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Voice Therapy:Does Science Support the Art?

Lisa B. Thomas and Joseph C. Stemple

University ofKentucky

Lexington, Kentucky

Three primary orientations to the treatment of functional voice disorders have emerged in the lit-

erature. Hygienic approaches focus on the elimination of behaviors considered to be harmful to

the vocal mechanism. Symptomatic approaches target the direct modification of aberrant features

of pitch, loudness, and quality. Finally, physiologic methods approach treatment holistically, as they

work to retrain and rebalance the subsystems of respiration, phonation, and resonance. With the va-

riety of approaches now available, selection of appropriate and effective techniques can be chal-

lenging for clinicians.The purposes of this review are to: (1) describe various hygienic, symptomatic,

and physiologic approaches to voice treatment, (2) investigate the evidence base behind the thera-

peutic approaches, (3) draw conclusions regarding the relative strength of hygienic, symptomatic,

and physiologic therapies, and (4) suggest directions for future study.

Introduction

Over the years, a number of techniques have emerged

for the treatment of functional voice disorders. Some

methods have emerged from our sister field, the vocal

arts, others from the scientific study of voice production,

and still others from the modification of basic vegetative

functions.What is more, some methods have approached

voice treatment holistically by modifying the full speech

production system, whereas others have treated via pa ,

tient education or through the retraining of a specific

voice parameter. The result has been the emergence of

a broad, and ever expanding, inventory of voice thera-

py methods.This growth, although exciting, has posed a

unique challenge to clinicians. The voice clinician of to-

day must not only be knowledgeable of available meth-

Coins unicative Disorders Review

Volume 1, Number 1, pp. 49-77

Copyright 2007 Plural Publishing, Inc.

ods, but he or she must also appreciate the evidence-

base . behind each.This can be a daunting task to the

clinician who is attempting to stay abreast of

developments across the breadth of the field.Therefore,

the purpose of this review is to provide clinicians with an

overview of voice therapy methods across a variety of

treatment orientations and establish the level of evidence

supporting each method. In so doing, the review will assist

clinicians in preparing appropriate and effective

treatment programs for the individuals whom they serve.

Evolution of Research

The first attempts to examine the effects of voice

therapy methods can be identified as far back as the

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