Resonant voice therapy (RVT) is an approach used to enhance the quality of one’s voice. It focuses on oral vibratory sensations at the alveolar ridge, lips or higher on the face in order to enhance it.
It emphasizes forward focus and easy phonation while increasing sensory awareness, all with the aim of decreasing hypernasality by making nasal sounds more oral in quality.
What is Resonance?
Communication through voice is one of the key aspects of everyday life, yet for some it does not sound clear and resonant; this could be caused by vocal resonance disorders. A speech language pathologist can assist in screening, assessing, diagnosing, and treating resonance disorders.
American Speech-Language-Hearing Association defines resonance disorder as any condition which alters or interferes with normal production of sounds in human voice.” There can be various causes for vocal resonance disorder; physical issues, mental health concerns or emotional difficulties could all play a part in its onset; but, the primary factor for its appearance is poor vocal technique such as improper breathing techniques, mouth placement issues and laryngeal valve valving issues are most frequently responsible.
Resonant Voice Therapy (RVT) is an evidence-based voice treatment method intended to strengthen and optimize vocal quality by increasing resonance and efficiency. RVT’s goal is to produce a healthy voice without experiencing excessive stress; specifically it focuses on improving breathing coordination during vocalization to achieve balanced oral-nasal resonance and its methods include both instruction and training for this approach.
In order to produce speech sounds, the soft palate (uvula) must rise up and touch the back wall of the pharynx (throat). This contact is known as velopharyngeal closure; when this occurs, we can produce both nasal and non-nasal speech sounds simultaneously. Without sufficient closure however, hypernasal resonance – when too much sound originates in the nose – may occur.
To address hypernasal resonance, you must teach your client to breathe through their nose while supporting their voice using diaphragm support. Furthermore, teach them how to move the uvula more efficiently during phonation and increase thoracic vibrations.
Your client can begin practicing these techniques by asking them to make both nasal and oral sounds, such as “n and a.” Next, have them gently touch both sides of their nose and uvula with fingers – they should feel and see the uvula move up and down during nasal and non-nasal sounds.
Causes of Resonance Disorders
Resonance disorders refer to abnormalities in how sound energy travels between the mouth and nasal cavities during speech production, typically during production of words. They can either be structural (cleft palate) or functional (mislearning, nasal airflow distortions).
Structures comprising the throat, mouth and nose all play an integral part in creating normal resonance for speech. Children who have cleft palate or velopharyngeal incompetence may not close properly when speaking, leading to resonance disorders; or these errors could come from improper articulation errors. SLPs must distinguish between structural and functional causes as they may require different approaches for treatment.
Hyponasal resonance refers to when too little of the sound energy passes through the nasal cavity during speech, leading to muffled or “stuffy” sounds from children, while hypernasal resonance results from too much sound energy passing through during conversation, leading to high pitched voices that are hard for others to understand.
Your child may experience multiple of these problems simultaneously. For instance, they could experience both hyponasal resonance and hypernasality simultaneously or may possess a cul-de-sac resonance which affects only certain sounds during speech.
If your child has a mild to moderate resonance disorder, speech therapy could provide the solution. In more serious cases, surgery may be required to address the root of their problem.
Children diagnosed with resonance disorders must work closely with a speech-language pathologist to learn proper use of their mouth, lips and the valve between their mouth and nose. Speech therapy techniques may help them speak more clearly and be understood, improving communication abilities overall. Speech language pathologists are trained to assess for, diagnose and treat resonance disorders; in some instances surgery may also be required in addition to speech therapy for full improvement of communication abilities. If you have any further queries about speech therapy for resonance disorders please reach out to either their pediatrician or CHOP SLP for help.
Diagnosis
An SLP trained in resonance disorders will evaluate the soft palate and walls of the throat to see if they move as different sounds are spoken out aloud, words, or phrases are repeated aloud. She may also assess voice quality as well as inquire into any relevant medical history such as allergies or throat infections that could impact on speech production.
For instance, if a voice sounds muffled and the therapist detects signs of cul-de-sac resonance or hypernasality (with decreased nasal emission and increased oral emission) this may indicate obstruction in the vocal tract and should prompt referral to a local craniofacial or cleft palate team (even without prior diagnosis of any condition).
If the voice sounds high in pitch and nasal, this may indicate an abnormally high vocal pitch index (VPI; see above). Furthermore, difficulty producing plosives and fricatives through one’s nose indicates hypernasal resonance; therefore the therapist should check all three organs to rule out obstruction as the cause.
Speech-language pathologists must also assess a client’s breathing and jaw movement to rule out issues like poor air circulation or an overly tight/clenched jaw as possible causes of voice disorders like aphonia and dysphonia. She may ask the client to hum, making note if its origin is nasal or oral.
Finally, an SLP will evaluate their client’s articulation skills to rule out apraxia and other motor planning execution issues that might lead to incomplete closures on nasal letter sounds. Based on her comprehensive evaluation results, she will then make a diagnosis.
Treatment
Resonance therapy treatments for velopharyngeal incompetence or hypernasality typically aim at restoring balanced oral-nasal resonance, teaching patients to produce an audible “buzz” when producing sounds or patterns that require velar tension, such as humming, lip trills (/v/, /z/, /m/), lateral lisps (//, d/, //), straw phonation or buzzy /u/.
Speech-language pathologists can offer vocal exercises designed to prevent the formation of voice nodules, callus-like protuberances located at the junction between the anterior and middle thirds of vocal folds that prevent proper adduction during voice production. Nodules often develop due to misuse or abuse, such as shouting, screaming, excessive talking or throat clearing.
Speech therapy cannot eliminate an abnormal resonance caused by cleft palate or other structural anomaly; however, it can teach children how to produce sounds correctly and thus lessening symptoms.
In some instances, surgery may be needed to correct structural anomalies in children. After surgery is performed, a speech-language pathologist can teach their client to utilize their newly corrected structures properly without producing compensatory productions that decrease intelligibility and may increase nasality.
An Ear, Nose & Throat doctor may utilize the services of a speech-language pathologist in treating speech sound disorders and resonance problems of their patient. A speech-language pathologist can teach children and families to avoid articulation errors as well as use strategies that promote good velar placement and carryover; for instance using abdominal rather than throat or chest muscles for tone initiation and reduced mouth opening during voicing to avoid loud, breathy utterances that stress glottal tissues can help avoid the development of lateral lisps, distortion of /r/ and hypernasality associated with VPI.
