Voice Disorders


Many do not realise what the voice is or what can go wrong with it.   The medical term for a voice disorder is dysphonia

Voice disorders are usually caused by something wrong in the  voice box (larynx) and/or   a problem in the respiratory system (lungs and windpipe), or the spaces above the voice box, such as the tongue, mouth, soft palate, nose or pharynx.

Voice disorders may be due to an organic or structural problem in the voice box,  or may be caused by the the way the muscles are used to produce the voice. Some are born with abnormalities to the voice box, or they may be acquired at any stage in life.  There may be discomfort in the vocal tract accompanying the voice disorder.  Sometimes voice problems are caused by underlying stresses or emotional imbalances which are expressed through the voice.

The best way to realise what is wrong with the voice is to have it examined.  This can be done when awake (fibre-optic nasoendoscopy) or when asleep (microlayrngobroncoscopy). This is usually done by an ENT specialist.

Some people require surgery to improve the voice, others need medication and many usually need voice therapy from a qualified Speech and Language Therapist specialising in voice disorders.   Surgery is not normally recommended for young children unless they  have a life-threatening disorder or is required to manage the airway.  This is because the vocal folds in young children are still developing and surgery may result in long-term scarring affecting vocal function.


Speech Management for People who Stammer (PWS)


Greater fluency is one of the goals for PWS.  Being able to communicate effectively and comfortably is something we all want.  Whilst it may be difficult to be 100% fluent  all of the time(no one is), it helps if the speech is less of a struggle.

The first thing to understand in the journey of discovery, is what stammering actually is and what you do when you stammer.  It is also important to understand the thoughts, feelings and reactions to stammering, as this has a physical imprint on our speech and may prevent you from living a full and meaningful life.

Physical approaches to manage speech are varied, packaged up in various ways and ‘sold’ on different courses.  What is important to understand is that the brain of a PWS is wired in a different way, so no matter what ‘technique’ is used, it takes a lot of conscious control to change the speaking pattern all of the time.  Changing the way a PWS speaks also interferes with the way language and speech flow in conversation.  Whatever, approach you choose to take, it is important to try it for short periods of time, to build up using it in different situations and with different people. You will need to ‘toughen yourself up’ in the process, so that if it doesn’t always ‘work’ you are kind and compassionate to yourself.

Breathing should be free and easy. It should be well timed with phonation (voice).  This is what often gets interrupted for PWS; the timing of speech at the level of the vocal folds.  This results in tension anywhere in the vocal tract, which often result in tension elsewhere.  Letting go of tension is an important part of the process. Instead of trying to ‘push through’ you should try to ‘let go’. The Valsalva technique is useful to teach this, which I will talk about in a different post.

Block modification is a widely used ‘stammer more fluently’ speech management technique developed by the American, Van Riper.  The speech management section in his whole programme is about breaking habits of tension.  Cancellation, is stopping after the stammered word and saying it again in a smoother, more relaxed way.  In block modification aims to let go of the stammer whilst in the moment of stammering. Pre-block modification manages the approach to saying a word immediately before saying it. All three stages rely on a) noticing and understanding what is happening in that speech  moment b) letting go of tension c) moving forward and going for what you want to say.   The approach goes hand-in-hand with reducing avoidance of  social and communicative situations. It encourages the speaker to live a full and meaningful life and being who they really are.

Other approaches encourage PWS to change their entire speech pattern all of the time. These techniques are known in the trade as ‘speak more fluently’.  The McGuire programme is well-known for this and focuses heavily on breathing methods.

There is also a place for technology – apps and small devices work on altering the way the PWS hears themselves talking, which effects the way the brain plans movement for speech.

Whatever you chose to do on the journey of greater fluency, be patient and kind to yourself.  If something does not work for you, try something different.  If it works some of the time do more of it. Develop a ‘toolkit’ and stay authentically you…

Voice and Communication Therapy for Trans Women


Voice and communication therapy for trans women is a journey of transformation, moving from a familiar place, to a less familiar or well-known place. Therapy is about exploring and experimenting with a different voice, whilst maintaining your authenticity.  This is vital in order to feel confident and comfortable with your voice and communication.

