Voice Disorders

According to ASHA, a voice disorder is characterized by a voice that is perceived to be inappropriate for an individual’s age, gender, cultural background, or geographic location (Aronson & Bless, 2009; Boone et al., 2010; Lee et al., 2004). A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant (American Speech-Language-Hearing Association [ASHA], 1993; Colton & Casper, 2011; Stemple et al., 2010; Verdolini & Ramig, 2001).

Speech resonance is the result of sound transfer from the vocal folds through the vocal tract, which is comprised of the pharynx, oral cavity, and nasal cavity. Resonance disorders occur when there is too much or too little nasal and/or oral sound energy in speech. Both voice disorders and resonance disorders can be a result of 

• structural (alterations in vocal fold tissue or in vocal tract), neurogenic (problems with the central or peripheral nervous system), or 
• functional (improper or inefficient use of vocal mechanism)causes.

Speech therapy for voice disorders begins with a voice assessment. The assessment process for both voice and resonance disorders involves a comprehensive assessment process that begins with a case history that includes 

• the individual's description of their voice or resonance problem;
• daily habits related to vocal hygiene (voice); 
• any relevant medical history of cleft palate, genetic testing, feeding or swallowing difficulties, and atypical nasal congestion. 

Assessment for resonance disorders also involves an audiologic assessment, feeding and swallowing screening, and perceptual evaluation of speech. The voice assessment typically includes an instrumental assessment that allows for laryngeal imaging using videostroboscopy, as well as objective measures of vocal function related to vocal loudness, pitch, and quality of voice such as vocal amplitude, vocal frequency, and vocal cepstral peak prominence.