., 2015) airflow and glottic some air back
exercises • Phonotraumatic competence. toward the vocal
lesions (Wattsnet folds, causing a
et al., 2015) backpressure and
• Muscle tension 'unpressing' of vocal
dysphonia folds (Rosenberg,
(Wattsnet et al., 2014). This results in
2015) improved subglottic
The image above is a description of some of the more commonly • Singers (Mendes airflow coordination
used SOVT exercises with some additional variations. The higher et al., 2018) and improved glottic
resistance variations provide the greatest occlusive effect but are • Benign vocal fold competence.
the most artificial. In contrast, the lowest resistance variations are lesions (Yamasaki
more comparable to connected speech, but result in a reduced et al., 2017)
occlusive effect (Titze, 2006).

Laryngeal A procedure involving digital manipulation of the neck and the Functional dysphonias (Ribeiro et To relax the Releases the Source
manual cervical structures, also referred to as manual circumlaryngeal al.,2018) musculature of the extrinsic musculature
therapies therapy, laryngeal therapy or voice massage. Muscle tension dysphonia neck, the scapular of the larynx by
(Khaddami et al., 2015) girdle and the massaging the
Full Laryngeal Massage (Sound) Functional dysphonia (Mathieson, larynx regions, thyroid membrane,
2011) seeking a muscular laterally displacing
 balance that the larynx and
Voice professionals and healthy enables the applying anterior
voices (both spoken and sung) phonatory pressure to the
normofunction. larynx. The strap
In general, this therapy is ideal for muscles of the larynx
a patient population with are also targeted,
excessive tension in the laryngeal and some therapies
musculature. stretch and release
the shoulder girdle
and the
sternocleidomastoids
too.

Resonant A procedure encouraging the patient to find a "forward tone". The Muscle tension voice disorders To improve Reduces the effect of Filter
voice forward tone can be found via biofeedback (vibratory sensations on (Yiu et al., 2017) supraglottic vocal pathology by
therapy the alveolar ridge and the maxillary bones). resonance facilitating the
Teachers (Chen et al., 2007) production of a
perceptually clear
In general, this therapy is ideal for voice using relatively
a patient population with heavy neutral, not over-
daily voice use who may require adducted vocal folds
therapy to improve projection of during phonation
their voice (e.g. teachers, (Verdolini et al.,
auctioneers) 1995).

It's also useful for patients with RVT maximises vocal

hyperfunctional or output while
phonotraumatic voice disorders minimising inter-
(e.g. muscle tension dysphonia). vocal fold impact on
vibration, thus
It would also be useful for woman minimising new
as they are more susceptible to injury.
 vocal injury with prolonged voice Specifically: when
use. phonation is
produced using
resonant voice, the
VFs are slightly
abducted (neutral
adduction with
minimal force)
during phonation.
Therefore the impact
force between the
two VFs would be
minimised and thus
reduce the
exacerbation of
existing VF
pathology.

Recent evidence
suggests that
resonant voice
production facilitates
vocal fold tissue
healing more so than
merely voice rest or
spontaneous speech
(Verdolini Abbott et
al., 2012).

Phonation Elderly presbyphonia (Ziegler et To strengthen the PHoRTE exercises Primarily Power
resistance al., 2014) muscles of increase the but also source.
training phonation by muscular workload
exercise Patients aged 55 with vocal targeting on the vocal
(PHoRTE) atrophy respiratory and mechanism
laryngeal muscular encouraging
deficits resulting overload of
from aging. phonatory
musculature.

Expiratory EMST uses a device loaded with a resistive spring that opens when a Elderly presbyphonia (Belsky et To strengthen the EMST improves POWER
Muscle desired level of expiratory pressure is reached and maintained. al., 2021) muscles involved active expiratory
Strength in exhalation and muscle force
Training Patients aged 55+ with vocal increase breath required for high-
(EMST) trophy capacity pressure activities
like long utterances,
Generally, patients with poor loud speech by
Maximum Phonation Time (MPT) increasing subglottic
air
control/coordination

It improves:
-MPT
-Maximum
expiratory pressure
-Dynamic range in
decibels

Accent A very specific, programmed voice therapy based on rhythmic Functional dysphonia (Shiromoto, To improve airflow Improves subglottic POWER
Method accentuations with abdominal breathing. 2003) rate, fundamental air
frequency and control/coordination
Abdominal breathing movements are initiated with alternations in resulting in increased
easy and soft voice without constriction and clearing of the throat sound pressure airflow rate,
and vocal folds to reduce excessive laryngeal muscle tension during level fundamental
phonation. In early training this rhythmic abdominal movement frequency and sound
entails easy and soft phonation with nonsense syllables. Later, pressure level.
speech is introduced at conversation level.