What’s going on with my voice? Videostroboscopy can help!

Is your voice not what it used to be?

Are you losing your voice frequently, experiencing hoarseness, or persistent strain?

Has an Ear, Nose, and Throat doctor (ENT) indicated that nothing is wrong with your vocal cords themselves?

A videostroboscopy assessment will provide a more detailed analysis of your vocal cords while you are producing sound and will help give you information on what is causing your voice issues so that changes can be made.

What Exactly is Videostroboscopy?

Videostroboscopy is a much more sensitive tool and more helpful in identifying subtle issues happening with the voice compared to other techniques, such as rigid or flexible transnasal laryngoscopy with continuous light sources (these tools are used through the nasal cavity). Videostroboscopy (through the mouth) provides a more detailed view than these other techniques and can reveal problems with the vocal cords such as growths, or irregularities in the vibration pattern or movement of the cords themselves.  Muscles surrounding the cords are viewed to see if they are working when voicing occurs.  The color of the cords and surrounding muscles is viewed to see if there is redness or swelling, and you can see if one cord is engaging more than another to make the voice work.  Videostroboscopy provides key elements in voice assessment to assist in a plan for voice recovery.

How Does Videostroboscopy Work?

Videostroboscopy uses a flashing light source to create a slow motion view of vocal cord vibration. Vocal cord vibration is very fast – the “slow motion” view is actually taken from many successive rounds of vibration. This unique viewing allows the voice care team to look at how each vocal cord vibrates during the different phases of the vocal cord’s vibration cycle, allowing for clear identification of smaller abnormalities in vocal cord movement that are unable to be observed using any other technique. From this information, therapy sessions to improve voice use can be prepared so that your intervention can be individualized and suited to your own specific needs.

Here is an example of a videostroboscopy analysis and how it looks when the vocal cords are viewed this way.

Who is a Candidate for Videostroboscopy?

Videostroboscopy is highly recommended when a voice disorder is due to abnormalities that affect vocal cord vibration. These abnormalities can include:

  • vocal cord scarring
  • a mass (cyst, polyp, nodule)
  • incomplete closure of the vocal cords
  • abnormal vocal cord vibration
  • asymmetrical/uneven movement of the vocal cords

At S.L. Hunter SpeechWorks we have a comprehensive Voice Lab where our voice team will assess your needs using both instrumental and non-instrumental equipment.  Our Voice Lab offers state-of-the-art videostroboscopy equipment to fully analyze your vocal issues.  Call us today or check out our voice lab for more information.

LindaSaarenvirta-220Linda Saarenvirta is a speech-language pathologist who has been practicing for over 20 years in the healthcare field.  She has worked with a variety of communication disorders and clients of all ages.  She is extremely passionate about voice therapy and enjoys helping clients achieve their vocal needs.  Her client centered approach to therapy ensures all clients maximize their potential and achieve their goals.

I’ve had voice loss for 2 weeks! What Can I do?

Losing your voice can be a scary thing.  Voice loss or laryngitis happens when your vocal cords become inflamed from overuse, infection, or irritation.  If you’re wondering about the severity of your voice loss, the Mayo Clinic has excellent information on symptoms and causes.

If you experience voice loss (laryngitis) for 2 weeks or longer, you should seek medical advice from an Ear, Nose, and Throat doctor (ENT) to examine the cause of the persistent voice loss.

Short-Term Tips for Managing Your Voice Loss

Below are some tips to help reduce the strain associated with voice loss while awaiting your appointment with the ENT:

  • Vocal rest- try not to use your voice as much as you typically do, however, do not whisper as that can be more harmful than shouting.
  • Avoid calling out and yelling- walk to the person who you are talking to
  • Drink lots of water- keep hydrated
  • Manuka honey and ginger are great for the voice and soothing to have when the voice is not at its best.
  • Avoid singing and throat clearing as they can be harmful to the voice when it is already in a weakened state.

What if the ENT recommends speech therapy for the voice loss?

If speech therapy is recommended for the voice loss, you will be referred directly to a qualified speech pathologist with experience in voice disorders.  The speech pathologist will complete an assessment and set goals to get your voice back on track.