Voice and communication therapy for trans women involves feminisation of the voice.  This includes raising habitual pitch, making the voice lighter, with a more forward focused resonance and altering intonation patterns.  The Speech and Language Therapist ensures you do this whilst maintaining optimal vocal health. You will learn some simple exercises to practise regularly between sessions.  Therapy will help you find ways to try out using the voice in different contexts.   It provides you with vocal choices and a supporting guide through this part of your journey.

What is voice therapy?


Voice therapy is treatment for a voice disorder.  The Speech and Language Therapist and you will explore what has predisposed you or your child to a voice problem, what precipitated it and what is maintaining it.

Before therapy begins, you should ensure that the voice box (larynx) is examined by an ENT doctor to work out what is physically causing the voice problem.  There might be a lesion on the vocal folds (cords) or it might be that the voice is produced with too much muscular effort.

Once you have a diagnosis, therapy can begin!

Therapy may involve making changes to your life style, such as what you eat and drink, how much you rest.   Your voice  is often a reflection of other issues or difficulties in your life.  Therapy can address anything that is out of balance that may be affecting your voice. You will have the opportunity to tell your ‘story’ and together with the Speech and Language Therapist you will find a way to bring balance to your life and voice.

Therapy may also involve making slight adjustments to the way you use your voice- how you use your breath, the muscles in and around the larynx and other muscles in your jaw, tongue, face and head and neck.  You may also need to adjust your posture.   You will find a way to practise these exercises between sessions in a meaningful and easy-to-do way, so that you quickly start to notice a difference to the way your voice sounds and feels.

By the end of your first session, you will have had the opportunity to tell your ‘voice story’, recorded your voice, filled out some questionnaires, tried out some voice therapy exercises and identified what you want to work towards in simple, manageable steps.

Some people require surgery to manage the voice condition, or need to take medication to help the health of the larynx.  You will learn what to do before and after surgery to help your way to vocal recovery and/or you can learn more about why the medication has been prescribed and how best to take it.

The voice therapy journey is a joint journey between you and the Speech and Language Therapist.  Together, you will find the way to the best vocal recovery possible.

Please get in touch for more information or advice.

Paediatric Voice Problems


Children are at risk of developing voice difficulties as their vocal folds (cords) are not fully formed until they are 16 year’s old.  The most common voice complaint is muscle tension dysphonia with lesions (vocal fold nodules).  Children may have more complex voice difficulties as a result of other medical conditions.

A child needs to be able to express themselves freely for all vocal tasks.  The voice should be free and feel comfortable.   Children often find it more difficult to self-regulate than adults and may shout and scream more than adults and use their voice forcefully to express their emotions rather than words in calmer conversation.

Children may also have a high vocal load in the primary school years when their vocal folds are still developing, such as singing and acting and sports that use the voice forcefully.  Other children may put themselves under pressure to perform well and the anxiety and stress in their lives may be reflected in their voice.

Voice therapy for children who need to adjust how they use their voice involves understanding what the voice is, how they should use it so that the voice is free and comfortable.  Regular practice  of new vocal patterns, using a gentle, efficient voice across a wide range of contexts and  addressing any psychosocial difficulties affecting the voice usually resolves the voice difficulties.  Therapy needs to be systemic, involving the family and school to support the child.

Therapy is made to be fun and meaningful for the child and takes into account the child and family’s life-style.  Please contact the Voice and Communication Clinic if you would like to find out more.

Psychogenic voice disorders…


I have been treating people with voice difficulties for many years.  There are many causes of voice problems including disease, infection, stress, structural anomalies, trauma, over use and injury.

One of the most fascinating areas of voice disorders is caused by an inability to ‘voice’  when there is a conflict over speaking out, or life stresses become too much.  People may lose their voice suddenly, or find it becomes disordered in some way with no organic reason for doing so (that is, a physical reason). This is known as a ‘psychogenic voice disorder’ or a ‘conversion disorder’.

The treatment for this is a combination of physical and emotional work to help the person express what they want to say, deal with the stresses in their lives and rehabilitate the voice box (larynx) to use normal muscle movement again.  Results can be very quick; in one session, but most need a period of time to understand and manage the conflict or stresses and reconnect physically with their bodies in a healthy way.

