NOTE: This post is intended for people with voice disorders who are looking for help with their speaking voices. If you are a singer with a voice disorder and are looking for help with your singing voice, you will need to find a singing voice specialist. I am planning a future post on that subject. Also, all information and terminology in this post is US-centric. Terminology, regulations, and scope of practice may be different in other English-speaking countries (Canada, UK, Australia) and elsewhere.
As a singer and voice teacher who has been diagnosed with several voice disorders, I am going to share some information that I wish I had known when I first started having voice problems.
First, not all ear-nose-throat doctors are equipped to diagnose and treat voice problems. (See my blog post on how to find a voice doctor.) Second, most speech-language pathologists (SLPs) have very little experience and training in treating voice disorders. As part of their masters degree, SLPs are required to take one course in voice disorders — and that course may focus more on signs and symptoms than on treatment.
Just as ENTs can specialize in many areas that do not include voice, SLPs (according to the American Speech-Hearing Association) may choose to focus on:
fluency: stuttering and cluttering
speech production: motor planning and execution, articulation, phonology
language: phonology, morphology, syntax, semantics, pragmatics, prelinguistic communication, paralinguistic communication, literacy
cognition: attention, memory, problem solving, executive functioning
voice
resonance
feeding and swallowing
auditory habilitation/rehabilitation
If you’ve been diagnosed with a voice disorder, it is essential that you see an SLP who is well-versed in voice. But how can you know whether an SLP has the experience to help you? This post will give you some ideas of what to look for or what questions to ask. Please note that the points listed below are simply guidelines to help you assess someone’s credentials. Most highly experienced voice specialist SLPs will not be able to check all these boxes.
Where they work: If you have access to a voice clinic at a large hospital (see my list of voice clinics), they certainly have at least one voice specialist SLP on staff. (If you can’t travel to a voice clinic, but your state has one, you may be able to see their voice specialist SLP via tele-health.) If an SLP works for — or is recommended by — a laryngologist (a voice specialist ENT), they are probably a voice specialist SLP.
Where they trained: Most hospitals, clinics, and private ENT or SLP practices list the basic credentials of their clinical staff. It shouldn’t be hard to find out if an SLP has completed a clinical fellowship in voice. However, don’t be deterred if they haven’t. There are other ways for SLPs to receive training and experience in voice work.
What post-graduate training they’ve completed: SLPs who specialize in voice are often trained in certain voice related modalities. A few examples include:
Lee Silverman Voice Treatment (LSVT) LOUD: designed for people with Parkinson’s disease and other neurological conditions
Phonation Resistance Training Exercises (PhoRTE): designed for people with pathologic age-related voice changes (presbyphonia)
SPEAK OUT!: designed for people with Parkinson’s disease
Estill Voice Training: “teaches isolated control of individual anatomical structures within the voice production system”
Linklater Voice: Often used by acting voice coaches, “Linklater Voice takes you through a series of step-by-step practical exercises that include relaxation, awareness of breathing, the experience of voice vibrating in the body, how to open the throat, the development of resonance and range, and the articulating activity of lips and tongue.”
Fitzmaurice Voicework: Another favorite of acting voice coaches, Fitzmaurice Voicework “combines adaptations of classical voice training techniques with modifications of yoga, shiatsu, bioenergetics, energy work, and many other disciplines”
Vocology: the National Center for Voice and Speech offers a summer training program; New York University and Lamar University offer graduate certificates; the Pan-American Vocology Association offers testing that leads to the designation of PAVA Recognized Vocologist
What titles they hold: Some clinics or practices clearly designate which clinicians take voice patients. They may hold a title such as Voice Specialist, Clinical Voice Specialist, or even Singing Voice Specialist.
What they studied: If an SLP has a music degree in vocal performance, they probably gravitate towards voice work. They may even rehabilitate injured singing voices. Just be mindful that some SLPs who start out as singers end up working in a completely different area. If you aren’t sure about someone’s clinical experience, just ask.
What they have published: Some clinic or practice websites will list articles that clinicians have published. Search for the word “voice” or search for your specific condition.
What memberships they maintain: A voice specialist SLP may be a member of the following organizations. They may also have presented at conferences held by these organizations.
American Speech-Language and Hearing Association (ASHA): Voice and Voice Disorders Special Interest Division (SID-3): While all American SLPs are ASHA members, only those interested in voice will be members of the voice special interest division.
Don’t be afraid to ask your speech therapist exactly how they can help you. Do they have direct experience helping someone with your condition? (This is particularly important for rare conditions like spasmodic dysphonia.) Do they think your condition will respond well to voice therapy? How many sessions might it take to see improvement? What will improvement look like? What else should you consider if voice therapy doesn’t make much difference? Is there anything you can do (lifestyle changes, stress reduction, bodywork) to make your voice therapy more effective? If a particular exercise doesn’t seem helpful, talk to your SLP about it. Can they explain the rationale behind the exercise? Finally, if you suspect that your SLP may not be a voice specialist, consider looking for someone who is. A true voice specialist SLP is well worth searching for.