Exercises may focus on the following areas depending on your specific type of voice loss:

  • Reduction of tension in the larynx (area where the vocal cords are housed)
  • Improving the tone of the voice (may sound rough, raspy, hoarse when you are experiencing voice loss)
  • Improving the pitch of the voice (how high or low the voice is)
  • Altering diet to reduce symptoms of acid reflux
  • Reducing hard contacts of the vocal cords when voicing, so that the voice starts easily and gently
  • Relaxation exercises to help alleviate stress and strain

How long will it take to improve my voice loss?

Everyone is different with respect to their vocal use and musculature, so it is tricky to put an exact time frame to the therapy.  Typically you will see vocal improvements in 6-10 sessions; you may need some maintenance sessions to keep up with the new strategies and improved way of using your voice.

At SpeechWorks, we have a fully equipped voice lab with videostrobscopy analysis to view your vocal cords when you are speaking and computer equipment that allows us to track your progress in therapy.  Call us or check out our voice lab for more information! We would be happy to help you with your vocal needs.

LindaSaarenvirta-220Linda Saarenvirta is a speech-language pathologist who has been practicing for over 20 years in the healthcare field.  She has worked with a variety of communication disorders and clients of all ages.  She is extremely passionate about voice therapy and enjoys helping clients achieve their vocal needs.  Her client centered approach to therapy ensures all clients maximize their potential and achieve their goals.

How Can I Help Pay for Speech Therapy?

It can be a scary and confusing time when you or a loved one is dealing with a chronic illness such as stroke, brain injury, Multiple Sclerosis, Parkinson’s disease, or Alzheimer’s disease.

The lack of publicly funded rehabilitation for the difficulties that come along with these illnesses can leave families feeling desperate and wondering who will help foot the bill for the therapies they or their loved ones need to recover.

In a cruel twist of fate, these illnesses often occur at a time in life when people are now needing to live on reduced income (e.g. retired and on pensions).

Take a closer look at your extended health benefits

Although most people know that services like physiotherapy and massage therapy are covered by the extended health benefits provided by their insurer, they often don’t realize that these benefits often include coverage that can help pay for speech therapy as well.

Typically this coverage is listed under the Medical Rehabilitation section of your policy. It may include a lump sum per calendar year (e.g. coverage up to $500 per calendar year) or a maximum amount covered per therapy session (e.g. coverage up to $100 per session).

If it’s unclear what is covered in your policy, a quick call to your insurer can answer many of your questions.

Think outside the box

Many insurance policies offer a maximum amount covered per year per claimant. This means that you and your spouse could BOTH be entitled to that amount of coverage.

Speech therapy sessions for you or your spouse can often include a component of caregiver/spouse training. This is where the speech therapist teaches you how to target the skill area so that you can practice with your partner at home in order to help carryover the skills learned in the therapy session.

What this means is that, if your case fits the criteria, part of the session can be billed/claimed for your spouse/caregiver and part of the session can be billed/claimed for you – extending the amount of coverage you can access to help pay for speech therapy

Stick it to “the man”

Just because the government doesn’t always fund these health services through OHIP doesn’t mean that you can’t get some assistance from the government to help pay for speech therapy

If you are receiving speech therapy for a chronic medical condition (e.g. brain injury, stroke, multiple sclerosis, etc.), you may be eligible for a Disability Tax Credit.

Visit the CRA website at http://www.cra-arc.gc.ca/tx/ndvdls/tpcs/ncm-tx/rtrn/cmpltng/ddctns/lns300-350/316/pply-eng.html for more information on eligibility and how to apply.

Take Advantage of Assistants

Communicative Disorders Assistants (CDAs) can work under the direction of a speech therapist to provide treatment to you or your loved one and are a lower cost alternative to treatment with a speech therapist.

However, CDA services are not appropriate for all clients and candidacy for these services is determined by a Speech-Language Pathologist. A speech therapist would still need to complete sessions with you or your loved one at regular intervals to monitor progress and make recommendations.

Consider Creative Alternatives to Help Pay for Speech Therapy

Although nothing can replace the benefits you or your loved one would receive from one-to-one treatment with a speech therapist, there are other alternatives to receive some level of help.

Group therapy, such as our brain injury groups, where people working on similar difficulties can receive therapy together, is one option to consider as the cost of a session could be shared with the other individual(s). Support-Focused groups can also be a more affordable alternative, such as the supported communication group offered by our clinic for adults with brain based communication impairments (e.g. stroke, dysarthria, brain injury, etc.).