The symptoms in a psychogenic voice disorder are a way of letting an individual know that something is not right, or out of balance and we should listen to these symptoms without fear,  seek help and a way forward.

Finding your voice after a stroke

A stroke can happen to anyone at any age, but is more common in the elderly.  It is caused by a blood clot or bleed in the brain.  The parts of the brain that control our language, speech and communication are spread out across the brain, but many are found on the left side.   Having worked with people who have had a stroke both in the NHS and in private practice I have witnessed how devastating a stroke can affect a person’s communication, but have also seen people recover well.

Aphasia, or dysphasia, is the medical word for language problems caused by a stroke.  A person may have difficulties understanding what is said to them, reading, understanding what objects are,  gestures or facial expression.   They may have problems expressing themselves through the spoken word, writing, drawing or using gestures.   Some may speak in long, rambling utterances unaware that they are not making sense.  People may lose whole grammatical parts of their lexicon (words) such as verbs or nouns, or specific groups of words.. such as words related to the body, vegetables, places.   Language disorders after a stroke have fascinated researchers for years due to what it can teach us about the brain.

However, for the person affected by the stroke, their friends and loved ones it can be devastating and frustrating.  People often become isolated and depressed by their difficulties to communicate. Speech and Language Therapists and charities such as CONNECT, Headway and the Stroke Association do wonderful work to help people rebuild their communication and lives.

Therapy for aphasia includes both ‘impairment’ based therapy (doing exercises to rebuild the neural connections) and ‘functional’ based therapy (using a total communication approach to get one’s message across through drawing, gestures, writing, speech, apps, communication aids etc).  Therapy usually includes family and friends to help them be effective communication partners.

It is not uncommon for the first few weeks and months to see rapid improvement in the language after a stroke as the brain begins to heal.  Improvements after that can be slow but steady.   The individual may experience low mood, fatigue and lability (emotions swaying dramatically) for some time, but this usually passes.  Patience is key.

If you are interested in therapy for aphasia please contact the clinic or get in touch with the wonderful charities that support those who have aphasia.

Stammering Therapy – Acceptance

the-kings-speechPeople who stammer have many expectations from therapy.  Most people want to achieve greater fluency, whilst others want to feel better about themselves as communicators.  In my experience, the best outcomes have been achieved when people develop a greater ‘presence’ when communicating and acceptance of the stammer.  Many of us are frequently caught in the ‘mind reading’ trap of thinking that others may think less of us due to our vulnerabilities or perceived flaws.  Therapy for stammering needs to ‘toughen up’ the person to be less bothered by the stammer, worry less about what others may think of them and get on with communicating ideas, feelings and thoughts in an authentic, comfortable way.  The individual also needs to develop greater kindness and compassion towards themselves.  Therapy to achieve all this includes psychological approaches integrated into speech therapy approaches, such as Mindfulness, Acceptance and Commitment Therapy (ACT), Narrative Therapy and CBT.   The Voice and Communication Clinic uses these approaches effectively in the treatment for our clients. Contact us to find out more…

What causes stammering


Most people are fascinated about stammering. They ask me what causes it and what they should do when people stammer.  I tell them that stammering is a multi-factorial condition that is caused by a predisposition to it due to the wiring in their brain.  If you are not sure what to do when people stammer I would advise you to just allow people to talk, just like anyone else.  Be patient, kind and authentic.  If you are not sure, you could always ask them!

Speech and Language Therapy

kids-in-circle-lying-downSpeech and language therapy is not about elocution

People often ask me if I am going to make them talk better when I tell them what I do for a living. Most people do not realise that Speech and Language Therapists work with all types of communication disorders and disorders of swallowing and feeding. We work in many places including schools, hospitals, prisons, clinics, mental health centres, old-age homes and in research institutes.  We work with premature babies and the dying and elderly.  We work with loss, disability and death and try to help people achieve their potential in their ability to communicate with everyone in order to live meaningful, fulfilling lives.  It is a privilege to do this work and can be very challenging.