Again, the caveat here is that there is less “treatment” going on in these larger group scenarios, so the gains made by you or your loved one will not be as great as if receiving individual therapy. That being noted, there is much to be said about the benefit of practicing communication skills with others in more natural contexts!

Although it may be frustrating to consider the lack of OHIP funded therapy, no matter what your situation, there is often a creative solution to help you provide for you or your loved one’s needs!

MelissaKiley-220Melissa Kiley is a registered Speech-Language Pathologist with a special interest in concussion/acquired brain injury as well as literacy skills development. She has been working with clients for over 10 years and is highly skilled in developing functional and innovative treatments.

Vocal fry: Trendy or Damaging?

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Vocal fry

Vocal fry is a term used to describe the low “creaky”, back focused voice quality that is produced with more tension and pressure than is modal voice ( a person’s average, comfortable speaking voice). With “normal” voice production at modal levels, vocal cords come together and open in a wave undulation via the power of breath support through our airway.  When we speak in vocal fry, pressure is dropped and there is more tension in the voice so the wave motion is halted and the cords move in a more irregular/chaotic pattern.

Why Do People Use Vocal Fry?

Everyone uses vocal fry sometimes, especially at the end of sentences – when tired or trying to get a point across in a lecture or presentation.  In the past few years, this register has been more popular with women aged 18-25.  Some famous actresses and singers have been known to use this register to make their voice sound “cool”, or “sexy”.  Researchers are still trying to determine what made this trend so popular and why so many young women have taken on this vocal habit.

Why is Vocal Fry Harmful?

The voice is best produced at its’ modal register (comfortable speaking/singing range).  When we move it out of that range for a period of time (high into falsetto or low into fry), the vocal musculature can become strained and stressed as they work harder to achieve the vibratory cycle they are used to.  This may not cause immediate damage to the cords themselves but is a vocal use problem that should be changed, or it may lead to damage down the road.

LindaSaarenvirta-220Linda Saarenvirta has been practicing for 11 years as a registered Speech-Language Pathologist at S. L. Hunter SpeechWorks.  For the past 5 years, Linda has focussed in the area of vocal rehabilitation including the use of videostroboscopy as well as the Visi-Pitch program.  She enjoys working with all clientele and believes strongly in the client centered approach that S.L. Hunter SpeechWorks provides.

Transgender Voice Therapy: How an SLP Can Help

TransGender-SymbolWith all the buzz surrounding Caitlyn Jenner’s transgender transition bringing public awareness to this process, there continues to be less awareness of speech therapy and how it can support the overall transition process.

What can an SLP do for transgender clients?

A Speech-Language Pathologist (SLP) can help to not only increase pitch, but also change rate of speech, intonation and inflection patterns, volume, tone and placement of voice, and feminize gestures and body language:  an overall package that can aid transgender clients and help them feel more comfortable with their new selves.

How does the process of transgender voice therapy work?

An SLP will assess the client to get a better understanding of the goals they wish to achieve by coming to voice therapy.  Have they started hormone replacement therapy or gender re-assignment surgeries? How much do they want to change their voice (modify it and make it more feminine or completely feminize it)?  Hormone replacement and gender reassignment surgeries can all impact progress of voice therapy.  Voice therapy with transgender individuals should definitely be conducted with a holistic viewpoint and approach.  Client perception, outcomes, and long term goals are very important to the overall outcome of therapy.

What are the outcomes of transgender voice therapy?

The outcomes are completely client directed.  Increasing client awareness of their voice, anatomy, how it can change, and how to safely produce their new voice is a main goal of therapy.  Consistent attendance to therapy sessions is a necessity, especially in the beginning stages when establishing pitch, tone, and intonation patterns.  The aim is to produce voice in a way that does not strain or put stress on the vocal mechanism.  The degree of change and feminization varies based on vocal anatomy, client preference, and ability to use the “new voice” more than the “old voice.”

Speech/voice therapy is a great tool to add to the transgender process and an important step in the whole transition process.

LindaSaarenvirta-220Linda Saarenvirta has been practicing for 11 years as a registered Speech-Language Pathologist at S. L. Hunter SpeechWorks.  For the past 5 years, Linda has focussed in the area of vocal rehabilitation including the use of videostroboscopy as well as the Visi-Pitch program.  She enjoys working with all clientele and believes strongly in the client centered approach that S.L. Hunter SpeechWorks provides.